1. Chapter 1. Introduction to the Bloodborne Pathogens
BY NATIONAL SAFETY COUNCIL

2. Overview
The United States Occupational Safety and Health Administration (OSHA) creates and enforces safety standards for workplaces. The Occupational Exposure of Bloodborne Pathogens Standard (the Standard0 was designed to eliminate or minimize employees’ exposure to human blood and other potentially infectious materials (OPIM) in the workplace. This Standard applies to all employees who, as part of their job, may reasonably expect to be exposed to blood and OPIM that may contain pathogens. Pathogens are germs that cause disease. Bloodborne pathogens are germs transmitted from one person to another through contact with blood or OPIM.

3. Overview Continued
The Standard applies to employees who may be at risk even if their job for the most part does not involve giving first aid or working near or with bloodborne pathogens. The U.S. Centers for Disease Control and Prevention (CDC) also provides guidelines for preventing exposure to bloodborne pathogens. Practices and procedures from both organizations are included in this training. Practices described in this training also meet the required education and training standards of the National Fire Protection Association (NFPA) for infection control. Additional recommendations for infection control programs for fire departments can be found at NFPA 1581 (

4. Who Does The Standard Protect?
The Standard protects anyone whose job involves handling or possibly being exposed to blood or blood products, blood components, or OPIM. This includes but is not limited to:
Airline mechanics
Animal handlers
Athletic trainers
Clinical technicians
Custodians
Dentists and other dental workers
Engineering staff
Firefighters
Healthcare workers
Housekeeping personnel
Law enforcement personnel
Morticians
Research technicians
Veterinarians

5. OSHA estimates that 5.6 million workers in healthcare and related occupations are at risk for occupational exposure to bloodborne pathogens. By following the regulations of the Standard, OSHA estimates that employers can prevent, for example, 9,000 hepatitis B infections every year. Remember that you do not need to directly contact someone carrying a bloodborne pathogen to be at risk for exposure. Employees who perform job tasks such as handling clinical specimens, bio-hazardous trash, blood or body- fluid soaked laundry; or needles or other sharps should also have bloodborne pathogens training.

6. Who is excluded from the Standard?
The Standard does not cover people who give first aid as Good Samaritans. This is first aid a person voluntarily gives to another person, such as helping someone with a cut, nosebleed, or other injury off the job. Rather, the Standard focuses on occupational exposure, which is specifically defined by OSHA as “a reasonably anticipated skin, eye, mucous membrane, or potential contact with blood or OPIM that may result from the performance of employees’ duties.”

7. What Training Is Required?
The Standard requires that all employees who perform tasks involving potential occupational exposure to bloodborne pathogens receive annual training. This training should cover the hazards they face (how bloodborne diseases are transmitted and their symptoms), the protective measures they can take to prevent exposure, and procedures to follow if they are exposed. See section (g) (2) (vii) of the Standard Appendix A for a complete listing of the 14 elements that at a minimum must be included in this training.

8. What Else Is Required By The Standard?
The Standard requires that where appropriate, employers have a written Exposure Control Plan that clearly outlines how employees are to prevent exposures through engineering controls and workplace practice controls, universal precautions, and personal protective equipment. These topics are covered in detail later in this training.

9. Other Regulations
The Needle Stick Safety and Prevention Act of requires employers to identify, evaluate, and implement safer medical devices. The Act provides expanded protection for employees, including the keeping of a sharps injury log and involving non-management workers in evaluating and choosing safer medical devices. Records must be kept in accordance with the Health Insurance Portability and Accountability Act (HIPPA) and must be maintained for a minimum of 5 years.

10. Chapter 2. Bloodborne Pathogens

11. How Are Infectious Diseases Transmitted?
Preventing transmission of infectious disease is based on understanding how disease is transmitted. This process involves four stages.
1. The process begins with someone with the infection.
2. The infectious pathogen (disease causing bacteria, virus, fungus, or parasite) leaves the infected person’s body. For example:
The person may bleed from a cut, and in that person’s blood is the pathogen
The person may sneeze out little droplets carrying the pathogen

12. 3. The infectious pathogen reaches another person and enters his or her body. This can happen in a number of ways:
The person may come into contact with the infected person’s blood, other body fluid, or infectious material in a way that the pathogen enters his or her body through mucous membranes or non-intact skin (bloodborne transmission)
The person may inhale the pathogen in tiny droplets in the air (airborne transmission)
The person may be bitten by an insect, such as a tick or mosquito, carrying the pathogen (vector transmission)

13. Transmission of a pathogen from one person to another is said to occur through direct or indirect contact:
Direct contact occurs with contact with an infected person or fluids or substances from that person
Indirect contact occurs with contact with contaminated objects, food or drink, droplets in the air, or vectors such as insects.

14. 4. The second develops the infection
4. The second develops the infection. Just having the pathogen enter the body does not automatically mean a person will become ill. He or she may have been vaccinated against the disease, which means the body will kill the infection before it can cause the disease. A person’s natural immune system may be able to kill some pathogens and thereby prevent illness. Or a person may become infected. The process then starts all over again.

15. What Are Bloodborne Pathogens?
Bloodborne pathogens are microorganisms that are present in human blood and can cause disease in humans. Common serious bloodborne pathogens that may be encountered in the workplace include but are not limited to:
Hepatitis B virus (HBV)
Hepatitis C virus (HCV)
Human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS)

16. Although the OSHA Occupational Exposure to Bloodborne Pathogens Standard (the Standard) covers all bloodborne pathogens, this training describes only the diseases caused by the three common pathogens listed here as these are the pathogens that you will most likely come in contact with at work. Measures you take to prevent these infections, however, will also help prevent diseases caused by other bloodborne pathogens.

17. What Other Substances Are Potentially Infectious?
Both blood and other potentially infectious materials (OPIM) may contain bloodborne pathogens. According to the Standard, OPIM may include these human body fluids and anything contaminated with them:
Saliva containing blood (as in dental procedures)
Semen
Vaginal secretions
Breast milk
Amniotic fluid (the fluid in the uterus around the fetus)
Cerebrospinal fluid (the fluid that surrounds the spinal cord and brain)
Synovial fluid (the fluid in joints)
Pleural fluid (the fluid between the linings of the lungs)
Peritoneal fluid (the fluid contained in the abdomen)
Pericardial fluid (the fluid surrounding the heart)
Any body fluid visibly contaminated with blood (such as vomit or urine)

18. OPIM may include the following:
Blood, organs, or other tissue from experimental animals infected with HBV or HIV
Tissue or organ cultures or cell cultures containing HIV
Unfixed tissues (acne, burns, rashes, etc0 or organs from a human
HBV-containing cultures or other solutions

19. Do Exposures Always Cause Infection?
No. The risk of infection following an exposure to blood or another body fluid depends on many factors, including these:
Whether pathogens are present in the source blood or body fluid
The number of pathogens present
The type of injury or exposure – how the infectious material gets into your body
Your current health and immunization status

20. This means that even if the source person’s blood or OPIM do contain pathogens, you are not necessarily infected. To be safe, however, always assume an exposure is potentially infectious and follow all recommended measures to prevent exposures from occurring.

21. Hepatitis B
Hepatitis B, also called serum hepatitis, is caused by the hepatitis B virus (HBV). HBV is transmitted by blood and OPIM. Although HBV has been found in all body secretions and excretions, blood and semen are the most infectious. HV infections are a major cause of liver damage, cirrhosis, and liver cancer. Because of routine hepatitis B vaccinations, the number of new infections per year has declined significantly, particularly in children and adolescents.

22. The Centers for Disease Control and Prevention (CDC) reports that in the United States, however, HBV still infects about 80,000 people yearly, and there are about 1.25 million chronic carriers in the population. About 5,000 people are die of liver problems associated with HBV infection every year. Infection by HBV can cause either acute hepatitis or a chronic (long-term) HBV infection, depending on how the body responds to the virus. In most cases the body produces an antibody that helps destroy liver cells that contain the virus, which eliminates the virus from the body.

23. The person then has lifelong immunity to the hepatitis B virus
The person then has lifelong immunity to the hepatitis B virus. About 95% of adults who are infected develop antibodies and recover within six months of being infected. Once they recover, they are no infectious to others. Those who do develop chronic HBV infections, however, do not develop the antibody and can carry the virus and be infectious to others for decades. A person who still has the virus six months after infection is considered chronically infected. Chronic infection can lead to sever liver damage and death.

24. How Is HBV Spread? HBV is spread in the following ways:
By injection (such as needle sticks or puncture wounds)
Through mucous membranes (blood contamination through the eye or mouth) and non-intact skin (for example, abrasions or lacerations)
Through sexual activity
From infected mother to newborn at birth

25. The most likely mode of transmission of HBV is direct contact with infectious blood through a needle stick, or injury by another sharp instrument. Healthcare workers face these risks in the work environment. With current blood testing, the blood supply today is generally safe, although a theoretical risk remains with blood transfusions. Exposure to HBV on contaminated environmental surfaces is another common mode of transmission. At room temperature the virus may survive for several days in dried body fluids on surfaces such as tables and faucets. HBV is easily transmitted because it can live longer outside the body and because very little blood is needed to cause infection. HBV can be spread by sharing such personal items as a razor, toothbrush, or drug paraphernalia like needles and syringes.

26. HBV is not transmitted in food or water, in fecal matter, through the air, or through casual contact with an infected person. Casual contact includes such things as the following:
Sharing a meal, utensils, or a drinking glass
Kissing, hugging, or touching
Being around someone who sneezes or coughs
Sharing a phone or bathrooms

27. Symptoms of HBV
Often an HBV-infected person has no symptoms. When symptoms do occur, they usually appear gradually and are often flu-like. These symptoms may include the following:
Loss of appetite
Nausea
Fatigue
Muscle or joint aches
Mild fever
Stomach pain
Occasionally jaundice (yellow time to whites of eyes or skin)

28. Hepatitis B Vaccination
ALERT
Hepatitis B Vaccination
In the typical vaccination schedule, the second does is generally given one month after the first, and the third does six months after the first. This schedule may vary depending on specific circumstances, but in all cases it is important to stay on the schedule as stated by the healthcare provider giving the vaccine.

29. How Do I Know If I Have HBV?
Since the symptoms vary so much, the only way to know for sure if you have HBV is to have your blood tested for hepatitis B. The blood test may not, however, indicate the presence of the virus shortly after being infected.

30. Hepatitis B Vaccine
Receiving the hepatitis B vaccine is the best protection against HBV. The vaccine is prepared from yeast cultures, not from human blood or plasma, and therefore there is no risk of contamination with other bloodborne pathogens or of developing hepatitis from the vaccine. Three doses of the vaccine are given by injection on three different dates. (In some situations more than three doses may be needed). The most common adverse reaction to vaccination is soreness at the injection site.

31. The use of the hepatitis B vaccine along with environmental, engineering, and work practice controls can prevent most workplace and occupational infections HBV.
In addition to employees at risk, the CDC also recommends that the following groups of people should get the hepatitis B vaccine:
Those who have unprotected sex with a partner who has HBV or have sex with more than one partner
Those who have anal sex
Those who use intravenous recreational drugs
Those with hemophilia
Those who frequently travel to or live in countries where HBV is common
Those who live with someone with chronic HBV

32. The vaccine prevents hepatitis B in about 95% of people who get all three shots. After receiving all three shots, you can be tested to make certain you are protected. This is important if you have a compromised immune system or your job frequently exposes you to human blood.

33. The Standard and the Hepatitis B Vaccine
The Standard requires employers to offer the hepatitis B vaccine to employees at risk for exposure at no cost to them and during their normal work hours. As an employee, you do, however, have the right to refuse the vaccine. If you choose not to be immunized, you will be asked to sign a declination form. You also have the right to change your mind at a later date and receive the vaccination.
Employers are required to:
Offer training and the hepatitis B vaccine before employees start a work assignment
Explain to employees that vaccination is voluntary
Make certain employees receive proper medical treatment following any exposure incident, regardless of their vaccination history, or are offered the vaccination if they have not received it before

34. Prevention of HBV Infection
Getting the hepatitis B vaccine is the best way to prevent becoming infected with hepatitis B. If you choose not to be vaccinated, however, you can prevent infection by protecting yourself from exposure to blood and OPIM. These include the same protections you should take to avoid all bloodborne pathogens:
Using barriers to prevent contact with any blood and OPIM
Handling sharps with extreme care
Avoiding recreational IV drugs, tattooing, and body piercing without sterile tools
Not sharing any personal care items that may be contaminated with blood

35. Hepatitis C
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). This virus lives in the blood of people with the disease and is spread via the blood. The CDC reports that an estimated 2.7 million people in the United States have chronic HCV infections, and about 25,000 new infections occur each year. HCV does not always cause serious health problems. Many people who carry HCV have some liver damage but do not feel sick from it. In others, cirrhosis of the liver may develop, resulting in eventual liver failure.

36. How Is HCV Spread?
In the general population, HCV spreads most often through drug injections with contaminated needles. HCV infection may also result from unclean tattoo or body piercing tools or from sharing toothbrushes or razors or any other item contaminated with blood. HCV can also be transmitted from a pregnant woman to the fetus and, more rarely, through sexual contact. For those employed in healthcare facilities, the primary risk of HCV transmission is via direct contact with infectious blood through an accidental needle stick or injury with other sharps.

37. Symptoms of HCV
Most people with hepatitis C do not have any symptoms. However, some people may feel one or more of the following symptoms:
Fatigue
Loss of appetite
Nausea
Anxiety
Weight loss
Alcohol intolerance
Abdominal pain
Loss of concentration
Jaundice

38. How Do I Know If I Have HCV?
Several different blood tests can be done to determine if you have HCV. A false positive test (a test result that appears positive when the person is not infected) can occur with HCV tests, however. Therefore, anyone who tests positive should have a follow-up test. False negative test results may also occur with HCV. These usually occur with testing done shortly after infection when antibodies have not yet developed and therefore cannot be accurately measured. A different type of blood test may then be recommended.

39. The CDC recommends HCV testing for the following group of people:
Healthcare workers who have been exposed to HCV- positive blood
Anyone who has used intravenous recreational drugs
Anyone who received a blood transfusion or organ transplant or was on kidney dialysis prior to 1992
Anyone treated with a blood product prior to 1987
Anyone with signs of liver disease
Testing is important for these people because if necessary, treatment can be given to protect the liver from additional damage, and people who know they are HCV carriers can take preventive measures to avoid spreading HCV to others.

40. Prevention of HCV Infection
There currently is no vaccine available for HCV and no cure. Therefore, preventive measures are very important. The following are recommended preventive practices:
Handle needles and other sharps with caution and follow barrier practices to prevent contact with blood and OPIM
Avoid recreational intravenous drug use
Never reuse or share syringes, or drug paraphernalia
Do not share toothbrushes, razors, or other personal care items that may be contaminated with blood
Remember the health risks associated with tattoos and body piercing if tools are not sterile or sanitary practices are not followed

41. Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome
Acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV). AIDS damages cells that are essential for immune function. As a result, people with AIDS are more susceptible to opportunistic infections, which invade the body as the disease progresses. The disease is eventually fatal.

42. How Is HIV Spread?
HIV is transmitted through an infected person’s body fluids. This includes:
Blood
Semen
Vaginal secretions
Breast milk
Other body fluids or OPIM if blood is present
Although HIV can sometimes be detected in saliva, tears, urine, cerebrospinal fluid and amniotic fluid, exposure to these fluids from an infected person does not result in transmission of the virus.

43. The greatest risk for healthcare workers involves exposure to the almost one million HIV-positive people in the U.S., one quarter of whom are unaware of their infection. Healthcare workers often come in contact with these carriers when they seek medical care for other health issues.
Some healthcare workers have been infected with HIV through work-related exposures involving blood or other infected substances.
Infection is most likely to occur with exposure to HIV- contaminated blood, blood components, or blood products through:
Injection through the skin
Unprotected mucous membranes
An open skin wound

44. Casual contact with those infected with HIV does not result in transmission of the virus. Casual contact includes such things as the following:
Sharing a meal, utensils, or a drinking glass
Kissing, hugging, or touching
Being around someone who sneezes or coughs
Sharing a phone or bathroom
HIV is not an airborne virus, nor can it be contracted if bitten by a mosquito, flea, tick, or other bloodsucking vermin.

45. Symptoms of HIV
Many people with HIV have no symptoms and do not even know they have been infected. HIV can take many years to develop into AIDS. AIDS symptoms may include the following:
Loss of appetite
Weight loss
Fever
Skin rashes
Swollen lymph nodes
Diarrhea
Tiredness
Night sweats
An inability to fight off infection

46. How Do I Know If I Have HIV?
The only reliable way to determine if a person has HIV is through a blood test. The test result is generally positive for an infection twelve weeks after exposure, although in some instances it may take longer for HIV antibodies to develop. Therefore, a confirmation test is recommended six months after an exposure.

47. Prevention of HIV Infection
No vaccine is currently available for HIV, and there is no cure for AIDS. Therefore, preventive measures are very important. Safe work practice controls significantly reduce the risk of contracting HIV in the workplace or transmitting infectious diseases to victims. These guidelines include the following:
Regular hand washing
Use of barriers
Universal precautions

48. Chapter 3. Preventing Infection from Bloodborne Pathogens

49. The OSHA Occupational Exposure to Bloodborne Pathogens Standard (the Standard) requires employers to sue four types of strategies to reduce occupational exposure to bloodborne pathogens:
1. Engineering controls
2. Work practice controls
3. Personal protective equipment
4. Universal precautions
In addition, the Standard requires having procedures in place in the event an exposure does occur and maintaining an exposure control plan.

50. Engineering Controls
OSHA defines engineering controls as devices that isolate or remove the bloodborne pathogen hazard from the workplace. Many kinds of devices have been developed to increase safety in the workplace. These devices include needless systems, eye wash stations, hand washing facilities, and biohazard labels. These all have an important role in reducing the risk of exposure to bloodborne pathogens.

51. Sharps
Sharps is a general term for any device or item that may accidentally cut a person handling it. Examples of sharps are needles, scissors, scalpels, and broken glassware. Needles pose one of the greatest risks to healthcare workers. Safer needleless systems are now used in many settings for administering medications. Other systems have needle shields, retractable needles, or other protective devices. Employers are not necessarily required to use the latest devices but must evaluate the feasibility of such devices when appropriate.

52. Approved sharps containers must also be available in appropriate places for safe disposal of used sharps. These containers must be leak proof, resistant to puncture and other damage, able to be securely closed, and labeled with a biohazard warning.

53. Hand Washing Facilities and Eye Wash Stations
When possible, hand washing facilities must be provided for all employees. When not possible, antiseptic hand cleanser may be provided instead. Eye wash stations should be available when appropriate for flushing contaminants from the eyes.

54. Warning Labels
Warning labels are required to be prominently displayed on the following:
Containers for waste that may contain contaminated materials (biohazardous waste)
Freezers and refrigerators used for blood or other potentially infectious materials (OPIM)
Containers used to transport, ship, or store blood or OPIM
Contaminated equipment until proper cleaning procedures are complete
Laundry bags used to hold and transport contaminated clothing
Entrances to places containing potentially infectious materials
All potentially infectious waste must be disposed of in properly labeled red containers or in containers clearly marked with a red, orange, or orange-red label with the universal biohazard symbol.

55. Antiseptic Hand Cleanser
ALERT
Antiseptic Hand Cleanser
If antiseptic towelettes or antibacterial hand washing liquid is used without water for the initial cleaning after an exposure, a thorough scrubbing with soap and water is still needed as soon as possible.

56. Work Practice Controls
Work practice controls are controls that reduce the likelihood of exposure by altering the manner in which a task is performed. Depending upon the environment, work practice controls might include using personal protective equipment (PPE), hand washing, decontaminating and sterilizing equipment and areas, safely handling laundry, and good personal habits.

57. Hand washing
Hand washing is a simple but very important step for preventing the transmission of bloodborne pathogens. The following are general guidelines to use with hand washing:
Wash any exposed skin, ideally with antibacterial soap, as soon after an exposure as possible
While washing, be gentle with any scabs or sores
Wash all surfaces, including the backs of hands, wrists, between the fingers, and under fingernails
Wash hands immediately after removing gloves or other personal protective equipment

58. Antiseptic towelettes and waterless antibacterial hand washing liquid can be used when soap and running water are not available. If one of those methods is used for the initial cleaning after a potential exposure, however, a thorough scrubbing with soap and water is still recommended as soon as possible and is required if there was exposure to blood or OPIM.

59. ALERT
Hand washing
Before handling any potentially infectious materials, know where the nearest hand washing facility is. You can use facilities such as restrooms, janitor closets, and laboratory sinks, as long as soap is available. Do not use sinks in areas where food is prepared. Merely wetting the hands will not prevent infection.

60. Decontamination and Sterilization
OSHA defines contamination as the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item so that it is no longer infectious. To sterilize something means to use a chemical or physical procedure to destroy all microbial life on the item. Use the following general guidelines for decontamination and sterilization:
All reusable sharps, such as knives, scissors, and scalpels, must be cleaned and sterilized after being used
Decontaminate equipment and working surfaces, bench tops, and floors with an approved disinfectant, such as 10% bleach solution:
At the end of a work shift
As surfaces become obviously contaminated
After any spill of blood or OPIM
Disinfect personal items such as jewelry and nail brushes, after hand washing
Use utensils, such as tongs or a dustpan, to clean up broken glass and other contaminated materials for disposal in a sharps container

61. Perform the Skill - Hand washing
1. Remove any jewelry and your watch. Do not let your clothing touch the sink. 2. Turn on water, and adjust the temperature to warm. 3. Wet your hands to above the wrists and lather up with soap. Keep your hands below your elbows throughout the hand washing. 4. Wash all areas of your hands and wrists. Interlace fingers to scrub between them. 5. If your hands were exposed to infectious material, scrub beneath fingernails with a nail brush or nail stick. 6. Rinse wrists and hands well. (repeat soaping and washing if your hands were exposed to infectious material.) 7. Dry hands thoroughly with paper towel, and dispose of it properly. 8. Use a dry paper towel to turn off the water faucet and open the door, and dispose of it properly.

62. Picking Up Sharps or Broken Glass
ALERT
Picking Up Sharps or Broken Glass
The Standard states that employees should never pick up broken glass or other sharps with gloved or bare hands. Always use tongs or some other device to pick them up. Do not use a vacuum cleaner.

63. Perform the Skill – Cleaning a Hazardous Materials Spill
1. Wear gloves and other personal protective equipment to protect yourself while cleaning the spill. 2. Bring supplies and a hazardous waste container to the location of the spill. 3. Use tongs or other means to pick up any broken glass, and dispose of it carefully. 4. Wipe up the spill with paper towels, and dispose of them in the biohazard container. 5. Clean the area thoroughly, and then disinfect the area with approved disinfectant. 6. Remove your gloves and wash your hands.

64. Handling Sharps
Guidelines for safe handling of sharps include the following:
Employers must put sharps disposal containers in easily accessible areas where sharps are used
Needles must not be recapped, removed, bent, sheared, or broken
The entire needle/syringe assembly must be disposed of in a sharps container
When medically necessary, a mechanical device may be used to recap a contaminated needle or remove it from a disposable syringe. OSHA requires that the exposure control plan must specify when, why, and how this is done and by whom.

65. Regulated Waste Handling and Disposal
Regulated waste requires special handling. Regulated waste includes:
Blood or OPIM in liquid or semi-liquid state
Items contaminated with blood or OPIM that could release liquid or semi-liquid blood or OPIM if squeezed
Items with dried blood that could be spread by handling
Contaminated sharps
Lab specimens containing blood or OPIM
All containers intended for disposal of potentially infectious materials should be clearly marked with the universal biohazard symbol. The facility mush follow approved procedures for disposing of regulated waste and disinfecting equipment for reuse.

66. Laundry
Uniforms, clothing, and cloth supplies should be kept free from contamination when possible. Clothing that becomes contaminated with blood or OPIM must be put in special laundry bags that are clearly labeled and color-coded to be sent to an approved laundry facility for cleaning. Anyone handling contaminated laundry must be trained to handled bloodborne pathogens and must wear appropriate personal protective equipment.

67. Work Area Restrictions
When working in an area where bloodborne pathogen exposure may occur, prevent entry of pathogens into your mouth or eyes by keeping your hands away from your face. In general, follow these guidelines:
Do not smoke
Do not put on lip balm, hand lotion, or cosmetics
Do not eat or drink
Do not handle your contact lenses
Do not store food or beverages in places where blood is stored or handled, including in refrigerators, freezers, shelves, or cabinets or on countertops or bench tops where blood or OPIM are present
Do not put pencils, pens, or other objects in your mouth where potentially infectious materials may be present
Do not use a sink that is used for food preparation for any other cleanup

68. Contaminated Clothing
ALERT
Contaminated Clothing
Never take contaminated clothing home to wash. Keep extra clothing at work in case your street clothes become contaminated and must be sent to the approved laundry facility.

69. Personal Protective Equipment
Personal protective equipment, often called PPE, consists of barriers such as gloves, jumpsuits or aprons, eye shields or goggles, face masks or face shields, and caps and booties that you wear to protect yourself from exposure to blood and OPIM. The Standard requires your employer to provide you with appropriate PPE at not cost to you. Your employer must also train you on how to use this equipment and must clean, repair, or replace it as needed. In any situation where exposure to bloodborne pathogens is a possibility, wear your PPE.

70. Gloves
Gloves are a type of barrier, which like other barriers separate you from potentially infectious materials. Medical exam gloves suitable for protection from bloodborne pathogens are made of nitrile, vinyl, latex, or other waterproof materials. For added barrier protection, two pairs of gloves may be worn together in some situations.
Check that your gloves are intact. If a hole or tear is present, replace the glove immediately with a new one.
Not use petroleum-based hand lotions. These lotions may cause latex gloves to disintegrate.
Remove contaminated gloves carefully. Do not touch any part of the contaminated material outside of the gloves.
Dispose of gloves properly. After working with any material that may be infected by bloodborne pathogens, dispose of your gloves in a container clearly marked for bio-hazardous waste.

71. Protective Body Clothing
Jumpsuits, aprons, lab coats, and gowns are sometimes worn to protect clothing from contamination by blood and OPIM. These barriers are available in different thicknesses and materials. Any article of clothing that becomes contaminated with blood should be removed immediately and handled as carefully as any contaminated item. Avoid contact with your skin, and put the article in a clearly marked bio- hazardous bag.

72. Goggles and Eye Shields
Certain occupations or work conditions involve a risk of being splashed in the face by blood or substances contaminated with bloodborne pathogens. Because the eyes are surrounded by mucous membranes, a splash in the eyes may allow bloodborne pathogens into the body. Use of barrier devices is therefore often essential. Eye protection is also recommended when cleaning spills or performing first aid. PPE for the eyes includes goggles and safety glasses with side shields. Face shields also protect the eyes.

73. Face Shields and Face Masks
Perform the Skill
Putting on Gloves
1. Pull glove onto one hand
2. Pull glove tight
3. Put on other glove
Face Shields and Face Masks
Face shields protect the eyes, mouth, and nose from splashes and contaminants. Face masks protect the mouth and nose. When worn with goggles or safety glasses, face masks help protect the whole face.
Caps and Booties
The forehead and the hair may be covered by a waterproof disposable cap, and shoes or boots by waterproof, disposable booties. Both provide additional barriers to bloodborne pathogens.

74. Removing Contaminated Gloves
Perform the Skill
Removing Contaminated Gloves
With your gloved dominant hand, grasp the other glove at the wrist or palm and pull it away from the hand.
Pull the glove the rest of the way off.
Holding the removed glove balled up in the palm of your gloved dominant hand, insert fingers of your non-dominant hand under the cuff of the remaining glove.
Remove the glove by stretching it up and away from the hand turning it inside out as you pull it off.
Dispose of gloves in a biohazard container and wash your hands.

75. Improvising Personal Protective Equipment
In unexpected or extreme circumstances, you may not have PPE with you when potentially exposed to bloodborne pathogens. Be creative in using items at hand to avoid contact with potentially infectious material. Using a plastic bag, a sheet, or a towel, or even removing an article of clothing to use as a barrier is better than being unprotected. Dispose of or decontaminate any articles you use as barriers as you would any contaminated item.

76. Disposing of Contaminated Personal Protective Equipment
Different forms of protective equipment require different disposal methods. Your employer may request that you put articles such as used gloves in a designated container for storage until they are disposed of. Contaminated clothing may be stored in clearly labeled bags until it is decontaminated, laundered, or properly disposed of.

77. Universal Precautions
Universal precautions is a phrase describing safety guidelines in which all blood and OPIM are handled as if they are contaminated. When universal precautions are followed, it does not matter whether you know the source of the substance. Under universal precautions, you treat all materials as if they are infected with bloodborne pathogens. This includes the following:
Blood
Semen
Vaginal secretions
Saliva that may contain blood
Cerebrospinal fluid
Synovial fluid
Pleural fluid
Any body fluid where blood is visible
Any body fluid that cannot be identified
Following universal precautions means using PPE and following all the safe work practice controls described in this manual.

78. Body Substance Isolation
Body substance isolation (BSI) is an alternative approach to universal precautions. BSI guidelines define all body fluids and substances as infectious. Since OSHA now requires all body fluids to be managed with universal precautions, this approach is essentially the same as BSI.

79. Emergency Procedures for Unexpected Exposure Incident
Even when you follow all safety guidelines and universal precautions, an unexpected exposure can occur. If so, both you and your employer need to take immediate action. Employers are required to inform you how to make an incident report in case you are exposed.
If you are exposed take the following actions:
If blood or OPIM splashes in your eyes or other mucous membranes, flush the area with running water for 20 minutes if possible.
Wash any exposed area well with soap, using an antibacterial soap if possible.
Treat any scabs and sores gently when cleaning your skin.
Report the exposure to your supervisor as soon as possible.
Save any potentially contaminated object for testing purposes.
Seek medical care as soon as possible.
After receiving your report, your employer must do the following:

80. OSHA Requirements for Reporting Exposure Incidents
Date and time of your exposure
Your job title/classification
Your work location where the exposure happened
Activity you were performing at the time of the exposure
Your training for that activity
Engineering controls (devices, equipment) you were using at the time of the exposure
Preventive work practice controls you were using at the time of the exposure
Personal protective equipment you were using at the time of the exposure
Identify and document the person or other source of the blood or OPIM

81. Obtain consent to test the source person’s blood and arrange for testing the person (unless he or she is already known to be infectious)
Inform you of the test results
Arrange for you to have your blood tested if you consent
Arrange for you to receive counseling and medical care as needed
The treatment and follow-up medical care depend on the type of exposure: the substance involved, the route of transmission, and the severity of the exposure. Treatment may include a hepatitis B vaccination or treatment with hepatitis B immune globulin (HBIG).
An exposure report form is kept in the employee’s personnel file. By federal law, employers must maintain strict confidentiality about any exposure incidents.

82. ALERT Exposure Incident
Don’t delay acting if you are exposed to blood or OPIM. Every minute counts in preventing pathogens from entering the body.

83. Exposure Control Plans
OSHA requires employers to have an Exposure Control Plan to prevent exposure to bloodborne pathogens. Your employer’s Exposure Control Plan should do the following: Identify the job positions and individuals to receive training Establish necessary engineering controls and work practice controls Specify PPE to be used Required using universal precautions State the opportunity for hepatitis B vaccination Include other measures appropriate for your specific work environment

84. The exposure Control Plan must be updated regularly to reflect any changes in work practice controls related to possible exposure to bloodborne pathogens. The plan should also describe how improved safety devices are to be evaluated for possible use. The Standard requires that employers inform new employees about their plan and conduct training before performing any work tasks that would put you at risk for an exposure. Refresher training is required annually or whenever changes are made to policies and procedures.

85. Chapter 4. Airborne Pathogens

86. OSHA regulations do not currently specify specific employee protections from airborne pathogens in the same manner as the Occupational Exposure to Bloodborne Pathogens Standard protects against employees from know hazards, however, which in certain settings can include airborne pathogens such as tuberculosis. A new standard for tuberculosis has been proposed but has yet to be implemented. The information in this chapter is based on the current Centers for Disease Control and Prevention (CDC) guidelines for control of tuberculosis in healthcare settings.

87. What Are Airborne Pathogens?
There are three types of airborne pathogens:
Viral
Bacterial
Fungal
Meningitis, influenza, pneumonia, and tuberculosis are all examples of diseases transmitted through the air. This chapter focuses on tuberculosis, since that is a common airborne disease for which employees may be at risk. Many of the precautions you take to prevent tuberculosis will also lower the risk of infection from other airborne pathogens.

88. Airborne pathogens differ from bloodborne pathogens in that they are spread by inhaling the germ. An infectious person’s coughing or sneezing can send tiny droplets of moisture into the air that contain the pathogen. Depending on the environment, these contaminants can remain airborne for several hours.
If an airborne pathogen is inhaled, the pathogen may be transmitted. Exposure to airborne pathogens may be transmitted. Exposure to airborne pathogens does not always result in infection,however. The likelihood of transmission depends on the following:
How contagious the infectious person is
Where the exposure occurs
How long the exposure lasts
How healthy you are at the time of the exposure
Those individuals who are around an infectious person on a regular basis, such as family members and coworkers, are more susceptible to airborne pathogens than someone who experiences a single isolated exposure.

89. Tuberculosis
Tuberculosis (TB) is caused by a specific bacteria. The disease usually affects the lungs, but it can also affect the brain, spine, or kidneys. Many people with TB infection may not be sick because their bodies are effectively fighting the bacteria, and these people are not contagious. Later, however, they may develop TB disease and become contagious. About 10% of people with a TB infection develop the disease at some point. The risk is greatest one to two years after infection and is higher for people with certain medical conditions such as:
HIV
Diabetes mellitus
Severe kidney disease
Low body weight
Certain types of cancer (leukemia, Hodgkin’s disease, or cancer of the head and neck)

90. According to the CDC, employees in certain workplaces also face a great risk of exposure. These workplaces include but are not limited to the following:
Commercial airlines
Correctional facilities
Drug and treatment centers
Healthcare facilities
Homeless shelters
Long-term care facilities

91. How Is TB Spread?
TB is spread when a person inhales the TB pathogen, which is present in the air after an infected person coughs or sneezes. Depending on room size, ventilation, and other factors, the TB pathogen can live up to 1 to 1 ½ hours outside the body.

92. Symptoms of TB
People with TB infection often have no symptoms and do not feel sick. If the infection advances to TB disease, however, the person’s symptoms may include:
Weight loss
Fever
Night sweats
Feeling weak
If the TB affects the person’s lungs, the common symptoms include coughing, chest pain, and coughing up blood. Other symptoms depend on the part of the body affected.

93. How Do I Know If I Have TB?
The tuberculin skin test, also called the Mantoux test, reveals whether a person is infected with the TB bacteria. This test is performed by injecting a small amount of tuberculin fluid under the skin in the lower part of the arm. Two or three days later, the test spot result is checked by a healthcare worker. This test is generally recommended for employees who have been at risk because of being near people who may have TB, such as those employed in the workplaces listed earlier.

94. The skin test alone, however, cannot distinguish between TB infection and TB disease. A chest x- ray and a sample of phlegm coughed up from the lungs are often needed to determine whether an infected person has TB disease. Someone who has another disease or illness is more likely to develop TB disease after an exposure and infection. Testing is even more important for someone with a compromised immune system, because treatment may need to begin immediately.

95. Prevention of TB Infection
Although it is impossible to eliminate all risk of infection from TB in the workplace, the risk can be reduced. In appropriate settings the employer should develop a plan to lower risks for employees. Engineering controls may include isolation of TB patients, UV lighting to destroy environmental bacteria (a method still being researched), special air filters that trap airborne bacteria, and fitted face masks and respirators for use around people known to have TB.

96. General guidelines to reduce the risk of TB exposure may include:
Requesting that all employees cover coughs and sneezes with a tissue to help eliminate airborne pathogens
Using ventilation systems to circulate fresh air and help reduce the spread of airborne pathogens
Using tuberculocidal disinfectants to eliminate TB germs on work surfaces
Requiring TB tests at the time of hiring

97. TB Exposure
Like an exposure to a bloodborne pathogen, an exposure to a known TB source should be reported to your employer. Similarly, you have the right to know if you have been exposed. Following an exposure you may be tested for TB, and if you are infected, your employer will make arrangements for appropriate treatment.

98. Treatment of TB
TB infections can be treated, although depending on the likelihood that the TB infection will develop into TB disease, sometimes the person is not treated if there is little risk of the disease resulting. Factors that influence this decision include the person’s age, overall health, lifestyle, and occupation. TB disease can be cured by taking prescribed antibiotics, generally for 6 to 12 months. The drugs must be taken exactly as prescribed. If taken incorrectly, or if the full round of treatment is not completed, the TB germs may become resistant to treatment.

99. SARS
In 2003 an outbreak of severe acute respiratory syndrome (SARS) in some parts of the world caused a new scare. SARS is primarily an airborne infectious disease, transmitted when an infected person coughs or sneezes within close proximity of others. During the epidemic almost 10% of approximately 8000 known SARS victims in the world died. Only 7 people in the U.S. were know to have contracted SARS, however, all during international travel to epidemic areas. The U.S. Centers for Disease Control and Prevention continues to monitor the risks of SARS and will issue updates and warnings if new outbreaks occur.

100. HEPATITIS B IMMUNIZATION CONSENT FORM
I, _________________________ have received training on Hepatitis B Vaccine, including information on its efficacy, safety, method of administration, the benefits of being vaccinated and that the vaccine and vaccination will be offered free of charge. I have had an opportunity to ask questions and I understand the risks and benefits of Hepatitis B vaccination. I understand that I must receive three (3) doses of the vaccine to confer immunity. However, as will all medical treatment, there is no guarantee that I will, in fact, become immune or that I will be free of adverse side effects from the vaccine.
I, ________________________ have read and understand the above and I hereby consent to be immunized against Hepatitis B and understand that I may experience some minor side effects.
1st Dose:
Employee Signature: ____________________ Date:_______________
Witness: ____________________
2nd Dose:
3rd Dose:
HEPATITIS B VACCINE DELCINATION (MANDATORY)
I, ________________________, understand that due to my occupational exposure to blood or other 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 occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with Hepatitis B vaccine, I can receive the vaccination series at not charge to me.
Employee Signature: ____________________ Date: _______________
Witness: ____________________

101. 1. Why get vaccinated? Hepatitis B is a serious disease.
The hepatitis B virus (HBV) can cause short-term (acute)
illness that leads to:
Loss of appetite
Tiredness
Pain in muscles, joints, and stomach
Diarrhea and vomiting
Jaundice (yellow skin or eyes)

102. It can also cause long-term (chronic) illness that leads to:
Liver damage (cirrhosis)
Liver cancer
Death
 About 1.25 million people in the U.S. have chronic HBV infection.
Each year it is estimated that:
80,000 people, mostly young adults, get infected with HBV
More than 11,000 people have to stay in the hospital because of hepatitis B
4,000 to 5,000 people die from chronic hepatitis B
Hepatitis B vaccine can prevent hepatitis B. It is the first anti-cancer
vaccine because it can prevent a form of liver cancer.

103. 2. How is Hepatitis B virus spread?
Hepatitis B virus is spread through contact with the blood and body fluids of an infected person. A person can get infected in several ways, such as:
·        By having unprotected sex with an infected person
·        By sharing needles when injecting illegal drugs
·        By being stuck with a used needle on the job
·        During birth when the virus passes from an infected mother to her baby
About 1/3 of people who are infected with hepatitis B in the United States don’t know how they got it.

104. 3. Who should get hepatitis B vaccine and when?
Everyone 18 years of age and younger
Adults over 18 who are risk
Adults at risk for HBV infection include:
People who have more than one sex partner in 6 months
Men who have sex with other men
Sex contacts of infected people
People who inject illegal drugs
Health care and public safety workers who might be exposed to infected blood or body fluids
Household contacts of persons with chronic HBV infection
Hemodialysis patients
If you are not sure whether you are at risk, ask your doctor or nurse.

105. People should get 3 doses of hepatitis B vaccine according to the following schedule. If you miss a dose or get behind schedule, get the next does as soon as you can. There is no need to start over.
Who
Hepatitis B Vaccination Schedule
Infant whose mother is infected with HBV
Infant whose mother is not infected with HBV
Older child, adolescent, or adult
When
First Dose
Second Dose
Third Dose
Within 12 hours of birth
1-2 months of age
6 months of age
Birth – 2 months of age
1-4 months of age (at least 1 month after first dose)
6-18 months of age
Any time
1-2 months after first dose
4-6 months after first dose

106. - The second dose must be given at least 1 month after the first dose.
- The third dose must be given at least 2 months after the second dose and at least 4 months after the first.
- The third dose should not be given to infants under 6 months of age because this could reduce long-term protection.
Adolescents 11 to 15 years of age may need only two doses of hepatitis B vaccine, separated by 4-6 months. Ask your health care provider for details.
Hepatitis B vaccine may be given at the same time as other vaccines.

107. 4. Some people should not get hepatitis B vaccine or should wait.
People should not get hepatitis B vaccine if they have ever had a life-threatening allergic reaction to baker's yeast (the kind used for making bread) or to a previous dose of hepatitis B vaccine. People who are moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting hepatitis B vaccine. Ask your doctor or nurse for more information.

108. 5. What are the risks from hepatitis B vaccine?
A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of hepatitis B vaccine causing serious harm, or death,is extremely small.
Getting hepatitis B vaccine is much safer than getting hepatitis B disease.
Most people who get hepatitis B vaccine do not have any problems with it.
Mild problems:
soreness where the shot was given, lasting a day or two (up to 1 out 11 children and adolescents, and about 1 out of 4 adults)
mild to moderate fever (up to 1 out of 14 children and adolescents and 1 out 100 adults)
Severe problems:
serious allergic reaction (very rare)

109. 6. What if there is a moderate or severe reaction?
What should I look for?
*???? condition such as a serious allergic reactions are extremely rare with any vaccine. If one were to occur, it would be within a few minutes to a few hours after the shot. Signs can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness.
What should I do?
Call a doctor or get the person to a doctor right away.
Tell your doctor what happened, the date and time it happened, and when the vaccination was given.
Ask your doctor, nurse, or health department to file a Vaccine Adverse Event Reporting System (VAERS) form, or call VAERS yourself at

110. 7. The National Vaccine Injury Compensation Program
In the rare event that you or your child has a serious reaction to a vaccine, a federal program has been created to help you pay for the care of those who have been harmed. For details about the National Vaccine Injury Compensation Program, call or visit

111. 8. How can I learn more?
Ask your doctor or nurse. They can give you the vaccine package insert or suggest other sources of information. Call your local or state health department's immunization program. Contact the Centers for Disease Control and Prevention (CDC): --Call or (English) --Call (Espanol) --visit the National Immunization Program's website at or CDC's Division of Viral Hepatitis website at

113. 15 to 50 days, average 8 to 12 weeks
Hepatitis A (HAV)
Hepatitis B (HBV)
Hepatitis C (HCV)
Hepatitis D (HDV)
Hepatitis E (HEV
What is it?
HAV is a virus that causes inflammation of the liver. It does not lead to chronic disease.
HBV is a virus that causes inflammation of the liver. The virus can cause liver cell damage, leading to cirrhosis and cancer.
HCV is a virus that causes inflammation of the liver. This infection can lead to cirrhosis and cancer.
HDV is a virus that causes inflammation of the liver. Only infects those with HBV.
HEV is a virus that causes inflammation of the liver. Rare in the US. There is no chronic state.
Incubation Period
15 to 50 days, average 8 to 12 weeks
4 to 26 weeks, average 8 to 12 weeks
2 to 26 weeks, average 7 to 9 weeks
4 to 26 weeks
2 to 9 weeks, average 40 days
How is it spread?
Transmitted by fecal/oral route, through close person/person contact or ingestion of contaminated food and water.
Contact with infected blood, seminal fluid, and vaginal secretions. Sex contact contaminated needles, tattoo/body piercing and other sharp instruments. Infected mother to newborn. Human bite.
Contact with infected blood, contaminated IV needles, razors, tattoo/body piercing and other sharp instruments. Infected mother to newborn. Is not easily transmitted through sex.
Contact with infected blood and contaminated needles. Sexual contact with HDV infected persons.
Transmitted through fecal/oral route. Outbreaks associated with contaminated water supply in other countries.
Symptoms
May have no symptoms. Adults may have light stools, dark urine, fatigue, fever and jaundice.
May have no symptoms. Some people have mild flu like symptoms, dark urine, light stools, jaundice, fatigue, and fever.
Same as HBV.
Treatment of Chronic Disease
Not applicable.
Interferon is effective in up to 50% of those treated.
Interferon is effective in 10-20% of those treated.
Interferon with varying success.
Vaccine
Two doses of vaccine to anyone over the age of two.
Three doses may be given to persons of any age.
None
Who is at risk?
Household or sex contact with an infected person or living in an area with HAV outbreak. Travelers to developing countries. Homosexual men, and IV drug users.
Infant born to infected mother having sex with infected person or multiple partners, IV drug users, emergency responders and healthcare workers, homosexual men, and hemodialysis patients.
Anyone who had a blood transfusion before 1990, healthcare workers, IV drug users, hemodialysis patients, infants born to mother, and multiple sex partners.
IV drug users, homosexual men, and those having sex with an HDV infected person.
Travelers to developing countries.
Prevention
Immune Globulin or vaccination. Wash hands after going to the toilet. Clean surfaces contaminated with feces, such as changing tables.
Vaccination and safe sex. Clean up any infected blood with bleach and wear protective gloves. Do not share razors or toothbrushes.
Safe sex. Clean up spilled blood with bleach. Wear gloves when touching blood. Do not share razors or toothbrushes.
Hepatitis B vaccine to prevent HBV infection. Safe sex.
Avoid drinking or using potentially contaminated water.

114. Bloodborne Pathogens Post-Exposure Checklist
Employee: __________________________
Date and time incident was reported: ___________________________________________________
Date and time incident occurred: ______________________________________________________
Post-exposure report completed: _______________________________________________________
Source individual identified: ____YES ___NO
If yes, was HBV or HIV testing conducted? ___YES ___NO
If no, incident reason:
A. Source individual know to be HBV/HIV infected
B. Legal consent not granted and could not be obtained
C. Other: _________________________________________________________________________________
If source testing conducted: __________________________________________________________
Results given to employee: ___________________________________________________________
Employee advised of confidentiality requirement of I.C. & : __________________________
Results given to evaluating healthcare professional: _______________________________________
Collection and testing of employee’s blood: _____________________________________________
Consent for testing granted: __________________________________________________________
Consent for collection only: __________________________________________________________
Date of initial testing: __________ Follow-up testing: __________
Six weeks Twelve weeks Six months

115. Bloodborne Pathogens Post-Exposure Report
Employee Name: ________________________ Division: __________________________________ Date and time incident was reported: ___________________________________________________ Description or route of exposure (E.G., needle-stick or left palm): _______________________________________________________________________________________________ ___________________________________________________________________ Date of exposure: _______________________ Time of exposure: ____________________________ Description of circumstances under which exposure incident occurred (work) practice controls and policies and procedures utilized: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _____________________________________________________ Personal protective equipment worn: ___________________________________________________ Recommendations for corrective action: _________________________________________________________________________________ Source individual: __________________________________________________________________ Report completed by: _______________________________________________________________ Date: ___________

116. DEVELOPMENTAL SERVICES, INC.
STANDARD OPERATING PROCEDURE FOR BLOODBORNE PATHOGENS

117. Standard Operating Procedure. No. 1
Standard Operating Procedure No Subject: Communicable Disease Control/Bloodborne Pathogens Effective Date: Authorized by: Bill Hadar Area(s) Affected: Agency Wide
In a comprehensive agency like Developmental Services, Inc., the agency must be aware of its responsibility to the public it serves and the public it invites into the service delivery system. The area of communicable disease presents a critical area for evaluation of those public responsibilities. In order to fully address those areas, Developmental Services, Inc. will promulgate and apply policies to promote maximum health and safety for its staff members, its clients, and the public as a whole. DEFINITIONS: Communicable Disease: an illness due to an infectious agent or its toxic products which is transmitted directly or indirectly to a well person from an infected person, animal, or other vectors. Chronic Communicable Disease: those communicable diseases which are incurable or not readily curable and from which person infected disease may suffer on-going or recurring effects. Such related diseases caused by the HTLV-III virus, cytomegalovirus, herpes simplex virus and hepatitis B. Acute Communicable Disease: those short-term and/or childhood communicable diseases which are readily transmissible by contact and form which a person infected with such disease generally fully recovers, or which is generally know to affect children of school age. Such diseases include chicken pox, impetigo, strep throat, scarlet fever, measles, whooping cough, mumps, influenza, and HIB. Other Disease Which Is A Danger to Health: any disease which is found by a state ore local health officer to pose a danger to health based upon the characteristics of the disease. Identification: Due to the fact that DSI provides a variety of services to clients, intake requirements may vary depending on the individuals program needs. Therefore, the requirements for documentation regarding communicable diseases prior to services may vary.

118. Standard Operating Procedure. No. 1
Standard Operating Procedure No Subject: Communicable Disease Control/Bloodborne Pathogens Effective Date: Authorized by: Bill Hadar Area(s) Affected: Agency Wide
If any serious chronic communicable disease is identified, Developmental Services, Inc. will provide programs or services
to the extent possible keeping in mind the health and welfare of clients and staff members. On a case by case, need to
know basis, co-workers, co-habitants, staff or family members will be advised the status of a client with a known serious
communicable disease after promptly analyzed and appropriate action taken. In addition to addressing others’ right to
know, this action will also follow policies which protect client confidentiality.
Current clients and employees will be referred for diagnostic screening if they request assistance for such. That referral
will include individual counseling to insure that the client fully understands the test results and the prognosis for recovery
from the communicable disease. The request for referral and subsequent counseling will be confidential.
Prevention/Control of Communicable Disease:
Every effort will be taken on the part of the agency and its personnel to insure limited likelihood of the spread of communicable disease. The following list reflects common practices to control and prevent infection.
All staff members will use the safe practice of washing their hands with soap and water after each potential contact with any communicable disease substance.
In adult programs all blood/body fluid spill situations will be handled only by designated staff with staff members wearing disposable surgical gloves to prevent direct contact following the precautions listed below. In cases of know or suspected communicable disease, children’s program staff will also observe these precautions:

119. Standard Operating Procedure. No. 1
Standard Operating Procedure No Subject: Communicable Disease Control/Bloodborne Pathogens Effective Date: Authorized by: Bill Hadar Area(s) Affected: Agency Wide
If a staff member is cleaning an area where blood or other body fluids such as vomit, urine, or feces have been spilled, disposable surgical gloves will be worn. The area will be flooded with one (1) part bleach and ten (10) parts water and allowed to evaporate and staff members will wash their hands after the occurrence.
If a staff member is feeding or dealing with a client who drools, disposable surgical gloves will be worn. A safe practice of washing hands with soap and water will be implemented after each potential contact with a communicable disease substance.
If a staff member is assisting in toileting or personal hygiene (such as assisting a client with her menstrual periods or brushing teeth) disposable surgical gloves will be worn.
If a staff member is changing diapers or soiled clothing, disposable surgical gloves will be worn.
Regular cleaning of restrooms will be conducted under staff supervision and persons directly involved in the cleaning will wear disposable gloves .
Disposal of all surgical gloves and waste products from cleaning any potential communicable disease substances will be handled only by staff members wearing protective gloves and placed in a red “Bio-Hazard” bag, marked dangerous.
If a staff member is working with a client who has a communicable disease, the employee will assist the client with training in areas dealing with blood/body fluid spills. Example: What do you do if you are cut?

120. Standard Operating Procedure. No. 1
Standard Operating Procedure No Subject: Communicable Disease Control/Bloodborne Pathogens Effective Date: Authorized by: Bill Hadar Area(s) Affected: Agency Wide
Contaminated Sharps
Contaminated sharps shall be discarded immediately or as soon as feasible in containers that are closable, puncture resistant, leak proof on sides and bottom, and appropriately labeled.
During use, the containers for contaminated sharps shall be: 1.) Easily accessible to personnel and located as close as feasible to the immediate area where sharps are used; 2.) Replaced routinely and not be allowed to overfill; 3.) kept in an upright position throughout use.
When moving containers of contaminated sharps, the containers shall be: 1.) closed immediately prior to removal or replacement to prevent spillage or protrusion of contents during handling, storage, or transport; 2.) placed in secondary container if leakage is possible. The second container shall be closed, constructed to contain all contents and prevent leakage of fluids, and be appropriately labeled.
Training:
DSI provides training regarding communicable disease control, Bloodborne Pathogens, and Universal
Precautions. This training is available to all staff and would provide them with a general understanding of
acute chronic communicable diseases, information pertinent to the type of work we are involved with, and
precautionary measures to be aware of. All staff that have direct client contact or perform custodial
duties, as part of their job responsibility must attend this training at least annually.

121. Standard Operating Procedure. No. 1
Standard Operating Procedure No Subject: Communicable Disease Control/Bloodborne Pathogens Effective Date: Authorized by: Bill Hadar Area(s) Affected: Agency Wide
Limitations: Each case of chronic communicable disease will be reviewed immediately to determine the ability of the client or staff member to prevent transmission of the disease. If, upon review, client behavior poses a threat to the health of the staff and clients in contact with the client, then they will be removed from program services. In the case where the client or staff member has an acute communicable disease that could be infectious, they will be asked to remain home until the disease is no longer contagious. Documentation of the end of the contagious state will be required.