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Bloodborne Pathogens Program (RMS-2, Rev. 2)CIT Y O F DE L R AY BEA C H EM P LOYEE SAFETY MANU AL DEPARTMENT: SUBJECT: REVISION: APPROVED BY: PURPOSE Risk Management Bloodborne Pathogens Program POLICY NUMBER: SUPERSEDES: E DATE: RMS-2 RMS-2 Rev.1 05/24/2023 Terrence R.Moore,ICMA-CM,City Manager The following Bloodborne Pathogens Program has been established to ensure that effective exposure controls are maintained to safeguard employees who are "at risk"of contacting or otherwise being exposed to blood borne pathogens or other potentially infectious materials as a result of their duties.All Departments with employees who are "at risk"will participate in this Program.A copy of this written Program is available online on the City's website. POLICY A.Each Department Head is responsible for the administration of this Program as it applies to the Department's various Divisions.This includes the development and maintenance of procedures which are specific to the various Divisions'operations and adhere,at a minimum,to the requirements of this Program. B.Each Department Head will designate a Program Coordinator for the Department or for each Division. The Program Coordinator(s)will then be trained in all aspects of this Program by the City's Safety Coordinator and will subsequently be responsible for ensuring that the requirements of this Program are met.The Program Coordinator(s)will conduct their activities in concurrence with the Department Head, Division Heads and their supervisors,and with the assistance of the City's Safety Coordinator as warranted. C.For the convenience of the Program Coordinator(s),appendices are attached to allow for compliance with the requirements of this Program.Any Department/Division may use other (existing)documentation providing it meets the intent of these appendices. DEFINITIONS Bloodborne Pathogens -Pathogenic microorganisms present in human blood that can cause disease in humans.Pathogens include Hepatitis A,Band C Viruses,and the Human Immunodeficiency Virus HIV). Exposure Incident -A specific eye,mucous membrane,non-intact skin or parenteral (piercing skin barrier)contact with potentially infectious materials that results from the performance of an employee's duties. Occupational Exposure -Reasonably anticipated eye,mucous membrane (i.e.,mouth or nose,etc.), skin or parenteral (piercing skin barrier)contact with potentially infectious materials that may result from the performance of an employee's duties (in other words at risk"). OSHA Standard 1910.1030 -Federal government regulation which can be referenced for Blood borne Pathogens information. OSHA Standard 1910.1030 -Federal government regulation which can be referenced for Blood borne Pathogens information. Potentially Infectious Materials-Human body fluids such as blood,semen,vaginal secretions, synovial fluid,pleural fluid,cerebrospinal fluid,pericardia!fluid,peritoneal fluid,saliva,urine,feces, nasal secretions,sputum,tears,vomit and any body fluid visually contaminated with blood;all situations where it is difficult or impossible to differentiate between body fluids;and any unattached/open tissue or organ from a human,living or dead. PROCEDURE A.JOB EXPOSURE EVALUATION 1.Each job classification within a department must be reviewed to specifically identify those tasks which may,regardless of frequency or degree of exposure,expose an employee to potentially infectious materials.Those job classifications requiring tasks which expose an employee must then be categorized as follows: Category I:Job classifications which routinely may expose an employee to potentially infectious materials (i.e.,Firefighters/Paramedics). Category II:Job classifications which do not routinely expose an employee to potentially infectious materials (i.e.,General Maintenance Workers).This Category includes all employees that are not included in Category I. 2.Each Department must identify its Category I and Category II job classifications.IN addition,each Department must identify,within Category II job classifications,the specific tasks that expose employees to potentially infectious materials.See the attached Job Classifications Lists (Appendix "A"and "B"). 3.Each Department must then use these job classifications listings to identify employees who are "at risk" of being exposed to potentially infectious materials which includes all employees in Category I and those employees in Category II who may possibly be exposed.These "at risk"employees will be subject to the training requirements of this Program. 8.EXPOSURE CONTROLS 1.Contaminated Conditions Employees who encounter or identify conditions involving equipment,surfaces,items or other materials that may be contaminated with potentially infectious materials will contact their immediate supervisor. The supervisor will then determine if the Department can eliminate the contaminated conditions via disinfecting or disposal,etc.or if the services of the City Fire Department's HazMat Team are required. If the Department decides to eliminate the contaminated conditions,all applicable controls and procedures outlined in this Program must be followed.This includes the use of red "bio-hazard bags" or properly labeled color-coded containers for the disposal of contaminated materials. 2.Universal Precautions Universal Precautions,as an approach to infection control,is a concept whereby all human blood and certain human body fluids are treated as if known to be infectious for blood borne pathogens.If there is a reasonable possibility of exposure to an employee,Universal Precautions will be observed. 3.Engineering Controls Engineering Controls reduce employee exposure by removing the hazard,isolating the hazard or isolating the employee.The following are examples of engineering controls which must be maintained, as appropriate,where there is a reasonable likelihood of occupational exposure: Use of puncture-resistant disposal containers for contaminated needles or sharps. Provision of readily accessible hand washing facilities and antiseptic towelettes for field use. Use of appropriate personal protective equipment. Maintenance of good housekeeping practices. 4.Work Practice Controls Work Practice Controls alter the manner in which a task is performed.The following are examples of work practice controls which must be maintained,as appropriate,where there is a reasonable likelihood of occupational exposure: Restrict eating,drinking,smoking,applying cosmetics or lip balm,and handling of contact lenses at locations where potentially infectious materials may be located. Prohibit food and/or drink storage in refrigerators or at other locations where potentially infectious materials may be located. Require the use of hand washing facilities. Wash hands after removing gloves or other personal protective equipment. Wash skin immediately after contact with potentially infectious materials. 5.Personal Protective Equipment Personal protective Equipment (PPE)is considered appropriate only if it prevents potentially infectious materials from directly contacting the employee's general work clothes,skin,eyes,ears,mouth,or other mucous membranes.The type of PPE to use is to be determined by the task and the degree of occupational exposure anticipated.PPE is required to protect the employee under normal working conditions and for the duration of the exposure.General work clothes are not considered to be PPE for the purpose of this Program. Departments/Divisions will provide (at no cost to the employee)and require the use of appropriate PPE. PPE must be provided in the appropriate sizes and must be stored at readily accessible locations.For example,in the case of gloves,an ample supply of latex gloves (or hypoallergenic gloves for sensitive or allergic employees)in sized medium,large,and extra-large must be kept at readily accessible locations within the Departments'/Divisions facilities and/or vehicles.All PPE must be properly used,cleaned, laundered,repaired and/or replaced as needed.The following procedures for proper PPE use,handling, inspection and maintenance must be maintained: Wear appropriate face and eye protection such as a face shield to guard against splashes,sprays or droplets of potentially infectious materials. Wear appropriate protective body covering when exposure is anticipated. Wear proper gloves (i.e.,latex or hypoallergenic)when touching,handling or otherwise making contact with items,surfaces or persons contaminated with potentially infectious materials. Never decontaminate disposable gloves for reuse. Discard disposable gloves if torn,punctured,and contaminated or if their ability to function as a barrier is compromised. Decontaminate utility gloves for reuse only if their integrity is not compromised. Discard utility gloves when they show signs of cracking,peeling,tearing,puncturing or deteriorating. Remove contaminated PPE and place in designated containers/areas for storage,cleaning, decontamination or disposal. 6.Housekeeping,Laundry and Disposal Departments/Divisions will develop and implement written procedures that ensure appropriate handling, cleaning,decontamination,storage,and disposal of contaminated materials.The procedures must take into account the types of surfaces or clothing to be cleaned,the types of contamination and their locations within the facilities.The following precautions must be considered: Immediately,or as soon as possible,clean and decontaminate all visibly contaminated equipment and surfaces with appropriate disinfectant. Never pick up broken glass,even with gloved hands;use tongs,forceps or a burh and dustpan. Seal bio-hazardous waste (liquid,blood,items contaminated with blood or other potentially infectious materials and contaminated sharps/needles,etc.)in properly labeled and color-coded containers that are constructed to prevent leakage. For the disposal of syringes and contaminated sharps,provide easy access to "sharps"container and locate same in appropriate areas. Maintain "sharps"containers in an upright position,do not overfill,close when moving and replace on a routine basis. Handle contaminated laundry as little as possible,using appropriate personal protective equipment. Contaminated laundry must be carefully secured in "bio-hazard bags"as soon as possible and segregated from uncontaminated laundry. If contaminated laundry is wet,it must be carefully secured in properly labeled and color-coded containers that are constructed to prevent leakage before moving. Drivers for the laundry service must be notified regarding the presence of contaminated laundry (in bio-hazard bags"and/or labeled and color-coded containers). All bio-hazardous waste (except clothing)must be bagged or containerized as noted and transported to the City's Fire Headquarters for disposal. Labels are used to show that the potential for exposure to bloodborne pathogens or other potentially infectious materials exists.Bloodborne pathogens and other potentially infectious materials hazards require a fluorescent orange or orange-red label with the word BIO-HAZARD and the "bio-hazard symbol" three interconnected circles with a background circle)in a contrasting color.These labels must be attached in a manner that will prevent unintentional removal.The following must display these labels: Bio-hazardous waste containers. Refrigerators and freezers containing potentially infectious materials. Containers used to store or transport potentially infectious materials. Labels are not required when red bags or red containers are used,or when individual containers of potentially infectious materials are placed in a labeled container during storage,transport or disposal. C.HEPATITIS B VACCINATION SERIES 1.Departments are required to make the Hepatitis B vaccination series available,at no cost,to all employees in Category I and "at-risk"employees in Category II job classifications.The vaccination series must be offered to employees within 10 working days of initial assignment to a Category I or an "at-risk" Category II job classification.The Department must arrange to provide the vaccination series at a time and place suitable to the employee. 2.The medical provider selected by the Department to provide the vaccination series will determine if the employee has already received the proper vaccination series,or if antibody tests reveal the employee is immune,or if medical reasons prevent the employee from taking,he vaccination series.In any case,the medial provided will provide the Department with documentation specifying whether or not a current Hepatitis B vaccination series has been given.The Department must maintain these documents on file. 3.Any employee has a legal right to decline the vaccination series. A declination form must be completed by any employee who declines the vaccination series. See the attached Hepatitis B Vaccine Declination form (Appendix "C"). Employees in the above-described Category I and Category 11 job classifications may reserve the right to request and obtain the free vaccination series at a later date. D.POST-EXPOSURE INCIDENT 1.Initial Notification and Blood Draw If an exposure incident occurs, or may have occurred, the exposed employee must immediately notify his/her supervisor of the incident. Once notified, the Department must immediately arrange for the exposed employee to obtain the necessary initial post-exposure medical treatment to include an initial blood draw. If the exposed employee consents to have blood drawn, he/she may refuse HIV testing at the time. The blood sample will be maintained for 90 days in case the employee changes his/her mind about HIV testing. Concurrent with the above noted activities, the Department must complete the State's First Report of Injury or Illness and the Workers' Compensation Accident Investigation Report in accordance with City Policy RM-10 (Workers' Compensation Claims Administration) and RMS-1 (Accident Investigation Program). The Department must arrange for the lab results of the initial blood draw to be sent to a City designated medical provided to assume responsibility for the evaluation of the lab results and all related communications with the exposed employee and the Department, as will be explained further in this Program. The Department should contact a City designated medical provider immediately to establish a procedure to accomplish these activities. NOTE: Of specific interest to the City Police and Fire Departments, Florida Statute 381.004 (HIV Testing) explains the Florida law regarding the drawing of blood for HIV exposure evaluation. For example, Statute 381.004(3)(h)(10) and (12) outline situations which allow involuntary HIV blood evaluation of a "source individual" (a person who exposed the City's employee). Results of the "source individual's" HIV testing must be made available to the exposed employee, and the exposed employee must be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the "source individual". 2.Medical Provider Evaluation and Communication Subsequent to a post-exposure incident, the Department must contact the medical provider and provide the following information: Description of the exposed employee's duties as they related to the exposure incident. Documentation of the route(s) of exposure and circumstances under which the exposure incident occurred. If applicable, the results of the "source individual's" blood testing, if available. All relevant medical records of the exposed employee including vaccination status. The medical provider is responsible for obtaining the results of the blood test from the lab, evaluate the results and provide a written opinion to the exposed employee and the Department within 15 days. The written opinion to the Department must indicate: Whether a Hepatitis B vaccination series is necessary for the exposed employee and if the vaccination series has been initiated. That the exposed employee has been informed of the medical evaluation results. •That the exposed employee has been informed of any medical conditions resulting from the exposure incident which requires further evaluation or treatment. All other medical findings or diagnoses will remain confidential, will not be included in this written opinion and will not be disclosed or reported to the Department without the exposed employee's expressed written consent. E.EMPLOYEE TRAINING 1.All employees who are "at risk" of contacting or otherwise being exposed to bloodborne pathogens or other potentially infectious materials will be trained initially regarding the following: An overview of the requirements contained in this Bloodborne Pathogens Program. Definitions associated with the Program. How occupational exposure evaluations are conducted. The exposure controls that will be maintained: contaminated materials, universal engineering controls, work practice controls, personal protective housekeeping/laundry/disposal procedures and labeling requirements. Discussion of job tasks that may result in occupational exposures. Review of decontamination and disposal procedures. Availability of Hepatitis B vaccination series. Post exposure evaluation and medical follow-up procedures. How to report an exposure incident. precautions, equipment, 2.The Program Coordinator(s) will ensure that the above noted training is provided, via verbal instruction and the use of a provided training video, for all employees who are "at risk" of contacting or otherwise being exposed to bloodborne pathogens or other potentially infectious materials. See the attached Employee Training Outline and Training Documentation Form (Appendix "D" and "E", respectively). 3.Periodically thereafter, at the discretion of the Department Head, the Program Coordinator(s) will review this Program's requirements with such employees. Appendix A B C D E F BLOODBORNEPATHOGENSPROGRAM APPENDICES" Contents Category I Job Classifications List Category II Job Classifications List Hepatitis B Vaccine Declination Employee Training Outline Training Documentation Form Employee Quick Reference Appendix "A" CITY OF DELRAY BEACH Blo o d b o rn e Patho gens Program Catego ry I Jo b Classifi catio ns List Department: Division,if applicable: Program Coordinator: I D a te: Category I Job Classifications are those in which employees routinely may be exposed to bloodborne pathogens such as Hepatitis A ,B or C Virus or the Human Immunodeficiency Virus {HIV)through contact with potentially infectious materials such as blood,saliva,vomit and skin tissue,etc. Category I Job Classification Appendix "B" CITY OF DELRAY BEACH Bloodborne Pathogens Program Category II Job Classifications List Department: Division,if applicable: Program Coordinator: Date: Category II Job Classifications are those in which employees are not routinely exposed to bloodborne pathogens such as Hepatitis A,B or C Virus or the Human Immunodeficiency Virus {HIV)through contact with potentially infectious materials such as blood,saliva,vomit and skin tissue,etc.This form identifies,for each Category II Job Classification, those tasks which may expose employees.Classifications with tasks that may possibly expose an employee will be considered "at risk"for purposes of the Blood borne Pathogens Program. Category II Job Classification Tasks Appendix "C" CITY OF DEL RAY BEACH Bloodborne Pathogens Program Hepatitis B Vaccine Declination I understand that,due to my occupational exposure to 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 an occupational exposure to potentially infectious materials and I want to be vaccinated with Hepatitis B vaccine,I can receive the vaccination series at no charge to me. Employee Signature._bate. Employee [ame; Print Name) Appendix "D" CITY OF DEL RAY BEACH Bloodborne Pathogens Program Employee Training Outline I:Explain the reason for the Bloodborne Pathogens Program and the City's policy. II:Show the provided video. Ill:Provide each employee with a copy of this Program (with appendices)and the Department's and/or Divisions' procedures for Bloodborne Pathogens. IV:Review this Program's requirements: A.Define the following: Bloodborne Pathogens Potentially Infectious Materials Occupational Exposure Exposure Incident OSHA Standard 1910.1030 B.Exposure Evaluation: Explain what an exposure evaluation is and how it is conducted. Discuss job tasks that may result in occupational exposures. Review Appendix "A"and Appendix "B" C.Review the following Exposure Controls to be maintained as part of this Program: Contaminated Conditions Universal Precautions Engineering Controls Work Practice Controls Personal Protective Equipment Housekeeping,Laundry,and Disposal Labeling D.Hepatitis B Vaccination Series: Discuss the specifics of the Hepatitis B Vaccination Series-purpose,availability and employee declination,etc. Review Appendix "C"-Hepatitis B Vaccination Declination form. E.Exposure Incident: Stress the fact that an employee must report an Exposure Incident or possible Exposure Incident to his/her supervisor immediately. F.Post-Exposure Evaluation: Review this Program's requirements and the Department's/Division's procedures for Post-Exposure Evaluation and medial follow-up. V:Review the Department's/Division's procedures for Bloodborne Pathogens. VI:Summarize. VII:Give each employee a copy of the Employee Quick Reference sheet (Appendix "F"). VIII:Allow time for questions and answers. Appendix "E" CIT Y O F D EL RA Y BEA CH Bloodborne Pathogens Program Training Documentation Form Department: Division,if applicable: Date of Training: Instructor (Program Coordinator): Topic Discussed:Bloodborne Pathogens Program EMPLOYEES IN ATTENDANCE: Name (Print)Signature Appendix "E" CITY OF DEL RAY BEACH Bloodborne Pathogens Program Employee Quick Reference Note:The information in this Appendix is for reference only.Employees must be already trained and knowledgeable concerning each bulleted item. Hepatitis B Vaccination Series This vaccination is for your protection against a serious disease.If you initially decline the vaccination,you may get it at a later date if you still may incur a jo-related exposure. If contaminated items,surfaces,equipment or materials are encountered. Contact your supervisor for instructions regarding who (the Fire Department or your Department)will decontaminate or dispose of the materials. If your department conducts this task and you are involved,follow all established exposure controls and use appropriate personal protective equipment (i.e.,face shield,protective body covering and/or gloves,etc.). Wash hands after removing globes or other personal protective equipment. Engineering and work practice controls Do not eat,drink,smoke,apply cosmetics/lip balm or handle contact lenses in areas where potentially infectious materials may be located. Wash skin immediately after contact with potentially infectious materials. Discard disposable gloves if torn,punctured or contaminated. Discard utility gloves if cracked,torn,punctured,or deteriorated. Handle contaminated laundry as little as possible using appropriate personal protective equipment and discard laundry in red "bio-hazard bags"or labeled and color-coded containers. Exposure incident If you come into unprotected contact with potentially infectious materials,contact your supervisor immediately for instructions.