Exposure Control Plan for Bloodborned pathogens

Universal precautions are prudent practices that apply to the prevention of infectious disease transmission. These precautions, based on recommendations from the Centers for Disease Control and Prevention, must be used routinely on all persons and contaminated items. Under normal circumstances, however, contact with sweat and tears does not require gloves or other personal protective equipment. These precautions must be used whenever differentiation of body fluids is difficult.

Handwashing. Handwashing is the single most effective means of preventing the spread of infections. Hands and other skin must be washed thoroughly and immediately with soap and water if they accidentally become contaminated with blood, body fluids, excretions, or secretions. Hands must be thoroughly and immediately washed with soap and water after removal of gloves. Further, mucous membranes must be flushed with water immediately after contamination (see OECP - 101.10 Handwashing and Handwashing Facilities).
Sharps disposal.
1. Used sharp items (needles, scalpel blades, glass pipettes, and other sharp instruments) should be considered as potentially infectious and be handled with extraordinary care to prevent accidental injuries.
2. Disposable syringes and needles, scalpel blades, glass pipettes, and other sharp items should be placed in puncture-resistant containers designated specifically for this purpose. These containers must be located as close as practical to the area where the sharps are used. Under normal circumstances, needles SHALL NOT be recapped, purposefully bent, or removed from disposable syringes, or otherwise manipulated by hand. Shearing or breaking of contaminated needles is prohibited. If recapping or removal of used needles must be done and no alternative is feasible or such action is required by a specific medical procedure, a single-handed method must be used, i.e., a resheathing device or the "scoop technique." The need to use this technique must be clearly documented (see OECP -101.20 Disposal of Sharps).
Anticipated potential exposure. All treatments and procedures must be performed in such a manner as to reduce the possibility of direct exposure to a patient's mucous membranes, broken skin (including rashes), blood or other body fluids, secretions or excretions, or potentially infectious laboratory cultures. Anticipated exposure may require gloves, as when having potential contact with blood or other body fluids, secretions or excretions, or when handling soiled items or contaminated equipment. Gloves are required and are always available to healthcare workers who perform venipunctures.
Gloves are mandatory for:
1. Direct contact with skin or mucous membranes at all times and especially when the employee has cuts, scratches, or other breaks in the skin.
2. Venipunctures.
3. Situations where the healthcare worker judges that hand contamination with blood may occur, for example, when changing dressings on a patient.
4. Finger and/or heel sticks on infants and children.
5. Persons who are receiving training in venipuncture procedures.
6. Persons handling body fluids or potentially infectious laboratory cultures.
Anticipated direct exposure. Masks, eye coverings,and gowns are required, in addition to gloves, if aerosolization or splashes are likely to occur (see OECP - 103.00 Personal Protective Equipment) when performing procedures involving more extensive and predictable contact with blood or other body fluids, secretions or excretions, as in some dental or endoscopic procedures, postmortem examinations, or in handling infectious cultures.
Ventilation devices. To minimize the need for emergency mouth-to-mouth resuscitation, mouth pieces, resuscitation bags or other ventilation devices should be strategically located and available for use in areas where the need for resuscitation is predictable.
Blood spills. If a spill of blood occurs, spray the spill with full-strength chlorine bleach (5.25% sodium hypochlorite) or any disinfectant certified to be effective for use against bloodborne pathogens (Appendix 1). Wearing gloves, wipe up the spill with paper towels. Spray the area again with disinfectant and then wipe again. Discard paper towels and gloves in plastic bag and tie securely prior to disposal.
Work restrictions. Routine work restrictions for personnel who are pregnant or who have chronic illness are not necessary for purposes of infection control.
Open wounds. No healthcare worker who has exudative lesions or weeping dermatitis should perform or assist in invasive procedures or other direct patient-care activities or handle equipment used in patient care.
Pipetting. Mouth pipetting or suctioning of blood or other potentially infectious materials is prohibited.
Specimen handling. Specimens of blood, laboratory cultures, or other potentially infectious materials, shall be placed in a container which prevents leakage during collection, handling, processing, storage, transport, or shipping.
1. The container for storage or transport shall be labeled or color-coded according to OECP-108.00 "Communication of Hazards to Employees" and closed prior to being stored or transported. When Universal Precautions are utilized in the handling of all specimens, the labeling/color-coding of specimens is not necessary provided containers are recognizable as containing specimens. This exemption only applies while such specimens/containers remain within the facility. Labeling or color-coding in accordance with OECP - 108.00 "Communication of Hazards to Employees"is required when such specimens/containers leave the facility. Shipping of biohazardous specimens must be in accordance with 42-CFR, part 72, "Interstate Shipment of Etiologic Agents",a copy of which can be obtained from the CEHS.
2. If outside contamination of the primary container occurs, the primary container shall be placed within a second container which prevents leakage during handling, processing, storage, transport,or shipping and is labeled or color-coded according to the requirements of OECP - 108.00 "Communication of Hazards to Employees."
3. If the specimen could puncture the primary container, the primary container shall be placed within a secondary container which is puncture-resistant in addition to the above characteristics.
Equipment decontamination. Equipment which may become contaminated with blood or other potentially infectious materials shall be examined prior to servicing or shipping and shall be decontaminated as necessary, unless the Department or Administrative Unit can demonstrate to the CEHS that decontamination of such equipment or portions of such equipment is not feasible.
1. A readily observable label in accordance with OECP - 108.00"Communication of Hazards to Employees" shall be attached to the equipment stating which portions remain contaminated.
2. The Department or Administrative Unit releasing such equipment shall ensure that this information is conveyed to all affected employees, the servicing representative, and/or the manufacturer,as appropriate, prior to handling, servicing, or shipping so that appropriate precautions will be taken.