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HAZMAT Bloodborne Pathogens

POLICY STATEMENT: This document is to establish a written policy to comply with the Occupational Safety and Health Administration (OSHA) to eliminate potential health hazards associated with infectious materials.

POLICY SCOPE: New Hampshire Community Technical Colleges & Institute, and the Christa McAuliffe Planetarium.

NOTE: Any employee found to have violated this policy and/or procedures may be subject to disciplinary action, up to and including dismissal as provided by the administrative rules of the New Hampshire Department of Personnel.

 __________________					_______________________
EFFECTIVE DATE						COMMISSIONER

PURPOSE: To minimize all exposures to bloodborne pathogens and to protect employees from the health risks associated with bloodborne pathogens.

PROGRAM RESPONSIBILITIES:

Management: Human Resource Department has the responsibility of monitoring an Exposure Control Plan which includes: Exposure Determination and Methods of Compliance.

Employees are responsible for:

1. Knowing what tasks they perform that have occupational exposure.
   
2. Attending bloodborne pathogens training sessions.
   
3. Conducting all work operations in accordance with established work practice controls.
   
4. Developing good personal hygiene habits.

Exposure control plan documented in the Human Resources Department.
Methods of compliance throughout the system.
Implementation of engineering controls or administrative controls.
Communication of the hazards associated with infectious waste through annual employee training program.
Procedures for the disposal of infectious waste.

I. EXPOSURE DETERMINATION: In accordance with the OSHA Standard 29 CFR 1910.1030, Bloodborne Pathogens, those employees with occupational exposure to bloodborne pathogens shall be required to participate in the NHCTC System's Exposure Control Plan.

Covered employees shall be defined as: "Employees who have a reasonably anticipated skin, eye, mucous membrane or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties."

1. The following educational departments and operational units shall be designated as "covered" pursuant to the above definition.

   EDUCATIONAL DEPARTMENTS:
   - Dental - Diagnostic Medicine
   - Fire Technology - Life Sciences
   - Medical Assistant - Medical Laboratory Technician
   - Nursing - Paramedic
   - Phlebotomists - Respiratory Therapy
   - Radiological Technician - Surgical Technician
   - Veterinarian Technician

   OPERATIONAL UNITS:
   - Maintenance - Residential Life - Security

2. The following positions (job classifications), within the above stated departments, shall be designated as "covered" in accordance with the Bloodborne Pathogens Standard.

   - Building Service Worker, I, II, or III - Building Service Supervisor
   - Carpenter II - Chief Security Officer
   - Custodial Watchman - Dental Assistant
   - Director of Residential Life (Supervisor I) - Dormitory Supervisor
   - Groundsman - Nurse Practitioner
   - Plant Maintenance Engineer I, II, or III - Residence Director
   - Security Officer - TI/C Assistant Professor
   - TI/C Associate Professor - TI/C Professor
   - Wellness Center Director (Supervisor I)

1. UNIVERSAL PRECAUTIONS is an approach to infection control by routine and consistent use of appropriate barrier protection to prevent skin and mucous membrane transmission of micro organisms resulting from contact with blood or body fluids. Universal Precautions shall be observed to prevent contact with potentially infectious materials. Under circumstances in which differentiation between body fluid types is difficult or impossible, all body fluids shall be considered potentially infectious materials.

   Handwashing and Barrier Protection: Hands shall be washed for 10 seconds using warm water, soap and friction, giving particular attention to areas around and under fingernails and between fingers. Hands must be washed

   1. following contamination with blood and body fluids.
      
   2. immediately or as soon as feasible after removal of gloves or other personal protective equipment.

2. ENGINEERING AND WORK PRACTICE CONTROLS shall be used to eliminate or minimize employee exposure. Where occupational exposure remains after institution of these controls, Personnel Protective Equipment (PPE) shall also be used.

   Engineering controls shall be examined and maintained or replaced on a regular schedule to ensure their effectiveness.

   Employees shall wash hands and any other skin areas with soap and water, or flush mucous membranes with water immediately or as soon as feasible following contact of such body areas with blood or other potentially infectious materials.

   1. Personal Protective Equipment (PPE) are, but not limited to, gloves, gowns, face shields, or masks and eye protection.
      1. All PPEs are inspected periodically and repaired or replaced as needed to maintain its effectiveness.
      2. Reusable PPEs are cleaned and decontaminated.
      3. Disposal gloves shall be discarded properly after the incident.

   2. Housekeeping: All spills shall be immediately contained and cleaned up by appropriate personnel who are properly trained and equipped to work with potentially infectious materials. "Spill Kits" are provided and they should be used at all times.

      Housekeeping Procedures: All personnel shall wear the proper Personal Protective Equipment (PPE) which includes, gloves and safety glasses when cleaning public areas on campus which include but are not limited to, restrooms, cafeteria, class rooms, dormitories and offices. All spills of infectious waste will be cleaned using the designated Spill Kits and used according to instructions.

      General purpose utility gloves should be used for all housekeeping chores especially when cleaning areas with potential exposures to blood and body fluids. Utility gloves may be decontaminated and reused but should be discarded when they show evidence of deterioration (peeling, cracks, discoloration, punctures or tears).

   3. Communication of hazard to employee:
      1. Label and signs shall be affixed to containers or regulated waste, refrigerators and freezers containing blood or other potentially infectious material.
      2. Labels required shall be fluorescent orange or orange-red or predominantly so with lettering or symbols in a contracting color.
      3. Red bags, or red containers may be substituted for labels.
      4. Labels required shall have standard BIOHAZARD sign.

   4. Hepatitis B Vaccination: Vaccines shall be made available after the employee has received the training required. All vaccinations are performed under the supervision of a licensed medical professional. Documentation of those receiving the vaccination is required. Those employees declining to take part in the program will also be documented. A signed "Vaccination Declination form" will be kept for those employees declining the vaccination. (see attached)

   5. Post-exposure evaluation: Following a report of an exposure incident, the exposed employee will receive a confidential medical evaluation which will include:
      1. Documentation of the routes of exposures and the circumstances under which the exposure incident occurred.
      2. The exposed individual will be tested if he/she consents.
      3. Identification and documentation of the source individual.
      4. The source individual's blood shall be tested as soon as feasible and after consent is obtained in order to determine HBV and HIV infectivity.

   6. Employee Training: All employees with occupational exposure will participate in a mandatory annual training program which will be provided during their regular work schedule.

   7. Program Evaluation: The Exposure Control Plan will be reviewed and updated at least annually and whenever necessary, to reflect new or modified tasks and procedures which effect occupational exposure and to reflect new or revised employee positions with occupational exposure.

   III. PROCEDURES FOR DISPOSAL OF INFECTIOUS WASTE:
   1. All infectious waste must be stored in proper containers that are puncture resistant and sealed according to regulations.
   2. All infectious waste must be stored in a locked designated storage area.
   3. Only authorized trained personnel shall transport infectious waste to the designated infectious waste storage area.
   4. All waste is disposed of by a certified hazardous disposal company on a regular schedule outlined by the college. This company also keeps track of all required recordkeeping.

   NEW HAMPSHIRE DEPARTMENT OF REGIONAL COMMUNITY TECHNICAL COLLEGES

   BLOODBORNE PATHOGEN STANDARD

   VACCINATION DECLINATION FORM

   EMPLOYEE NAME:_____________________________________DATE:___________
   			(please print) 

   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 this vaccine 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 the Hepatitis B vaccine, I can receive the vaccination series at not charge to me.

   EMPLOYEE SIGNATURE________________________________DATE___________
   
   
   MANAGEMENT SIGNATURE______________________________DATE___________ 
   
   
   
   

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