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

Utah EMS Law Senate Bill 19 Utah Code Title 34, Chapter Utah Code Title 78, Chapter Effective date, May 2, 2005 Rule R and Form 350 9/05 adopted by Utah Labor Commission December 2005 Rule in effect on February 1, 2006

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

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

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.

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

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

  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

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

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

  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

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”

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

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

Receiving Facility Responsibilities RReceiving facility “shall”: (Rule R ) 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

 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)

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.

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

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)

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.

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

Exposure Control Plan  OSHA  Title: Bloodborne Pathogens  (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.”

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).”

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.

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 (f)(3)(ii)]

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

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

Contact Information Rebecca Fronberg, BS, CHES HIV Counseling & Testing Coordinator Utah Department of Health (801) State of Utah – Labor Commission Division of Industrial Accidents 160 E 300 S, 3 rd Floor—P O Box Salt Lake City, UT (801) —(800) —Fax (801)