RESPONSIBILITY

     It is the responsibility to become familiar with the procedures as outlined in this exposure control plan. Disregard for this policy will result in disciplinary action as outlined in the members SOG book.

A.     Policy:  It is the policy of HNFD that, whenever possible, personnel will carry out operations according to SOG in order to work as safely and efficiently as possible.

B.     Procedure:  In accordance with the OSHA Bloodborne Pathogens standard, 29 CFR 1910.1030, the following exposure control plan has been developed:

C.    Definitions

1.      BLOOD – means human blood, human blood components, and products made from human blood.

2.      BLOODBORNE PATHOGEN – means pathologic microorganisms that are present in human blood and can cause disease in humans.

3.      CONTAMINATED – the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface.

4.      CONTAMINATED SHARPS – any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, capillary tubes, and blood tubes.

5.      DECONTAMINATION – means the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface of item rendered safe for handling, use, or disposal.

6.      OCCUPATIONAL EXPOSURE – means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of a member’s duties.

7.      OTHER POTENTIALLY INFECTIOUS MATERIALS (OPIM) – means the following body fluids: semen, vaginal fluid, synovial fluid, peritoneal fluid, amniotic fluid, saliva, fluid visibly contaminated with blood, and all body fluids in situations where it is impossible to differentiate between body fluids. Any unfixed tissue or organ (other than intact skin) from a human (living or dead).

8.      PARENTERAL – means piercing mucous membranes or the skin barrier through such events as needle sticks, human bites, cuts, and abrasions.

9.      BODY SUBSTANCE ISOLATION – is 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.

10. PERSONAL PROTECTIVE EQUIPMENT – is specialized equipment or clothing worn by a member for protection against a hazard. (for example, eye wear with side shields, surgical or exam gloves, gown or apron) Protective equipment shall only be considered appropriate if it does not prevent blood or OPIM to pass through to or reach the members’ work clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of the time that the protective equipment will be used.

D.    Exposure Determination:  HNFD has determined the following job classifications are likely to have potential exposure to bloodborne pathogens:

1.      Vehicle Operator

2.      First Responder

3.      Emergency Medical Technician – Basic

4.      Emergency Medical Technician – Intermediate

5.      Emergency Medical Technician – Critical Care

6.      Emergency Medical Technician – Paramedic

7.      Fire Fighter – if duties are other than administrative only

The above personnel can expect occupational exposure in the course of providing EMS services.  Risk is particularly present when performing the following skills:  Bleeding control, dressing wounds, intravenous access, intubation, intra-muscular injection, subcutaneous injection, suctioning, cricothyrotomy, chest decompression, intraosseous access, delivery of the newborn, multi-trauma patients, and cleaning/disinfecting ambulances and equipment.

E.     Should a member have parenteral or mucous membrane exposure to human blood or OPIM they shall immediately or as soon as feasible notify the Infection Control Officer. The member shall then be instructed to seek, if necessary, medical attention. The member shall complete an incident report which includes the following:

1.      Description of the incident, time, date, what precautions were taken, Maine State EMS run form number or source of exposure.

2.      The incident report will be submitted to the Infection Control Officer as soon as possible.

F.     Methods of Compliance

1.      In general, BSI will be observed to prevent contact with blood or OPIM. All blood or OPIM will be considered infectious regardless of the perceived status of the source individual.

2.      GLOVES

a.      All HNFD members shall wear disposable, single use gloves that are provided in each ambulance. These gloves shall be worn where it can be reasonably expected that the member may have hand contact with blood, OPIM, mucous membranes, and non-intact skin.

b.      Contaminated gloves shall be discarded in an appropriate container as soon as possible after each patient contact. Gloves shall also be discarded before leaving the patient area and entering the cab. Single use gloves are not to be washed or decontaminated for reuse. However, utility gloves such as those worn for cleaning the ambulance can be reused unless torn, punctured or peeling.

c.      Gloves shall be provided by HNFD and shall be kept in its vehicles and jump kits.

3.      EYE / FACE PROTECTION

a.      In those situations where it can be reasonably anticipated that splashes, spray, spatter or droplets of blood or other potentially infectious materials may be generated, the member shall wear masks in combination with eye protection with solid side shields, or chin length face shields.

b.      Masks and eye protection shall be provided by HNFD and shall be kept in the patient compartment of the ambulance and in the jump kits.

c.      Keep in mind that uncooperative patients may increase the risk of exposure to blood or OPIM.

4.      PROTECTIVE BODY CLOTHING

a.      Protective body clothing (such as aprons, lab coats, clinical jackets, gown) shall be worn when an occupational exposure exists that could potentially soak through a member’s clothing. Should a member’s clothes become soaked with blood or OPIM the member will change into clean clothes as soon as feasible. Contaminated clothing shall not be taken home. Contaminated laundry shall be placed in a red biohazard bag and laundered at the station.

b.      All protective equipment shall be decontaminated before reuse or disposed of if applicable.  Impermeable gowns shall be provided by HNFD and shall be kept in the patient compartment of the ambulance.

5.      ASSISTING RESPIRATION

a.      Members shall utilize a pocket mask or bag-valve-mask when assisting respirations on a patient. Both of these devices shall be provided by HNFD and shall be kept in the patient compartment and the jump kits.

6.      SHARPS

a.      There is a sharps container on the shelf of the patient compartment of the ambulance that is readily accessible to the patient treatment area. In addition, there will be portable, single-use sharps containers in the jump kit and with the I.V. supplies. Sharps containers will be inspected weekly and replaced when 3/4 full. Once full, sharps containers will be sealed and taken to either local hospital ED.

b.      Contaminated needles and other sharps shall not be bent, recapped, removed, sheared, or purposely broken. If it is absolutely necessary to recap a needle, the one-handed method must be used, then pushed against a solid object to lock. All members shall observe universal precautions when disposing of contaminated sharps. Sharps containers will not be hand held when sharps are being deposited. Single use sharps containers are deposited into the large sharps container on the ambulance.

7.      AMBULANCE / RESCUE VEHICLES

a.      Contaminated surfaces shall be decontaminated after contact with blood or OPIM immediately or as soon as feasible utilizing the cleaning solution provided in the ambulance / rescue vehicle.

b.      In addition, vehicles will be thoroughly cleaned, including the patient compartment, cab, outside compartments, and inside compartments, and stretcher.  Trash receptacles will be lined only with red biohazard bags.

c.      Eating/drinking shall be permitted in the cab of the ambulance only.  Eating/drinking shall not be permitted in the patient compartment area. Smoking is prohibited anywhere in the ambulance/rescue vehicle. Lip balm, contacts, and cosmetics shall not be applied in the patient compartment area. Antiseptic hand cleaner will be provided on the ambulance so personnel may immediately cleanse their hands after removing gloves, before leaving the patient compartment area.

8.      HANDWASHING

a.      Handwashing is still the best method of preventing the spread of germs. All personnel shall wash their hands immediately after removing gloves, either with soap and water or with the antiseptic hand cleaner provided in the vehicle or jump kit. If personnel use the antiseptic hand cleaner, they should still wash with soap and water as soon as reasonably feasible. Use a dry paper towel to turn off the faucet(s).

9.      EQUIPMENT

a.      Equipment that has become soiled from use or exposure to OPIM will be cleaned and decontaminated before being used again. Personnel will use disinfectant provided to clean equipment. Personnel will wear gloves (as well as gowns, masks and goggles if appropriate) when cleaning equipment. Equipment will be cleaned in the designated area only, away from food preparation or personal hygiene area.

10. HEPATITIS B VACCINE

a.      HNFD will offer the hepatitis B vaccine to all personnel identified in section B (SOG II.12) free of charge before being placed on active status. Personnel declining must sign a waiver indicating such. Personnel who refuse may still receive the vaccination at a later date if they change their mind. The Infection Control Officer has the responsibility for offering the vaccine to all personnel. The vaccine will be administered by Parkview Hospital ED.

11. POST EXPOSURE EVALUATION AND FOLLOW-UP

a.      When the member experiences an exposure incident, it should be reported to the Infection Control Officer.

b.      All personnel who incur an exposure incident will be offered post-exposure evaluation and follow-up in accordance with the OSHA standard. This follow-up will include the following:

c.      Documentation of the route of exposure and the circumstances related to the incident.

d.      If possible, the identification of the individual and the status of the source individual. The blood of the source individual will be tested (after consent is obtained) for HIV/HBV.

e.      Results of testing of the source individual will be made available to the exposed member with the exposed member informed about the applicable laws and regulations concerning disclosure of the identity and infectivity of the individual.

f.        The exposed person shall be offered the option of having their blood collected for testing of their HIV/HBV serological status. The blood sample will be preserved for up to ninety days to allow the member to decide if the blood should be tested for HIV.

g.      The member will be offered post exposure prophylaxis in accordance with the current recommendations of the U.S. Public health Service and overseen by (the service Medical Director).

h.      The member will be given appropriate counseling concerning precautions to take during the period after the exposure incident, including what potential illnesses to watch for.

i.        The following person has been designated to assure that the policy outlined here is effectively carried out as well as maintain all records related to this policy:  Infection Control Officer.

j.         The Health Care Professional designated by this service to evaluate HNFD personnel will notify HNFD only about:

1)     Date of hepatitis B vaccination

2)     That the member has been informed of the results of any evaluation

3)     That the member has been informed about any medical condition resulting from exposure to blood or OPIM.

12. TRAINING

a.      Training for all members will be conducted prior to initial assignment where exposure may occur according to the requirements as outlined in the OSHA standard.