2. Blood Borne Pathogen Exposure Update and Procedures Adapted and updated from a slide show by; Rebecca Fronberg, BS, CHES HIV Counseling & Testing Coordinator Utah Department of Health By Dorrell Henderson EMS / Safety and Wellness Div. Salt Lake City Fire Department

3. Utah EMS Law Senate Bill 19 Utah Code Title 34, Chapter 2-0-5 Utah Code Title 78, Chapter 29-102 Effective date, May 2, 2005 Rule R612-10-1 and Form 350 9/05 adopted by Utah Labor Commission December 2005 Rule in effect on February 1, 2006

4. Significant Changes Made by SB19   Moves provisions from the Health Code to the Labor Code regarding worker’s compensation presumption for EMS providers   Adds Hepatitis C to the definition of disease for the purposes of disease testing and the presumptions for workers’ compensation

5. Purpose   To protect the workers compensation benefits of EMS providers who become HIV infected and/or contract hepatitis B or C due to an exposure during their job duties

6. Presumption & Baseline Testing   An EMS worker who contracts HIV, HBV or HCV is presumed to have contracted the disease on the job if:   They were hired prior to July 1, 1988 or…   They were hired after July 1,1998 and were tested negative for HIV, HBV and HCV at the time of hire. (baseline testing) and…   They test positive during employment or within 3 months after termination.   If they refuse or fail to be tested they are not entitled to this presumption.

7. Reporting Requirements   All significant exposures must be reported   Significant exposure means:   Exposure of the body of one person to the blood or body fluids visibly contaminated by blood of another person by:   Percutaneous injury, including needle stick or cut with a sharp object or instrument  Contact with an open wound, mucous membrane or non-intact skin because of a cut, abrasion, dermatitis or other damage  Any other method of transmission defined by the Utah Department of Health

8. Potentially Infectious Body Fluids   blood   amniotic fluid   pericardial fluid   cerebrospinal fluid   vaginal secretions  )  or any other fluid visibly contaminated with blood (bloody sputum)  peritoneal fluid  pleural fluid  synovial fluid  semen  cervical secretions

9.   EMS provider documents on-the-job exposure   EMS provider is tested and becomes infected with HIV, HBV and/or HCV   EMS law presumes the infection(s) is (are) job-related   Employee can be compensated under the Workers Compensation Program Presumptive Eligibility Provisions

10. EMS Provider Responsibilities   Know, understand and follow the provisions of your Agency’s Exposure Control Plan

11. EMS Provider Responsibilities CComplete the Exposure Report Form (ERF) AAssure that a copy of the ERF accompanies the patient to the receiving medical facility and is… SSubmitted to an authorized person at the receiving facility KKeep the original or obtain a copy of the ERF for personal record and further distribution

13.   If unable to submit a copy of the ERF to the receiving facility at the time of exposure   You must call in the information needed to complete the ERF to the authorized person at the receiving facility   Telephone report must be followed by a hard copy of the completed ERF within 3 days of the incident   Hard copy is sent directly to the receiving facility

14. EMS Provider Responsibilities   Go immediately to your Workers’ Compensation authorized medical facility. Take a copy of the ERF and follow instructions on prophylactic treatment if recommended for your exposure.   (Those with high and moderate risk of HIV exposures should be started on treatment within 2 hours of the exposure.)   Follow your Agency’s policy for reporting an “On the Job Injury” This is an “On the Job Injury”

15. Post Exposure Prophylaxis (PEP)   CDC recommendations :   If indicated, start PEP as soon as possible after an exposure   Re-evaluation of the exposed person should be considered within 72 hours post exposure, especially as additional information about the exposure or source person becomes available   Administer PEP for 4 weeks, if tolerated   If a source patient is determined to be HIV-negative, PEP should be discontinued Source: MMWR June 29, 2001 / 50(RR11);1-42

16. EMS Provider Responsibilities   Notify the “Contact Person at Employment / Agency”   Submit a copy of the ERF to the Contact Person within 3 days of the incident

17. Receiving Facility Responsibilities RReceiving facility “shall”: (Rule R612-10-1) EEstablish a system of receiving ERFs and information telephoned in by exposed EMS provider EEnsure that a designated person is available 24-hours a day to receive the ERFs HHave trained pre-test counselors available or on call for counseling source patients CComplete the Source Patient Information section of the ERF

18.  Obtains permission from source patient to test for HIV, HBV and/or HCV  Patient, next of kin or legal guardian may consent  No consent required if under Utah Department of Corrections custody or if deceased  If unable to provide counseling, provide the patient with phone numbers for trained counseling services within 24 hours (see bottom of form)

19. Receiving Facility Responsibilities AAdvise patient that they can refuse testing, but EMS agency may seek court order NNotify EMS Agency immediately if patient refuses blood testing. DDraw patients blood and send it with the ERF to a qualified laboratory for testing WWork with the laboratory to assure the charges for the Source Patient are put on the Exposed EMS Providers worker’s Comp. bill.

20. Laboratory Responsibilities   Receives the samples with the accompanying ERF form   Tests the sample(s) for HIV, HBV and/or HCV   “Shall” send test results by Case ID number to the “Contact” at the EMS agency or employer

21. EMS Agency/Employer Responsibilities   Provides training (initial and annual) to all EMS providers on this law, procedures for submitting an ERF and provisions of the Agency/Employers’ Exposure Control Plan (OSHA)   Maintains records of disease exposures as per OSHA Blood Borne Pathogen standards (R)

22. EMS Agency/Employer Responsibilities   If appropriate, reports refusal of testing by the source to the EMS provider and assists them in obtaining a court order for source patient blood testing.   Reports testing results immediately by case number, not name, to the exposed EMS provider   Ensures that exposed EMS provider receives a confidential medical evaluation, Post Exposure Prophylaxis (PEP) and follow-up according to OSHA regulations and CDC recommendations.

23. Responsibility for payment of fees   The Agency/Employer of the exposed EMS provider is responsible for all medical charges to the EMS provider and the Source Patient.   These costs can be addressed by Workers Compensation and or insurance.   Costs billed must be within the Labor Commission fee schedule

24. Exposure Control Plan  OSHA 1910.1030  Title: Bloodborne Pathogens  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.”

25. Exposure Control Plan  Who qualifies as an “employer” in this regulation?  Utah Labor Commission UOSHA Compliance Assistant Shaheen Safiullah gives the following definition….  “As long as employees are paid for their services they are considered employees. They would be covered by OSHA regulations. The regulations do not apply If they are purely volunteers ( no payment).”

26. Exposure Control Plan  If you do not have an Exposure Control Plan… Do Not Despair!!!! This can be done…  By following the information in the Standard  By adapting a plan already written  By filling in the blanks of one of the sample Exposure Control Plans available.  See resources in your handouts.

27. Other Regulations that may influence your implementation  For Fire Departments adopting NFPA Standards  NFPA 1581 “Standard on Fire Department infection Control Program”  NFPA 1582 “Standard on Medical requirements for Fire Fighters”  CDC Guidelines “Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis”  Information needed by the Healthcare Professional treating the EMS provider [Required by 1910-1030(f)(3)(ii)]

28. Conclusions Encourage your EMS providers to..  Observe universal precautions.  Report and document all incidents, even if they are unsure it is necessary  Keep forms and instructions at hand (with SMIRFs).  Follow all instructions when exposed.  NEVER ASSUME the rest of the system will work as planed.  The most important acronym of all for your agency and your people is… CYA

29. Thank You, Stay Safe And Have Fun!! Salt Lake City Fire Department Division of EMS/Safety and Wellness EMT Coordinator Dorrell Henderson

30. Contact Information Rebecca Fronberg, BS, CHES HIV Counseling & Testing Coordinator Utah Department of Health (801) 538-6299 rfronberg@utah.gov State of Utah – Labor Commission Division of Industrial Accidents 160 E 300 S, 3 rd Floor—P O Box 146610 Salt Lake City, UT 84114-6610 (801) 530-6800—(800) 530-5090—Fax (801) 530-6804