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Infectious Diseases Exposure Guidelines

Recommended Guidelines for Exposures to Infectious Diseases

PREVENTION AND IMMUNIZATION PRACTICES

Purpose Each employer shall identify “at risk” workers based on job descriptions. (OSHA CFR
1910.1030)

Risk Levels:

At-risk Workers. Emergency medical and public safety workers are at risk for exposure to
blood, body fluids, feces and/or respiratory secretions.

Low-risk Workers. These workers are identified through job descriptions as having job tasks
that are low or not “At-risk” to exposure to blood, body fluids, feces and/or respiratory secretions. For these workers timely postexposure prophylaxis rather than preexposure
vaccination may be considered.

Special Risk Workers. Periodic evaluation of job description may be done as indicated to
evaluate certain tasks that may be considered at a higher level.

History of Immunity. Workers who are “at risk” for exposure to and possible transmission of
vaccine preventable diseases should have on record of employment all immunizations currently
recommended by the US Public Health Service. A medical evaluation that includes childhood
immunity or immunization history for Measles, Mumps, Rubella, Tetanus, Diphtheria, Polio,
Pertussis (Whooping cough) and Varicella zoster (chicken pox) should be obtained and recorded
for these workers. This program should be completed at the time of hire or as part of a catch-up
program. (CDC MMWR November 25, 2011/60(RR07); 1-45). (NFPA 1581; 2010ed., 4.5.2.1).
INFECTION CONTROL PROGRAMS.

Infection Control Officer: Employers shall identify a Designated Infection Control Officer.

Education: Workers shall have Bloodborne/Airborne Pathogen Training.

Immunization Programs :Employers with vaccination programs shall offer vaccine product
information and declination statements as determined by CDC and OSHA regulation. Employers
shall make vaccines available to workers who initially decline and later decides to accept the
vaccines within 10 days.

Medical Records and Test Maintenance: All workers’ medical records, immunization records
and baseline testing shall be maintained according to applicable laws governing medical
confidentiality. (29 CFR 1910.1030(h)).

Needle-Stick Prevention Programs: Employers shall provide needleless systems (where
applicable). Needleless systems means a device that does not use needles for:
(1) The collectionof bodily fluids or withdrawal of body fluids after initial venous or arterial access is established.
(2) The administration of medication or fluids.
(3) Any other procedure involving the potentialfor occupational exposure to bloodborne pathogens due to percutaneous injuries from
contaminated sharps. (OSHA 29 CFR 1910.1030(e) (2)).

Hepatitis Vaccination Programs
All “At-Risk” workers shall have made available to them at
employment (within 10 days) of initial assignment the Hepatitis vaccine and education, unless
the worker has documentation of the following: completed vaccination series, record of
immunity (positive titer), or medical contraindications. (29 CFR 1910.1030(f) (2)). Hepatitis A
vaccination is strongly recommended and may be offered if specific local conditions dictate.
(NFPA 1581; 2010 ed., 4.5.2.1).

Influenza Vaccination Programs
“At-Risk” Workers are considered to be at significant risk for acquiring or transmitting influenza (the common Flu). Influenza vaccine should be made available to workers from October through February annually. (CDC MMWR November 25, 2011/60(RR07);1-45) (NFPA 1581).

Tdap Vaccination Programs
“At-Risk” Workers are considered to be at significant risk for acquiring or transmitting tetanus toxoid, diphtheria toxoid and acellular pertussis. Tdap vaccines should be made available to workers from October through February annually. . (CDC MMWR November 25, 2011/60(RR07);1-45).

Periodic Titer Screening for Immunizations
Routine periodic post vaccination screening is not recommended after initial titer level has been determined. Booster doses are not currently recommended. If the US Public Health Service recommends a routine booster dose(s) at a future date, such booster dose(s) shall be made available. (29 CFR 1910.1030(f) (1) (ii).

BASELINE AND ANNUAL SCREENING

Baseline Screening. Baseline screening for TB, Hepatitis A, B and C is indicated for presumptive laws requirements. Meningitis is also covered in the presumptive law but does not require a baseline screening. (FS 112.181 6(a) (b)). (Florida Pension Statue for police and firefighters only)

TB Screening. A tuberculin skin test (PPD) or Quantiferon-TB (CPT 84480) Test shall be performed for all “at-risk” annually. Workers who have previously tested negative and now test positive shall have a baseline chest x-ray and one follow-up a year later. All new positive TB test results shall have prophylactic treatment offered. (CDC MMWR 1994:43(RR13) or for
Quantiferon MMWR 2003: January 31 (RR02; 15-18).

Postexposure Management

A. 1. Provide first aid
2. Secure area to prevent further contamination
3. Remove contaminated clothing
4. Wash the injured area well with soap and water, or waterless hand cleanser, and apply an antiseptic.
5. If the eyes, nose, or mouth are involved, flush them well with large amounts of water.

B. Notification and Relief of Duty: The worker's supervisor should be immediately notified if a worker experiences an exposure involving potentially infectious source material. The supervisor should determine if the worker needs to be relieved of duty.

C. Assess the Exposure/Blood or Body Fluid: A significant bloodborne exposure is considered a combination of one or more of the types of body fluids and one or more of the injuries listed below:

Body fluids:
- Blood, serum, plasma, and all fluids visibly contaminated with blood
- Pleural, amniotic, pericardial, peritoneal, synovial, and cerebrospinal fluids
- Uterine/vaginal secretions or semen
- Saliva

Injuries:
- Percutaneous (needle stick, laceration, abrasion, bites, etc.)
- Mucous membrane (e.g. eyes, nose, mouth)
- Skin (e.g. cut, chapped or abraded skin). The larger the area of skin exposed and the longer the time of contact, the more important it is to verify that all the relevant skin area in intact.

D. Assess the Exposure/Air or Droplet: A significant airborne exposure is considered a combination of a subject (source) exhibiting signs/symptoms of suspected airborne illness and an activity that would place the worker at risk of droplet or airborne exposure:

1. Source: Any aerosolized exhalations, sputum, or saliva, either by source coughing, spitting, breathing; any pulmonary (lung) secretions either brought forth by patient (source) or by manual suctioning and exposed individual has not
worn appropriate barrier protection.

2. Activity: Suctioning of nasopharyngeal airway; active gag/cough reflex upon suctioning or insertion of nasgastric tube and/or intubation.

E. Report the Exposure: The worker or immediate supervisor should begin filling out an "Infectious Disease Exposure Report Form" and submit it to the Designated Infection Control Officer/Nurse.

Section 6 - Medical Attention, Counseling, Consent and Testing

A. Transport: A significantly exposed worker should be transported to a designated facility for medical evaluation, counseling and testing within 2 hours after the exposure. The worker and source patient should be transported to the same medical facility, preferably one that offers rapid HIV testing if the source material was blood or body fluids.

B. Triage: The worker should be triaged as quickly as possible. The worker should present to the facility an Infectious Disease Exposure Reporting Form and an Employer Information Sheet that contains information about the employer; its Worker's Compensation policy, Designated Infection Control Officer/Nurse contact information, and contact information for the designated medical provider that will provide follow up care.

C. Postexposure Testing for Blood and Body Fluid Exposures: Counseling should be provided to and consent shall be obtained from both source of the exposure and exposed worker. (29 CFR 1910.1030 (f)(3)). The facility should perform Acute Hepatatis Panel (CPT 80074), HIV and RPR (syphilis) tests.

D. Source Blood Sample Available: If consent cannot be obtained from the source of the exposure and a blood sample is available, the facility may conduct testing without consent as long as the worker has the same series of tests run on his/her blood sample and a licensed physician documents need in the medical record of the worker.

E. Source Blood Sample Not Available: If the source of the exposure will not voluntarily submit to testing and a blood sample was not obtained during treatment for a medical emergency, the worker, or the employer of the worker acting on behalf of the worker may seek a court order directing the source of the exposure to submit to testing. A sworn statement by a physician that a significant exposure has occurred constitutes probable cause for the issuance of an order by the court. The results of the test should be released to the source of the exposure and the exposed worker.

F. Postexposure Testing for Airborne or Droplet Exposures: For airborne exposure, screening is recommended for communicable disease once counseling is provided and consent is received, for the source of the exposure and the worker. If a TB exposure is suspected, a PPD test following the exposure should be performed. Do not administer a PPD test if worker has been tested within the previous 12 weeks and/or workers reports a history of positive skin test reaction.

G. Discharge: The receiving facility should provide the exposed worker with a complete discharge summary and a completed Infectious Disease Exposure Report Form that includes a description of all diagnostic tests performed on the worker.

H. Filing the Exposure Report: The Infectious Disease Exposure Reporting Form should be signed by both the exposed worker and the agency's Designated Infection Control Officer/Nurse. A copy of the form should be provided to the exposed worker with the original filed into the worker's infection control (medical) records.

I. Postexposure Medical Follow-Up: The worker is responsible for following postexposure monitoring and periodic testing as directed by the medical provider. Follow-up testing to detect seroconversion will be performed at week six, week twelve and week twenty-six after the exposure. Testing one year after the exposure is optional.

Section 7 - Master Forms and Instructions

A. Infectious Disease Exposure Report Form:

1. This is an exposure reporting form that should be made readily available to all workers at risk for occupational exposure to infectious diseases.

2. The form is intended as a "real time" documentation tool to collect and maintain vital information about the exposure incident; demographic information for the exposed worker and source patient; and associated medical evaluation and testing. Data collected on this form may be used to develop programs aimed at preventing future exposures.

3. As soon as an exposure occurs, the worker and/or supervisor should begin documenting the exposure incident on this form. If medical evaluation is needed, the form should be carried by the exposed worker to the receiving medical facility (if applicable) for completion, then brought back to the Designated Infection Control Officer/Nurse for review and copy distribution to the worker, risk manager and medical examiner.

4. The "Infectious Disease Exposure Report Form" shall be combined with the "Exposure Information Form" as a back/front copy.

B. Exposure Information Form:

1. This is the postexposure management assessment tool taken from the "Recommended Guidelines for Occupational Exposures to Infectious Diseases". This form should be available to all workers and reviewed at the time of a potential exposure.

2. The "Exposure Information Form" shall be combined with the "Infectious Disease Exposure Report Form" as back/front copy.

C. Infectious Exposure Reference Sheet (Disease Matrix):

1. This is a quick reference sheet that includes the sources of most common occupational exposures. The matrix includes transmission, prevention, and exposure follow-up information. Workers should have direct access to this form.

2. The "Infectious Exposure Reference Sheet" shall be combined with the "Employer Information Form" as a back/front copy.

D. Employer Information Form:

1. This form is intended to communicate current information about the Employer, the Worker's Compensation plan, and Occupational Medical Provider to assist the receiving medical facility in managing admissions. The employer should complete the information on one master copy.

F. Forms Availability:

1. All forms should be readily available to workers by placing them in areas where workers have immediate access such as: in the station; in emergency response vehicles; in administrative offices; and in emergency rooms.

2. All workers receive training on the location of, and appropriate use of these forms.

3. All required forms are located in the Public Folder's section of Outlook and in Fire Station file cabinets.

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