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BLDBRN 8.1A TEQUESTA POLICE DEPARTMENT GENERAL ORDER TITLE BLOOD BORNE PATHOGEN EXPOSURE GENERAL ORDER: 8.1A EFFECTIVE: April 1, 2004 REVISES: G.O. 8.1 PAGES: 8 CONTENTS: This order consists of the following numbered sections: I. EXPOSURE CONTROL PLAN IMPLEMENTATION AND REVIEW II. EXPOSURE RISK DETERMINANTS III. EXPOSURE CONTROLS IV. PERSONAL PROTECTIVE EQUIPMENT V. HOUSEKEEPING VI. REGULATED WASTE VII. CONTAMINATED LAUNDRY VIII. BIOHAZARD WARNINGS IX. HEPATITIS B VACCINATION X. EXPOSURE INCIDENT EVALUATION XI. EXPOSURE FOLLOW-UP XII. INFORMATION AND TRAINING XIII. RECORD KEEPING XIV. GLOSSARY PURPOSE: To provide guidelines intended to limit occupational exposure to blood and other potentially infectious body fluids, in compliance with the Occupational Safety and Health Act, 29 U.S.C. 655, 29 CFR 1910.1030, and Florida Administrative Code 10D-104 and 38I-20. SCOPE: This order applies to all Police Department members. DISCUSSION: OSHA Standards, and the Tequesta Police Department’s commitment to the health and safety of its members mandate procedures for the management of potential occupational exposures to blood borne pathogens. This general order, which utilizes engineering and work practice controls to identify and eliminate infectious material, serves as a guideline for the Exposure Control Plan. POLICY: All members, who work in high-risk exposure positions, will be provided with training and current safety procedure information to minimize risk from exposure to blood borne pathogens, and to increase understanding of the nature and hazards of communicable diseases. PROCEDURE: I. EXPOSURE CONTROL PLAN IMPLEMENTATION AND REVIEW: The Infection Control Officer is responsible for the implementation and annual review of the Exposure Control Plan. G.O. 8.1A II. EXPOSURE RISK DETERMINANTS: Members anticipated to face occupational exposures will be considered “high risk.” This determination will be based on the work duties and procedures of members in each job classification and work area. Members in the high-risk category include, but are not limited to, police officers, crime scene technicians, property evidence handlers, and others who may have physical contact with arrestees, and the public. The occupational actions that create the expectation of an occupational exposure to blood borne pathogens include, but are not limited to the following: A. Providing first aid. B. Processing crime scenes where human blood or body fluids are present. C. Entering an area where the presence of body fluids can be expected. D. Gathering and handling evidence contaminated with body fluids. E. Arrest situations involving physical confrontations or other force. III. EXPOSURE CONTROLS: A. Each member facing occupational exposure to blood borne pathogens will observe universal precautions to prevent contact with blood or other potentially infectious materials. All human body fluids will be considered potentially infectious material. B. Engineering and work practice controls will be used to limit a member's exposure to blood, and other potentially infectious material. These controls will be examined on an ongoing basis and maintained or replaced as necessary. If the risk of occupational exposure exists after engineering and work practice controls have been instituted, personal protective equipment will be used. C. The following personal hygiene procedures will be observed by any member who contacts blood or other body fluids. 1. Members will use soap and water to wash their hands and any other exposed skin as soon as possible after contact with blood or other potentially infectious material, or after removing gloves or other personal protective equipment. 2. When hand washing facilities are not available, members will use the agency antiseptic hand cleanser immediately, and wash their hands with soap and running water as soon as possible. 3. Care should be taken to minimize splashing, spraying, spattering, or generating droplets when cleaning up blood or other potentially infectious material. D. Internal Absorption: Eating, drinking, smoking, applying cosmetics or lipstick, or handling contact lenses are prohibited in work areas where there is occupational exposure. Food and beverages will not be kept in refrigerators, freezers, cabinets, or on shelves, counter tops, bench tops where blood or other potentially infectious materials are present. E. Handling Sharps: Members will handle sharps with extreme caution to avoid a skin puncture. Sharp items will be stored or disposed of in properly labeled puncture resistant containers. Sharp objects that may be contaminated will be picked up by mechanical means or with appropriate hand protection. F. Handling Infectious Materials: 1. The collection, handling, processing, storage, transport, and shipping of all potentially infectious materials will be in leak proof containers. 2 G.O. 8.1A 2. Containers of specimens of potentially infectious materials will be appropriately labeled or color coded and sealed before being stored, transported, or shipped. If the outside of the primary container becomes contaminated, that container will be placed into a second, leak proof container that is properly labeled and color-coded. G.Tools and Equipment Handling: 1. Batons, flashlights, handcuffs, or other equipment that becomes contaminated with blood, or other potentially infectious materials will be decontaminated at the Tequesta Fire/Rescue Decontamination Room. 2. The interior and exterior of vehicles contaminated with blood, or other potentially infectious materials, will be decontaminated at the contract facility. The back seat and other detachable items will be removed from the vehicle and cleaned separately to ensure that the item has been completely decontaminated. 3. Before handling any item known to be potentially infectious, all members, service agents, and manufacturers must be given notice of the possibility of contamination so safety precautions can be taken. H. Cleaning and Disinfecting: All surfaces exposed to blood or other potentially infectious materials will be cleaned and disinfected using an agency-approved disinfectant. Cleanup kits will be used on equipment and surfaces exposed to blood or other potentially infectious material. IV. PERSONAL PROTECTIVE EQUIPMENT: A. Members will use appropriate personal protective equipment whenever there is a potential for occupational exposure. The equipment must provide reasonable protection against the penetration of potentially infectious material. Personal protective equipment, such as gloves, gowns, face shields, masks, eye protection, shoe covers, and caps will be considered appropriate only if they do not permit penetration to the wearer’s clothing, skin, eyes, mouth, or other mucous membranes. 1. A member may decline the use of personal protective equipment when, in the member’s judgment, its use will Prevent delivery of lifesaving first aid or public safety services, or will pose an increased hazard to the member or anyone else. B. Personal protective equipment or underlying garments penetrated by blood or other potentially infectious materials will be removed as soon as possible. Skin areas under the contaminated area of the protective garment will be cleaned with an appropriate disinfectant until washing with soap and running water is possible. C. Personal protective equipment will be removed before leaving the perimeter of the exposure area. After use, personal protective equipment and underlying garments will be placed in an area or container designated for storage, washing, decontamination, or disposal. D.Gloves: Surgical type gloves will be worn at all medical calls or whenever it is anticipated there will be contact with blood or other potentially infectious materials, or when handling or touching contaminated surfaces. Disposable, single use gloves will be replaced when contaminated, torn, punctured, or when their ability to function as a barrier is compromised. Disposable gloves will not be washed or decontaminated for reuse. E. Eye protection and/or fluid resistant masks will be worn at all medical calls or whenever splashes, spray, spatter, blood droplets, or other potentially infectious materials may be generated, or where any eye, nose, or mouth contamination is possible during the cleanup. F. Protective clothing such as gowns, aprons, lab coats, or similar outer garments will be worn in extreme occupational exposure situations. The type and characteristics of such protective clothing must be appropriate to the task and degree of exposure anticipated. 3 G.O. 8.1A V. HOUSEKEEPING: Work sites within the Police Department will be maintained in a clean and sanitary condition. The Village’s Infection Control Officer will ensure proper attention is given to potentially infectious areas. Bins, cans, pails, and containers intended for reuse, which have potential for becoming contaminated, will be routinely decontaminated and immediately after known contamination. The environmental area, all equipment, and working surfaces therein will be cleaned and decontaminated after contact with blood or other potentially infectious materials. An appropriate disinfectant will be used on all contaminated work surfaces. VI. REGULATED WASTE: A. Contaminated sharps will be discarded immediately in containers that are closeable, puncture resistant, leak proof, and appropriately labeled or color-coded. B. Other regulated contaminated waste will be placed in leak proof containers that are appropriately labeled or color coded, and closed before removal. If outside contamination of a regulated waste container occurs, it will be placed in a second leak proof container that is appropriately labeled or color coded, and closed. Disposal of regulated waste will be in accordance with all federal, state, and local regulations. VII. CONTAMINATED LAUNDRY: A. Universal precautions will be used when handling soiled laundry. It will be handled as little as possible with a minimum of agitation, and bagged or containerized where used or found. Soiled laundry will be placed and transported in appropriately labeled or color coded, leak proof bags or containers. B. Uniforms and other clothing that cannot be effectively decontaminated will be treated as biohazardous waste and disposed of properly. C. Uniforms and other clothing will be decontaminated. After decontamination, the garments should be washed or dry cleaned, as necessary. D. Members handling contaminated laundry will wear appropriate personal protective equipment. VIII.BIOHAZARD WARNINGS: A. Warning labels containing the word “Biohazard” and the biohazard symbol will be fluorescent orange or orange- red, with symbols and lettering in a contrasting color. The label will be an integral part of the container or affixed in a way that prevents its loss or unintentional removal. B. A biohazard-warning label will be affixed to each container of regulated waste, or other potentially infectious material, including all biohazardous waste containers, refrigerators, freezers, and other containers for biohazardous materials. Red bags for biohazardous material may be substituted for labels. IX.HEPATITIS B VACCINATION: A. Hepatitis B vaccine will be made available to all high risk members within 10 days of initial assignment to duties involving occupational exposure, unless the member previously received the vaccination series; or, antibody testing, available at the member’s option, indicates immunity; or, the member’s medical history indicates the vaccination would be medically improper or undesirable, or that the vaccination could produce an adverse medical reaction. B. The vaccine will be offered at a reasonable time and place, and at no charge to the member, and will be administered in a series of three scheduled inoculations under the supervision of a physician or licensed health care professional. Members who request the service must complete all three series. C. Members declining the vaccine will be required to sign a Hepatitis B Declination Form. Those who decide later to be inoculated may receive the vaccine at a reasonable time and place, at no charge, if their assignment still involves 4 G.O. 8.1A occupational exposure. D. Members who leave the agency before finishing the series will be given the opportunity to complete the series at their own expense at the same cost that would have been incurred by the agency. E. Members who are not in the high risk category but want the preventive inoculations will be allowed to pay for the inoculation series at the cost that would have been incurred by the agency. X. EXPOSURE INCIDENT EVALUATION: A. Whenever a member experiences an exposure incident, the circumstances will be documented on a Village of Tequesta Infectious Exposure Form. Elements to be included in the documentation include a copy of the engineering and work practice controls in place at the time of the incident; personal protective equipment and clothing utilized at the time of the exposure incident; and policy and control failures, if any. B. The Infectious Exposure Form, Supervisor's Report of Accident/Injury, and Worker’s Compensation Medical Disposition Report are to be completed by and submitted to the administrative division within 48 hours. The Infection Control Officer will be contacted immediately to coordinate care and exposure follow-up. XI. EXPOSURE FOLLOW-UP: A. The Exposure Control Officer is responsible for contacting the member and completing the post exposure evaluation. A confidential medical evaluation and follow-up will be made immediately available to the member at no cost. Information will include the circumstances and routes of exposure. 1. If the individual, who is the source of the exposure, consents, his or her HBV and HIV antibody titers will be obtained. 2. If the source individual refuses consent for testing, the agency will seek a court order for testing, in accordance with F.S. 796.08 (70)(a)(c). 3. A source individual whose consent is not required by law will be tested and the results documented. B. With consent, a sample of the exposed member’s blood will be taken for HIV status testing. The exposed member’s blood will be collected and tested as soon as feasible after consent is obtained. If the member consents to baseline blood testing, but not HIV testing, the sample will be preserved for at least 90 days. During this time, further testing will be done only if the member consents. C. Follow-up includes repeat antibody testing, counseling, and post exposure prophylaxis, as may be medically indicated. D. The evaluating physician will be provided with a copy of OSHA regulations; a description of the exposed member’s duties as related to occupational exposure; the route and circumstances of exposure; the results of the source individual’s blood tests, if available; and the member’s post exposure treatment record including vaccination status. E. The member will be provided with a copy of the evaluating physician’s written report within 15 working days of completion of the evaluation. The report will contain recommendations on the need for, or receipt of, hepatitis B vaccine and a statement that the member has been informed of the results of the evaluation, including information on other medical conditions resulting from the incident that may require further evaluations and treatment. Any other findings or diagnosis will remain confidential. F. Accurate medical records will be established and maintained for each member with occupational exposure. These records will contain the member’s name and social security number; a copy of the member’s hepatitis B vaccine record; a copy of the examinations, test results, and follow-up procedures; a copy of the health care professional’s 5 G.O. 8.1A written report; and a copy of any information provided to the evaluating health care professional. 1. Member medical records will be maintained by the administrative division and kept confidential. Information contained in a member’s medical record will not be disclosed to any person without the expressed written consent of the member, except as provided by law. XII. INFORMATION AND TRAINING: A. All members facing the potential of occupational exposure will participate in an infection/control program provided at the time of initial assignment to tasks involving occupational exposure. Additional training will be offered when tasks or procedures involving occupational exposure are added or modified. B. The training program will provide members with the following: 1. Access to a copy of OSHA Standards and an explanation of the contents. 2. A general explanation of the epidemiology and symptoms of blood borne diseases. 3. An explanation of the modes of transmission of blood borne pathogens. 4. A review of this order. 5. Information on how to identify situations and activities that could provide exposure to blood or other potentially infectious materials. 6. Information on the use and limitations of methods to prevent or reduce exposure including appropriate engineering controls, work practices, and personal protective equipment. 7. Information on the types, proper use, removal, location, handling, decontamination, and disposal of personal protective equipment and cleanup kits. 8. The basis for selecting personal protective equipment. 9. Information about hepatitis B and the hepatitis B vaccination. 10. Information concerning the actions to take in case of exposure incident to include what to do, who to contact, the method of reporting the incident, post exposure evaluation, and follow-up 11. An explanation of proper signs, labels, and color-coding. 12. An opportunity for interactive questions and answers with the individual conducting the training. C. Records of each training session will include the date of the session, a summary of the training, the names and qualifications of instructors conducting the training, and the names and job titles of members attending. Training records will be maintained for three years from the date of the training. XIII. RECORD KEEPING: All member and agency records will be maintained in accordance with the records retention schedule established by the State of Florida. XIV. GLOSSARY: AIDS - Acquired Immune Deficiency Syndrome, an infection caused by the HIV virus. 6 G.O. 8.1A ANTIBODY TITER - The minimum volume of antibodies required to provide a barrier of resistance to a pathogen. BIOHAZARD - A biological material that, if infective, poses a threat to human beings or their environment. BLOOD - Human blood, human blood components, and products made from human blood. BLOOD BORNE PATHOGENS - Microorganism present in human blood that can cause disease in human beings. These pathogens include, but are not limited to, the hepatitis B virus (HBV) and the human immunodeficiency virus (HIV). BODY FLUIDS - Amniotic fluid, cerebrospinal fluid, pericardial fluid, peritoneal fluid, pleural fluid, saliva, synovial fluid, semen, urine, any body fluid that is visibly contaminated with blood, and all body fluids in situations where differentiating between body fluids is difficult or impossible CONTAMINATED - The actual or anticipated presence of blood or other potentially infectious materials on an item or surface. CONTAMINATED LAUNDRY - Laundry soiled with blood or other potentially infectious materials. CONTAMINATED SHARPS - Any contaminated object that can penetrate the skin, such as broken glass, knives and needles, etc. DECONTAMINATE - The use of physical or chemical means to remove, inactivate, or destroy blood borne pathogens on an item to the point they are no longer capable of transmitting disease and the surface or item is rendered safe for handling, use, or disposal. DISINFECTANT - A substance or spray capable of inhibiting the growth or destroying harmful microorganisms. ENGINEERING CONTROLS - Those controls that isolate or remove the blood borne pathogen hazards from the workplace. EXPOSURE CONTROL PLAN - A written program developed and implemented by the Tequesta Police and Fire/Rescue Departments to establish procedures, engineering controls, personal protective equipment, work practices, and other methods capable of protecting members from exposures to blood borne pathogens, and meets the requirements contained in the OSHA Blood Borne Pathogens Standard. EXPOSURE INCIDENT - Contact with a potentially infectious material arising from performance of a member’s duties. HBV - Hepatitis B Virus HIV - Human Immunodeficiency Virus, the virus that causes AIDS. INFECTION CONTROL OFFICER - The Tequesta Fire/Rescue employee who is qualified by training or experience, to act as the liaison between the Police Department and any appropriate medical facility, or the Department of Health and Human Services. The Infection Control Officer will notify a member involved in an exposure incident of the disease status of an inmate, arrestee, or patient. OCCUPATIONAL EXPOSURE - Anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of a member’s duties. Potentially infectious material includes, but is not limited to human body fluids and any unfixed tissue or organ, other than intact skin, from a living or dead human body. PARENTERAL - Piercing of mucous membranes or the skin through punctures, human bites, cuts, and abrasions. PERSONAL PROTECTION KITS - These kits are 7 G.O. 8.1A provided for personal protection from contact with blood or other bodily fluids. They contain, at a minimum, surgical type gloves, goggles, facemask, protective coat, and cap. - PERSONAL PROTECTIVE EQUIPMENTSpecialized clothing or equipment worn by a member for protection against biohazard. General work clothes, such as uniforms, pants, shirts, or blouses that are not intended to function as protection against biohazard are not considered personal protective equipment. REGULATED WASTE - Liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid state if compressed; items caked with dried blood or other potentially infectious materials and can release these materials during handling; contaminated sharps; and wastes containing blood or other potentially infectious materials. SHARPS - Hypodermic needles, scalpel blades, or other objects likely to be contaminated. SHARPS CONTAINER - A plastic container that is especially designed and properly labeled for the storage of hypodermic needles and other sharp objects. SOURCE INDIVIDUAL - Any person, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the member. STERILIZE - The use of a physical procedure or chemical substance to destroy all microbial life. UNIVERSAL PRECAUTIONS - An approach to infection control in which all human blood and body fluids are treated as if known to be infectious with HIV, HBV, and other blood borne pathogens, and includes the use of protective equipment. WORK PRACTICE CONTROLS - Controls that reduce the likelihood of member exposure to blood or other potentially infectious materials by altering the manner in which a task is performed. INDEXING: AIDS EXPOSURE BIOHAZARD BLOOD BORNE PATHOGEN EXPOSURE BLOOD EXPOSURE EXPOSURE CONTROL PLAN HEPATITIS EXPOSURE HIV EXPOSURE DRAFTED: DJR/March 17, 2004/FILED: Bldbrn8.1A APPROVED: Pete Pitocchelli, Chief DATE: November 05, 2011 Tequesta, Florida 8