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U.S. Geological Survey Manual

SM 445-2-H CHAPTER 25

Occupational Industrial Hygiene – Human Bloodborne Pathogens Protection Program

Instruction: This handbook chapter is replaced in order to update Section 2 - References, Section 3 - Scope, and Section 4 - Requirements.

1. Purpose. To specify the minimum Occupational Safety and Health Program (Program) requirements to protect U.S. Geological Survey (USGS) personnel engaged in activities that expose them to human blood or other potentially infectious materials or where exposure is reasonably anticipated. This chapter does not apply to exposures to animal blood unless exposure is to blood or tissues of experimental animals that are infected with human immunodeficiency virus (HIV) or hepatitis B virus (HBV).

2.  References.

A. 5 CFR 339, Medical Determinations Related to Employability.

B. 5 CFR 630.403, Subpart D, Sick Leave, Supporting Evidence.

C. 29 CFR 1910.1020, Access to Employee Exposure and Medical Records.
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10027&p_text_version=FALSE

D. DOI Occupational Medicine Handbook.
http://www.doi.gov/safetynet/information/general/medical/DOI%20Handbook%202009Final.pdf

E. 29 CFR 1910.1030, Occupational Exposure to Bloodborne Pathogens.
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051&p_text_version=FALSE

F. Centers for Disease Control and Prevention. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis. MMWR 2001;50(No. RR-11)
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm

G. U.S. Geological Survey Manual SM 445-2-H, Chapter 35 Public Safety and Health. http://www.usgs.gov/usgs-manual/handbook/hb/445-2-h/ch35.html

3. Scope.

A. This program shall apply to all USGS employees, volunteers, and cooperators who may come into contact with human blood or other potentially infectious materials (OPIM) during the conduct of their duties. This includes employees who are required to be trained in first aid as part of their duties.

B. While HBV and HIV are specifically identified in the Bloodborne Pathogen (BBP) standard (29 CFR 1910.1030), the term includes any pathogenic microorganism that is present in human blood or OPIM and can infect and cause disease in persons who are exposed to blood containing the pathogen. Pathogenic microorganisms can also cause diseases such as hepatitis C, malaria, syphilis, babesiosis, brucellosis, leptospirosis, arboviral infections, relapsing fever, adult T-cell leukemia/lymphoma (caused by HTLV-I), HTLV-I associated myelopathy, diseases associated with HTLV-II, viral hemorrhagic fever, and West Nile Virus. Although not a microorganism, Creutzfeldt-Jakob disease can be transmitted through blood.

NOTE: According to the Centers for Disease Control and Prevention (CDC), hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States. (Morbidity and Mortality Weekly Report: Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease, October 16, 1998/Vol.47/No. RR-19.)

HCV is a viral infection of the liver that is transmitted primarily by exposure to blood. Currently there is no vaccine effective against HCV.

C. Examples of possible exposures due to USGS occupations include, but are not limited to, the following employees and situations: :

(1) First Aid Responders.

(a) Employees who require training in first aid because they work in areas that are more than a few minutes travel from a hospital, clinic, or ambulance service.

(b) Employees who are part of a facility Automatic External Defibrillator (AED) team.

(2) Researchers.

(a) Researchers working with human blood.

(b) Researchers working with animals. (These researchers may use a modified bloodborne pathogen program as a method to control and minimize exposure. Training should be modified to include the appropriate risks.)

(3) Accidental Exposures.

a) Employees who are cut, stuck, or otherwise exposed by coming into contact with used syringes from illicit drug use, various types of sharp objects, or trash that may be contaminated with human blood.

(b) Employees who are exposed when providing assistance as a “Good Samaritan” act.

4.  Requirements.

A.  Each facility that has personnel with potential occupational exposure to bloodborne pathogens shall have a written exposure control plan. A template exposure control plan is found in Appendix 25-4, Sample Exposure Control Plan for USGS Employees with Limited Potential for Exposure to BBP. An Exposure Control Plan for Members of USGS Automatic External Defibrillator (AED) Teams is found in Appendix 25-5. This plan may be used by any USGS AED team that provides AED services under the oversight of a medical director. A more general template for an Exposure Control Plan was developed by the Occupational Safety and Health Administration (OSHA). The exposure control plan shall be reviewed and updated at least annually and whenever necessary to reflect new or modified tasks and procedures that affect occupational exposure and to reflect new or revised employee positions with possible occupational exposure. The review and update of such plans shall also:

(1) Reflect changes in technology that eliminate or reduce exposure to bloodborne pathogens, and

(2) Document annually consideration and implementation of appropriate commercially available and effective safer medical devices designed to eliminate or minimize occupational exposure.

B. Universal precautions outlined in 29 CFR 1910.1030(d) shall be implemented to prevent contact with human blood or OPIM.

C. Biohazard warning labels shall be placed on containers of regulated waste, refrigerators and freezers containing human blood, OPIM, and containers used for storage, transport, or shipment of human blood or OPIM.

D. Personnel training shall be in accordance with 29 CFR 1910.1030(g) (2) and include site-specific information. Qualified instructors include the American Red Cross. Retraining is required at least annually and when changes such as modification of tasks or procedures or institution of new tasks or procedures affect the employee's occupational exposure.

E. Training and medical records shall be maintained as described in 29 CFR 1910.1030(h).

F. Medical Program/Vaccination.

(1) The hepatitis B vaccination series shall be made available using organizational funds to personnel determined to have occupation exposure in accordance with 1910.1030(f) (2). The vaccine will be made available after the training required in 29 CFR 1910.1030 has been accomplished, and within 10 days of initial assignment of the employee to duties with occupational exposure. USGS realizes that some personnel, even after training, may decline to receive the hepatitis B vaccine. In such case, the declining employee is to sign the declination statement that is in Appendix A of 29 CFR 1910.1030. The employee can receive the vaccine after signing the declination statement if a change of mind occurs and if duties still involve those with occupational exposure.

(2) USGS offers post-exposure evaluation and follow-up after an exposure incident to any employee who suffers an exposure incident while performing duties on the job. All medical evaluations and procedures are to be made available at no cost to USGS personnel, at a reasonable time and place, and under the other conditions set forth in 29 CFR 1910.1030(f).

In the event of an exposure incident (as defined in 29 CFR 1910.1030), the employee is to immediately wash any skin with soap and water and flush mucous membranes with water when such areas have had contact with human blood or other potentially infectious materials. The employee should then seek medical attention. It must be realized that any exposure incident is an event for which immediate attention must be sought, as the effectiveness of prophylaxis depends on the immediacy of its delivery. In addition, the employee who has had an exposure incident is to report such incident to his or her supervisor as soon as possible. The supervisor will inform the local Collateral Duty Safety Program Coordinator (CDSPC) who will contact the facility where the exposure incident occurred. The CDSPC will work together with the supervisor to ascertain the source individual's identity, arrange for testing of the source individual, and communicate with the physician evaluating the USGS employee. Assistance may be obtained from the Bureau safety staff. Additionally the exposure incident shall be documented using the format in Appendix 25-2, Exposure Incident Record for Bloodborne Pathogens Exposure. Healthcare providers evaluating the exposure incident shall be given the form in Appendix 25-3, Health Care Provider Report of Post-Exposure Evaluation to fill out.

G. Special Issues.

(1) First Aid Responders.

(a) Employees whose primary job is unrelated to rendering of first aid or medical assistance but who may perform these functions as a collateral duty in an emergency are considered to have occupational exposure and are covered by all provisions of the standard.

(b)  A facility may choose to defer vaccinating designated first aid responders until after their involvement in a first aid incident. If this policy is chosen, the following conditions (i-v) will be met:

(i)  Reporting procedures shall be instituted to ensure that all first aid incidents involving the presence of human blood or OPIM are reported before the end of the work shift during which the first aid incident occurred. This report will include the names of all first aid responders who rendered assistance, regardless of whether personal protective equipment was used and must describe the first aid incident, and the time and date of the incident. The description must include a determination of whether or not, in addition to the presence of blood or other potentially infectious materials, an "exposure incident," as defined by the standard, occurred. This determination is necessary in order to ensure that the proper post-exposure evaluation, prophylaxis, and follow-up procedures required by paragraph 29 CFR 1910.1030(f)(3) are made available immediately, whenever there has been an "exposure incident" as defined by the standard. (See H of this section.)(Appendix 25-2, Exposure Incident Record for Bloodborne Pathogens Exposure).

(ii)  The training program will include the specifics of this reporting procedure for first aid responders.

(iii)  A report will be maintained that lists all such first aid incidents. This report will be readily available, upon request, to all employees and to OSHA Compliance Officers. Records in the Safety Management Information System (SMIS) meet this requirement.

(iv)  The full hepatitis B vaccination series will be made available within 24 hours, to all unvaccinated first aid responders who have rendered assistance in any situation involving the presence of human blood or OPIM regardless of whether or not a specific exposure incident occurred.

(v)  In addition to the requirements of 29 CFR 1910.1030(d)(3), personal protective equipment for emergency medical providers shall include:

o disposable non-latex (e.g. vinyl or nitrile) gloves in a variety of sizes,

o face shields or masks and eye protection,

o gowns if there is the potential for splashes of body fluids, and

o resuscitation equipment such as pocket mouth-to-mouth resuscitation masks.

H. Post-exposure Evaluation and Follow-up.

Following a report of an exposure incident, the supervisor shall make immediately available to the exposed employee a confidential medical evaluation and follow-up, including at least the following elements:

(1) Document the route of exposure and the circumstances under which the exposure incident occurred

(2) Identify and document of the source individual, unless the supervisor can establish that identification is infeasible or prohibited by state or local law

(3) When the source individual is already known to be infected with HBV or HIV, testing for the source individual's known HBV or HIV status need not be repeated.

(4) Results of the source individual's testing will be made available to the exposed employee, and the employee shall be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual.

(5) The exposed employee's blood will be collected as soon as feasible and tested after consent is obtained.

(6) If the employee consents to baseline blood collection, but does not give consent at that time for HIV serologic testing, the sample will be preserved for at least 90 days. If, within 90 days of the exposure incident, the employee elects to have the baseline sample tested, such testing will be done as soon as feasible.

(7) The employee will be provided with post-exposure prophylaxis, when medically indicated, as recommended by the U.S. Public Health Service; counseling; and will have reported illnesses evaluated.

5.  Responsibilities.

A.  Bureau Safety Manager/Industrial Hygienist.

(1)  Provides Bureau-wide oversight and direction for the BBP program.

(2)  Conducts reviews and evaluates the effectiveness of USGS, Regional Headquarters and BBP programs, as feasible and modifies policy and procedures as applicable.

(3)  Provides assistance to Regional Safety Managers in development of BBP programs.

B. Regional Safety Manager.

(1) Provides region-wide direction and oversight for the administration of an appropriate BPP, serving as the focal point for program development and implementation and provides technical advice to Regional Safety Officers and Collateral Duty Safety Program Coordinators (CDSPCs).

(2)  Evaluates effectiveness of Regional Headquarters and science program BBP programs and makes recommendations for improvement as part of the overall safety evaluation program.

C. Regional Safety Officers.

(1)  Oversee the administration of an appropriate BBP programs for regional science program field locations.

(2)  Serve as the focal point for the implementation of the regional science BBP programs and provide technical advice to field level CDSPC’s and management.

(3)  Provide assistance to regional science program field location organizational managers and CDSPC’s in development of BBP programs.

(4)  Evaluate effectiveness of regional science program field-level BBP programs and make recommendations for improvement as part of the overall safety evaluation program.

D. Collateral Duty Safety Program Coordinators.

(1) Assist organizational management and supervisors in implementation of the BBP program and training and education component.

(2)  Assist supervisors in identifying personnel with potential for occupational exposure to BBP and help conduct or coordinate appropriate training programs.

(3)  Assist in local development of standard operating procedures (SOP’s) and in maintaining required BBP program documentation.

E. Organizational Managers and Supervisors.

(1)  Coordinate personnel training and education on the BBP program by qualified instructors.

(2)  Upon request, arrange for access to personnel medical records for employees' own records and to others with written consent of the employee in accordance with 29 CFR1910.1020.

(3) Determine which personnel have occupational exposure to bloodborne pathogens and ensure that these employees receive required annual training and that training is properly documented. USGS personnel who are responsible for rendering first aid or medical assistance will be considered to have possible occupational exposure to bloodborne pathogens and will be covered under 29 CFR 1910.1030 and this chapter.

(4) Provide access for employees to vaccination and medical evaluation as required and maintain records as part of the employees’ permanent records.

(5) Develop SOPs for operations where potential BBP incidents could occur covering appropriate decontamination and disposal procedures, personal protective equipment, engineering controls, and appropriate work practices.

(6)  Establish and maintain an effective organizational BBP program.

(7) Review and update the exposure control plan at least annually and whenever necessary to reflect new or modified tasks and procedures that affect occupational exposure and to reflect new or revised employee positions with occupational exposure.

F. Employees.

(1)  Participate in all required training programs.

(2)  Read and be familiar with the facility’s Exposure Control Plan and SOP’s related to BBP.

(3)  Wear appropriate personal protective equipment and observe appropriate work practice controls, including universal precautions.

(4)  Sign a consent or declination form for the hepatitis B vaccine (see Appendix 25-1, Hepatitis B Vaccination Information and Consent/Declination Form).

(5)  Report all first aid incidents involving the presence of blood or OPIM to the Supervisor or Manager before the end of the work shift during which the incident occurred.

6.  Additional Resources.

A.  OSHA Safety and Health Topics, http://www.osha.gov/SLTC/bloodbornepathogens/index.html

B.  USGS Bloodborne Pathogen On-Line Training Program via DOI LEARN, https://doilearn.doi.gov/

C.  CalOSHA Exposure Control Plan for Bloodborne Pathogens, http://www.dir.ca.gov/dosh/dosh_publications/expplan2.pdf

D.  Hepatitis Network, http://www.hepnet.com/

7. Definitions.

A. AED - Automatic External Defibulater

B. BBP - Bloodborne Pathogens - pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV).

C. CDC - Centers for Disease Control and Prevention.

D. CDSPC - Collateral Duty Safety Program Coordinator.

E. CFR – Code of Federal Regulations.

F. HBV - hepatitis B virus.

G. HCV - hepatitis C virus.

H. HIV - human immunodeficiency virus.

I. OPIM - Other Potentially Infectious Materials.

J. OSHA - Occupational Safety and Health Administration.

K. OPIM - Other Potentially Infectious Materials - (1) The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; (2) Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and (3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.

L. SMIS - Safety Management Information System

M. Universal Precautions - an approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.

N. USGS - United States Geological Survey

Approved:
_________________________________
Karen Baker for Carol F. Aten
Associate Director for Administrative Policy and Services
Designated Agency Safety and Health Official


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