Appendix B: Bloodborne Pathogens

RECOMMENDATION FOR PREVENTION OF HIV TRANSMISSION; HEPATITS B; AND OTHER BLOOD BORNE PATHOGENS

All Health Sciences students will utilize the following polices regarding exposure to blood borne pathogens in conjunction with the policies of the individual clinical agencies regarding blood borne pathogens.

Universal standard precautions shall be observed to prevent contact with blood or other potentially infectious materials (including the following body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva, and any body fluid that is visibly contaminated with blood, and in all situations where it is difficult or impossible to differentiate between body fluids; and any unfixed tissue or organ from a human (living or dead) by all students’ in both laboratory and clinical settings. Consider all (patient’s) blood and body fluids to be contaminated.
Use extreme caution when handling needles, scalpels, and other sharp instruments (sharps) during procedures and when handling them after procedures are completed. Dispose of sharps in an approved puncture-proof container that is located as close as practical to the work area. Recapping, bending, breaking and shearing of needles/sharps is strictly prohibited in clinical settings and college laboratory.
Broken glassware which may be contaminated shall not be picked up by hand. It shall be cleaned up using mechanical means, i.e. dustpan and brush or tongs.
Always wash hands before and after (patient) contact and if contaminated with blood or body fluids. Wash hand after glove removal. Gloves do not replace handwashing techniques.
Students must utilize all personal protective equipment such as, but not limited to, gloves, gowns, laboratory coats, face shields or masks and eye protection, and mouthpieces, resuscitation bags, pocket masks and other ventilation devices. All protective equipment shall be removed prior to leaving the work area, and placed in the appropriately designed area or container for storage, washing, decontamination or disposal.
Wear gloves when handling or touching blood, body fluids, body tissue, mucous membranes, non-intact skin, or contaminated equipment and supplies. Wear glove when performing venipuncture and other blood access treatments or procedures. Change gloves after each patient contact.
All procedures involving blood and other potentially infectious materials shall be performed in such a manger as to minimize splashing, spattering, and generation of droplets of these substances.
Mouth pipetting/suctioning of blood or other potentially infections materials is prohibited.
Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is reasonable likelihood of exposure to infectious material.
Individuals with open lesions (injury or wound) or dermatitis (skin rash) should keep the area covered to avoid direct contact with patients, supplies and equipment until healed.
Clean blood and body fluid spills with agency disinfectant or a 10% solution of sodium hypochlorite (household bleach).

Exposure Procedure: POTENTIAL Exposure to Blood-Borne Pathogens

Adhere to universal precautions.
Report needle sticks, splashes, and contamination by wounds or body fluids to instructors and other appropriate personnel at the clinical facility site.
Document what the incident was, how it occurred, and the resident source involved.
Area should be cleaned well with soap and water. Mucous membranes should be flushed with water for a minimum of 15 minutes. Immediate evaluation must be performed by a qualified healthcare professional.
The resident source should be tested for Hepatitis B Surface Antigen (HBsAG) and Human Immunodeficiency Virus Antibody (HIV) only after providing counseling regarding this testing and obtaining consent for such testing.
The student should be counseled regarding his/her risk of Hepatitis B and HIV and offered testing for HIV. The student shall not be tested until he/she has been counseled and has given consent for HIV testing. The recommended testing schedule for HIV testing of a student post blood exposure is as follows:
1. Time of the incident;
2. Six weeks post incident;
3. Twelve weeks post incident;
4. Six months’ post incident.
  1. **Recognize that all costs for the testing will be the student’s responsibility.
If the If the source resident (patient) is positive for HBsAG, the student should be treated in the following manner:
1. If the student has received the Hepatitis B vaccine series, he/she should be tested for Hepatitis B Surface Antibody (HBsAG). If adequate levels are in the blood, no further treatment is needed. If inadequate levels are in the blood, the student should receive another dose of the vaccine and one dose of HBIG.
2. If the student has not received the Hepatitis B vaccine, the series should be started at this time and one dose of HBIG given also.
  1. **Note: HBIG should be given within seven days to be effective.
If the source resident (patient) is negative for HBsAG, and the worker has not been vaccinated, use this opportunity to start the vaccine series.
If the source resident refuses or is unable to give consent to be tested, the patient should be evaluated via medical history for risk factors to Hepatitis B. Based upon this history HBIG may be recommended. If the student has not received the Hepatitis B vaccine series, it should be started.
If the resident source is found to be HIV negative, no further follow up of the student is recommended.
If the resident source is found to be HIV positive, is unable to give consent, or refuses to be tested, the student should be encouraged to be tested for HIV on the previously stated schedule, and should be instructed to report any febrile illness occurring within the first twelve weeks of the incident. Symptoms of febrile illness include: fever; rash; enlarged lymph glands.
If the source of the splash or puncture wound is unknown, each case should be evaluated on an individual basis. The student should be offered HIV testing on the previously described schedule.
Careful attention should be given to record keeping regarding the incident and any testing to provide and protect the confidentiality of both the resident and student member.
Cost incurred for testing and/or immunization are the responsibility of the student.

Reference: osha.gov website

Hepatitis B Vaccination Policy

In accordance with clinical facility policies and Occupational Safety and Health Administration (OSHA) regulations (Federal Register, Vol. 56, NO. 235) the following policy is set forth for all nursing, medical laboratory and emergency medical service students:

All students in MACC’s above listed health occupation programs are technically considered to be included in “high risk” categories of occupational exposure to blood borne pathogens by OSHA. OSHA defines “high risk” as having a minimum of one exposure to blood/blood pathogens per month and strongly recommends that all healthcare workers in high risk categories be vaccinated against Hepatitis B. Although OSHA regulations address healthcare employers and workers, they do not include students in any part of the directive.