Universal precautions are observed at this facility to prevent contact with blood or other potentially infectious materials. All human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, HCV, and other bloodborne pathogens. The body fluids considered to be potentially infectious for bloodborne pathogens are semen, vaginal secretions, amniotic fluid, saliva in dental procedures, and fluid around the brain, spinal cord, joints, lungs, heart, and abdomen.

Feces, nasal secretions, saliva, sweat, tears, urine, or vomitus are not considered a risk for transmitting bloodborne disease unless visibly contaminated with blood. Even though these bodily substances are not considered to be infectious for bloodborne pathogens (unless visibly contaminated with blood), they can transmit many other infectious diseases. CAUTIOUS handling (even the use of Universal Precautious) is advised with these substances.

Engineering controls serve to reduce exposure in the work place by either removing the hazard or isolating the worker from it. Engineering controls include inspections and removal, if necessary, of bloodborne pathogens. Generally, though, control is achieved through the use of equipment designed for a particular purpose. Examples of an engineering control include red biohazard bags, a sharps-disposable container, decontaminating sprays or cleaning liquids, biosafety boxes, and labels.

Work practice controls reduce the likelihood of exposure through changes in the way a task is performed. Tasks are performed in the safest manner possible (e.g. washing hands, use of protective gloves, etc.).

Hand Washing- All employees who have the potential of coming into contact with infectious materials shall wear protective gloves. It is advisable to wash hands prior to donning gloves, but is required subsequent to removing gloves. If anybodies area (s) contact blood or other potentially infectious materials, employees must wash hands and any other skin thoroughly with soap and water 15-20 minutes, or flush (e.g.) eyes with water for 15 minutes, immediately or as soon as feasible.

Where hand-washing facilities are not available, employees must sanitize their hands with running water and soap.

Personal Habits and Eating- OSHA prohibits eating drinking, applying cosmetics or lip balm, and handling contact lens in work areas where there is reasonable likelihood of occupational exposure. Likewise the OSHA standard on bloodborne pathogens also prohibits storage of food and drink in refrigerators, freezers, shelves, cabinets, or other countertops or benchtops where blood or other potentially infectious materials are present. 

Waste Disposal and Containment - Receptacles used for regulated waste must not leak and must be maintained in a clean and sanitary condition. Specified receptacles in Beu Health Center will utilize red disposable liners. When moving containers of contaminated objects, they must be closed to prevent spillage or protrusion of contents. If leakage is possible, the initial container must be placed in a second container that has the same characteristics as the first. Non-reusable containers must not be opened, emptied, or cleaned manually or in any other manner that will expose employees to the risk of contact. (Note: it is important that only approved containers are used.)

Laundry Procedures - Universal precautions will be observed in the handling of soiled laundry. Gloves shall be worn as all soiled laundry will be handled as potentially infectious. Laundry contaminated with blood or other potentially infectious material will be handled as little as possible. Such laundry will be placed in red bags. Contaminated laundry will not be shaken and will be folded in a manner that has the contamination to the inside of the folded area. Then place in laundry bags.

Personal Protective Equipment - When there is a chance for occupational exposure to bloodborne pathogens personal protective equipment (PPE) will be provided at no cost to the employee. This includes gloves, face shields or masks, gowns, eye protection and /or other appropriate equipment. Eye glasses are not considered personal protective equipment or a replacement for eye goggles. Bloodborne Pathogen kits consisting of personal equipment and disinfectants are located at key stations.

The employment policy of WIU is that employees shall wear appropriate personal protective equipment at all times when there is potential exposure. Deviation from this policy will result in investigation and documentation of the action. Personal Protective Equipment can only be worn at the work site. They are not to be worn out of t he designated work site. Building Services’ employees shall wear waterproof gloves (and eye protection, if desired) whenever they clean toilets, bathrooms, and other related facilities. Employees who have occasion to handle discarded needles, syringes, and other potentially contaminated sharps should wear puncture resistant gloves and pay attention to their hands.

Building Services employees shall wear gloves when they handle or expect to handle discarded condoms, sanitary napkins, and other similar items. Employees shall wear gloves when cleaning up messes where blood or other potentially infectious material is present and when handling soiled laundry. (Gloves shall always be checked for leaks, tears, and punctures before use.) Disposable gloves should be replaced if torn or punctured. Visibly contaminated it should be disposed as biohazardous waste. All garments penetrated by blood shall be removed immediately or as soon as feasible. When PPE’s are removed, they shall be placed in an appropriately designated area or container for storage, washing, or disposal. Cuts or non-intact skin on hands, if blood/fluids penetrate gloves, this becomes a potential exposure.

Cleaning and Disinfection - 

All equipment and surfaces that could be contaminated must be properly cleaned and decontaminated after coming in contact with blood or potentially infectious materials. Initial clean-up of blood or other potentially infectious materials shall be done with the use of an approved hospital disinfectant chemical germicide that is tuberculocidal or a fresh 1 to 10 solution of bleach and water. Disinfection time should be according to times listed on the EPA approved disinfectant times vary from product to product. For routine cleaning employees will utilize products registered by the EPA as being effective against HIV with an accepted HIV (Aids virus) label. 

“Exposure Determination” is made without regard to the use of personal protective equipment. It is primarily Building Service workers who  have the potential of occupational exposure to blood and other potentially infectious body fluids.

Specifically, they are called upon to perform tasks (e.g., cleaning equipment or surfaces which may be contaminated, removal of waste, cleaning body fluid messes, and clean up of broken glassware which may be contaminated) that may result in occupational exposure.

Specifically, these:

Building Service Worker (BSW) - Location & Classification

• BSW - Beu Health Services (including floater & student worker)
• BSW - Western Hall & Recreation Center
• BSW - Brophy Hall
• BSW - Waggoner Hall (including floaters)
• BSW - Resident Halls
• BSW - University Union
• BSW - Classrooms
• BSW - Supervisor & Foreman

Mechanical Maintenance

• Plumber
• Pipefitter

The following descriptions are geared toward the general duties associated with custodial services.

1. The following safe work practices apply to the general duties associated with custodial services: Gloves shall be worn by employees whenever they anticipate touching blood, bodily fluids, and mucous membranes while they conduct their operations. Gloves shall also be worn by employees whenever they anticipate touching wastes marked with a “Biohazard” symbol, or wastes from medical, dental, or biotechnology facilities.
2. Gloves shall be born when handling items or surfaces obviously contaminated with blood or bodily fluids. Gloves should not be worn when moving from area to area. Gloves should be removed or changed when moving to a new area.
3. Hands and other skin surfaces should be washed immediately and thoroughly with water and soap if contaminated with blood or other bodily fluids.
4. Hands should be washed immediately after gloves are removed.
5. Employees should cleanse hands with soap and water immediately after working on or with potentially infectious equipment.
6. Employees should wear eye protection whenever they are cleaning toilets, sinks, or other facilities; eye protection should also be worn when handling waste containers with the “Biohazard” symbol.
7. Employees must take precautions to prevent injuries caused by needles, syringes, broken glassware and other sharp objects. Broken glassware should not be picked up directly with the hands. It should be cleaned up using a mechanical means such as a brush and dust pan, tongs, or forceps.
8. Clothing which becomes contaminated with blood or other bodily fluids during custodial activities should be removed immediately (or as soon as possible) and separated from other clothing until properly laundered.  The employee should have a set of spare clothing available when clothing becomes contaminated.
9. Areas and equipment that become contaminated with blood or other bodily fluids should be cleaned immediately with a fresh 1 to 10 solution of bleach to water or an appropriate EPA registered disinfectant.
10. Pregnant employees should review safe work procedures with Beu Health Center personnel.
11. Any tool or equipment that comes into contact with potentially infectious materials should be disinfected according to times listed for the EPA approved disinfectant.
12. Gloves shall be worn by employees whenever they are handling soiled laundry. Contaminated laundry shall be placed and transported in red bags or containers properly labeled properly.

The employer shall make available the Hepatitis-B vaccine and vaccination series to all employees who have the potential to occupational exposure to BBP, and post-exposure evaluation and follow-up to all employees who have had an exposure incident.

The employer shall ensure that all medical evaluation and procedures, including the Hepatitis-B vaccine and vaccination series and post-exposure evaluation and follow-up, including protective treatment are done in such fashion that the following occur:

1. No cost to the employee
2. Available to the employee at a reasonable time and place
3. Performed by or under the supervision of a licensed physician or under the supervision of another licensed health care professional.
4. Provided according to the recommendations of the United States Public Health Services that are current at the time of vaccination or exposure incident.
5. If laboratory tests are necessary, they must be conducted by an accredited laboratory at no cost to employee.
6. Hepatitis-B vaccination shall be available after the employee has received the training required as part of this standard.
7. The employer shall make this vaccination available within ten working days of initial assignment to all employees who have occupational exposure unless the employee has previously received the complete Hepatitis-B vaccination series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicated for medical reasons. The employee is responsible for providing previous immunity records.
8. Pre-screening for Hepatitis-B immunity is not a prerequisite for receiving Hepatitis-B vaccine.
9. The employee may initially decline the Hepatitis-B vaccination, but at a later date (if still covered under this bloodborne pathogen standard) decides to accept the vaccination, it will be made available at that time, at no cost to the employee.
10. An employee who declines to accept the Hepatitis-B vaccination offered by the employer must sign a declination statement. This declination form is included under the record keeping portion of this exposure control plan.
11. If a routine booster dose(s) of the Hepatitis-B vaccine is recommended by the U.S. Public Health Service at a future date, such booster dose(s) shall be made available according to the provisions of this Bloodborne Pathogens Exposure Control Plan.
12. The employer will provide a copy of t he “OSHA Standard” to any professional evaluating an employee or administering vaccine.

Communication of Hazards

Communication of the hazards associated with blood, blood products, or other potentially infectious materials is extremely important. WIU provides such hazard information to employees through the use of labels and signs. Information and training programs are also provided which review the hazards associated with bloodborne pathogens.

Label

1. The required label is the biohazard symbol and the legend “Biohazard” which is fluorescent orange or orange-red with lettering or symbols in a contrasting color.
2. Labels will be affixed or attached as closely as possible to the container, so that there is no possibility of loss. Alternatively, labels can be imprinted on the container or bag.
3. Red bags or red containers may be substituted for labels.
4. Regulated waste that has been contaminated need not be labeled or placed in red bags. For example, sterilized waste would not be labeled.
5. Biohazard labels are to be placed on containers of regulated waste (e.g. sharps containers), refrigerators, and freezers. Laundry contaminated with blood or other potentially infectious materials must also be labeled or color coded.
6. Individual containers placed in a labeled container during storage, transport, shipment, or disposal, are exempted from the label requirements.

The Facilities Management Department of the Physical Plant in conjunction with Beu Health Center provides all potentially exposed Physical Plant employees with appropriate training, in accordance with the Federal regulation and the University’s concerns for employee health and safety. Training is conducted using video tape and written material accompanied with an oral presentation. Training of employees is provided:

1. At the time of initial assignment to duties that may result in occupational exposure;
2. At least annually or when there are changes in procedures or in job assignments;
3. In a manner and language that can be understood by all employees;
4. In an interactive style that encourages questions and answers.;
5. By a person knowledgeable in the subject matter specified by the Standard;
6. During working hours; and
7. In addition, the training will include an explanation of the following
   1. The OSHA standard on Bloodborne Pathogens
   2. Epidemiology and symptomatology of bloodborne diseases
   3. Modes of transmission of Bloodborne Pathogen
   4. This Exposure control plan (i.e. points of the plan, lines of responsibility, how the plan will be implemented, etc.)
   5. Procedures that might cause exposure to blood or other potentially infectious materials at this facility
   6. Control methods which will be used at the facility to control exposure to blood or other potentially infectious materials
   7. Personal protective equipment available at this facility
   8. Poster Exposure evaluation
   9. Signs and labels used at the facility
   10. Hepatitis B vaccine program at the facility

Training Records

Training records for Physical Plant personnel are  maintained for at least three years from the date on which the training occurred. Training records include the following items:

1. The dates of the training session;
2. A summary of the training session;
3. The names and qualifications of all persons conducting the training; and
4. The names and job titles of all persons attending the training session.

Epidemiology, Modes of Transmission and Symptoms

Hepatitis B

Epidemiology – numerous studies document that workers occupationally exposed to blood have a prevalence of serum HBV markers, which indicates previous infection, several times that of the general population of workers exposed to blood. Prevalence of serum HBV markers is related to the number of exposures to blood and/or needles but not patient contact per se. High risk-groups for hepatitis B include, among others, operating room staff, phlebotomist,  surgeons, dental professionals, and blood bank technicians.

Modes of transmission – blood and body fluids contaminated with blood contain the highest quantities of virus and are the most likely vectors of HBV transmission. Certain other body fluids such as saliva and semen contain infectious virus but one-thousandth of the concentration found in blood. Other body fluids such as urine or feces contain only small quantities of virus unless they are visibly contaminated with blood. Lesions on the hands from injuries incurred at the work place or at home or from dermatitis may provide a route of entry for the virus. In addition, transfer of contaminated blood via inanimate objects or or environmental surfaces has been shown to cause infection in health care workers.

Symptoms- about one third of infected individuals have no symptoms when infected with the virus, one third have a relatively mild clinical course of flu-like illness that is usually not diagnosed as hepatitis, and the remaining third have a much more severe clinical course of jaundice, dark urine, extreme fatigue, anorexia, nausea, abdominal pain, and sometimes joint pain, rash, and fever. Of the estimated 18,000 infections in health care workers each year in the United States, there are about 500 to 600 hospitalizations and over 200 deaths. Approximately 1,000 of these health care workers will annually become carriers of HBV, at risk of chronic liver disease, cirrhosis, and liver cancer.

Human Immunodeficiency Virus (HIV)

Epidemiology - while at the present there have been more than 1.1 million people in the United States are living with HIV infection, and almost 1 in 5 (18.1%) are unaware of their infection.

Modes of Transmission - HIV is spread primarily by not using a condom when having sex with a person with a person who has HIV contains some risk. However unprotected anal sex is riskier than unprotected vaginal sex. Among men who have sex with other men, unprotected receptive anal sex is riskier than unprotected insertive anal sex. Having multiple sex partners or the presence of other sexually transmitted diseases (STDs) can increase the risk  of infection during sex. Unprotective oral sex can also be a risk for HIV transmission, but is is a much lower risk than anal or vaginal sex. Sharing needles, syringes, rinse water, or other equipment used to prepare illicit drugs for injection. Being born to an infected mother to child during pregnancy, birth, or breast feeding.  The actual amount of virus may be very important in the likelihood of transmission since it appears that there is great probability of infection from HIV-contaminated blood transfusions than from accidental needle sticks with needles which have been contaminated with HIV.

Symptoms – within a month after exposure, an individual may experience an acute retroviral syndrome (ARS), the first clinical evidence of HIV infection.  This is a flu-like illness with signs and symptoms that can include fever, if it occurs at all is often accompanied by other usually mild symptoms, such as fatigue, swollen lymph glands, and a sore throat. Fatigue the inflammatory response generated by your immune system also can cause you to feel tired and lethargic. Achy muscles, joint pain, swollen lymph nodes ARS is often mistaken for the flu, mononucleosis, or another viral infection, even syphilis or hepatitis. Sore throat and headache, skin rash like boils, with some itchy pink areas on arms. Weight loss once called AIDS wasting weight loss is a sign of more advanced illness and could be due in part to severe diarrhea. Dry cough that can go on for weeks that doesn’t resolve is typical in very ill HIV patients. Pneumonia, night sweats during early stages of HIV infection. Nail stages such a clubbing thickening and curving of the nails. Yeast infections another fungal infection that’s common in later stages is thrush a mouth infection caused by Candida, a type of yeast. Confusion or difficulty concentrating could be a sign of HIV-related dementia, which usually occurs late in the course of the disease. Cold sores or genital herpes can be a sign of both ARS and late stage HIV infection. Tingling and weakness late HIV can also cause numbness and tingling in the hands and feet. This is called peripheral neuropathy, which also occurs in people with uncontrolled diabetes. Menstrual irregularities is a symptom of advanced HIV disease appears such as fewer and lighter periods.

Actions to Take and Persons to Contact in an Emergency

In case of an emergency that may pose the potential for exposure to blood or other potentially infectious materials, be certain to use appropriate personal protective equipment. For example, if a blood spill occurs, don the protective gloves before proceeding with the cleanup. Continue to wear protective equipment when decontaminating the area with bleach. If you are unsure of the appropriate action to take in an emergency, contact your immediate supervisor.

Handwashing Procedure

1. Wet hands.
2. Apply soap thoroughly; get under nails and between fingers.
3. If necessary, use a brush to remove any substance offering particular resistance.
4. With rotating, frictional motion, rub the hands together for 15-20 seconds.
5. Wash a least 2 to 3 inches above the wrist.
6. To wash fingers and the spaces between them, interlace the fingers and rub up and down.
7. If using bar soap, hold bar in hands while washing hands.
8. While rinsing and after rinsing, hold hands up and above level  of elbows so water runs down your wrists instead of over clean hands.
9. Rinse well.
10. If your hands have been in contact with blood, repeat entire procedures
11. Dry hands.
12. Use paper towel to turn off faucets so hands remain clean.

Recommended First Aid for Accidental Exposure to Human Biohazards

Needle Stick or Cut with Biohazard Material

Immediately rinse the injury area in flowing tap water for several minutes to permit a controlled loss of blood that contain infectious material. Swing the hand injured with a needle stick or moderate cut gently in the sink to promote some additional blood flow being careful not to splatter others. Rinse frequently with tap water.

Blot the area gently, cover the wound and secure medical assistance immediately. Immediately report the accident to your supervisor or to someone in the chain of operations in your workplace. Recover and save any offending clinical specimens that are involved, in the refrigerator for possible future testing. Report immediately as some prophylactic treatment should be started within hours (a few short hours) of exposure.

Eye, Mouth, Mucous Membrane Exposure

Splashing of human biohazardous materials to the face, eyes, nose and mouth or to non-intact skin warrants immediate, gentle flushing of the eye, nose, mouth or skin lesion with copious amounts of room temperature tap water where possible. Use eyewash if one is available. The goal is to promote rapid dilution of the material without irritating the mucous membranes or underlying tissues. The nose, mouth or abraded skin, BUT NOT THE EYE, can then be rinsed with diluted soap as a gentle wash solution where feasible and tolerated. Then the area should be rinsed. Immediately report t he incident to the supervisor, secure any offending samples for future testing and report to the physician for medical attention. 

Definitions

Blood - human blood, human blood components, and products made from human blood.

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).

Contaminated - the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface.

Decontamination - the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.

Engineering Controls - controls that isolate or remove the bloodborne pathogens hazard from the workplace. Self-sheathing needles, puncture-resistant disposal containers for contaminated sharp instruments, absorbant powders, and ventilation devices are examples of engineering controls.

Exposure Incident -  a specific eye, mouth, other mucous membrane, non-intact skin, or parental contact with blood or other potentially infectious materials that results from the performance of an employee’s duties.

Occupational Exposure - 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.

Other Potentially Infectious Materials means:

1. The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, pleural fluid, pericardial fluid, amniotic fluid, salvia 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 intact skin) from a human (living or dead) and
3. HIV-containing cell or tissue 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.

Parenteral – piercing mucous membranes or the skin barrier through such events as needlesticks, human bites, cuts, and abrasions.

Personal Protective Equipment – specialized clothing or equipment worn by an employees for protection against a hazard.  Gloves, masks, eye protection, face shields, and gowns are examples of personal protective equipment.

Regulated Waste – liquid or semi-liquid blood or other potentially infectious materials, contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials.

Universal Precautions - an approach to infection control whereby all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, HCV and / or other bloodborne pathogens. Where differentiation of types of body fluids is difficult or impossible, all body fluids are to be considered as potentially infectious. 

Work Practice Controls - alter the manner in which a task is performed. Examples of work practice controls:

1. Frequent hand washing
2. Procedures for handling “sharps”
3. Regulated waste disposal procedures
4. Prohibiting eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses in areas where there is reasonable likelihood of occupational exposure.