300-55
OCCUPATIONAL EXPOSURE TO BLOODBORNE PATHOGENS

Department: HUMAN RESOURCES & RISK MANAGEMENT

Effective Date:    2/1/95

Supersedes:    10/18/93

Staff Contact:    B. Nelson Glode

Approved by:    Earl Clymer

1.0 PURPOSE:

To establish a plan to control exposure to diseases caused by bloodborne pathogens, medical evaluation and reporting procedures if exposure occurs, and related record keeping procedures.

2.0 ORGANIZATIONS AFFECTED:

All departments/divisions.

3.0 REFERENCES:

OSHA Bloodborne Pathogens Standard (Title 29 Code of Federal Regulations, Part 1910.1030) and WAC 296-62.

4.0 POLICY:

It is the policy of the City of Renton to provide a safe and healthful working environment and to eliminate as far as possible employee exposure to accidents and disease, including controlling occupational exposure to diseases caused by bloodborne pathogens. The Exposure Control Plan for diseases caused by bloodborne pathogens created by this Policy and Procedure will be available and in an easily accessible place at each work site.

The City of Renton and City employees assume that all human blood and specified human body fluids are infectious for HIV, HBV, and other bloodborne pathogens. Where differentiation of types of body fluids is difficult or impossible, all body fluids are to be considered as potentially infectious.

5.0 DEFINITIONS:

5.1    Blood

Human blood, human blood components and products made from human blood.

5.2    Bloodborne Pathogens

Pathogenic microorganisms that are present in human blood and can cause disease in humans. These include, but are not limited to, Hepatitis B virus (HBV) and Human Immunodeficiency virus (HIV).

5.3    Contaminated

The presence or the reasonably anticipated presence of blood or other potentially infections materials on an item or surface.

5.4    Contaminated Sharps

Any contaminated object that can penetrate the skin, including, but not limited to, needles, scalpels, broken glass, broken capillary tubes and exposed ends of dental wires.

5.5    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.

5.6    Departmental Exposure Control Officer

The employee selected to act as the person responsible for procedures and activities related to implementation of the Exposure Control Plan for a specific department. The Departmental Control Officer works in conjunction with the City Exposure Control Officer.

5.7    Exposure Control Officer

The Human Resources and Risk Management Administrator acts as the City Exposure Control Officer and has overall responsibility for implementing the City's Exposure Control Plan and coordinating with department heads, departmental exposure control officers and other personnel.

5.8    Parenteral

Piercing mucous membranes or the skin barrier through such events as needlesticks, human bites, cuts and scrapes.

5.9    Exposure Incident (Reportable Exposure)

A specific eye, mouth, or mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee's duties.

5.10    Other Potentially Infectious Materials

1)    Human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva, and body fluid 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 than intact skin) from a human living or dead: (3) HIV-containing cell or tissue cultures, organ cultures, and HIV or HBV-containing cell or tissue or organ cultures. Sewage is not at this time considered potentially infectious for bloodborne pathogens.

5.11    Personal Protective Equipment

Specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes not intended to function as protection are not considered to be personal protective equipment.

5.12    Source Individual

Any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee.

6.0 PROCEDURE:

EXPOSURE CONTROL PLAN:

6.1    Exposure Determination

The exposure determination for City of Renton employees shall include the following: (a) a list of job classifications in which all employees in those job classifications have occupational exposure; (b) a list of job classifications in which some employees have occupational exposure; and (c) a list of all tasks and procedures or groups of closely related tasks and procedures in which occupational exposure occurs, performed by employees. (Refer to the attached Exposure Determination lists attached to this Policy and Procedure.)

6.2    Methods of Control

6.2.1    Engineering Controls

Engineering controls are designed to eliminate or minimize employee exposure by removing or isolating the hazard or isolating the worker from exposure. Examples of engineering controls are puncture-resistant disposal containers for contaminated sharp instruments, resuscitation bags, and ventilation devices. The City of Renton shall be responsible for providing, maintaining and replacing such controls on a regular basis.

6.2.2    Work Practice Controls

Work practice controls alter the manner in which a task is performed. In work areas where a reasonable likelihood of occupational exposure exists, work practice controls include:

6.2.2.1    Prohibiting eating, drinking, applying cosmetics or lip balm and handling contact lenses in work areas where there is a reasonable likelihood of occupational exposure.

6.2.2.2    Requiring hand washing immediately or as soon as possible after skin contact with blood or other potentially infectious material or when gloves are removed. When provision of hand washing facilities is not feasible, appropriate antiseptic hand cleanser and clean cloth or paper towels or antiseptic towelettes shall be provided. When antiseptic hand cleansers or towelettes are used, hands shall be washed with soap and running water as soon as feasible.

6.2.2.3    Requiring hand washing and any other skin 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.

6.2.2.4    Prohibiting employees from recapping, removing or bending used needles unless it can be demonstrated that there is no feasible alternative to shearing or breaking contaminated needles. Such bending, recapping or needle removal must be accomplished through the use of a mechanical device or a one-handed technique.

6.2.2.5    Providing approved storage containers for contaminated reusable sharps. Such containers shall be puncture resistant, labeled or color-coded as provided for in the standards, leak proof on the sides and bottom.

6.2.2.6    Requiring that all procedures involving blood or other potentially infectious materials be performed in such a manner as to minimize splashing, spraying, spattering, and generation of droplets of these substances.

6.2.2.7    Prohibiting mouth pipetting/suctioning of blood or other potentially infectious materials.

6.2.2.8    Requiring that specimens of blood or other potentially infectious materials be placed in a container which prevents leakage during collection, handling, processing, storage, transport, or shipping.

6.2.2.9    Requiring that equipment which may become contaminated with blood or other potentially infectious materials be examined prior to servicing or shipping and that the equipment be decontaminated as necessary, unless it can be demonstrated that decontamination of such equipment or portions of such equipment is not feasible.

6.2.3    Personal Protective Equipment

6.2.3.1    Personal protective equipment may include gloves, gowns, face shields or masks and eye protection, mouth pieces, resuscitation bags, pocket masks or other ventilation devices. Personal protective equipment will be made available, without cost to the employee, by the City as needed. The City shall determine the type of that protective equipment required and assure it is accessible, properly used, cleaned, laundered, repaired or replaced, as needed.

6.2.3.2    Hypoallergenic gloves, glove liners, powderless gloves, or other similar alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided.

6.2.3.3    Disposable (single use) gloves shall be replaced as soon as practical when contaminated or as soon as feasible if they are torn, punctured, or when their ability to function as a barrier is compromised. Disposable gloves shall not be washed or decontaminated for re-use. Utility gloves may be decontaminated for re-use if the integrity of the glove is not compromised. They will be considered compromised and appropriately discarded when they are cracked, peeling, torn, punctured, or exhibit other signs of deterioration or when their ability to function as a barrier is compromised.

6.2.3.4    Masks in combination with eye protection devices such as goggles or glasses with solid side shields, or chin-length face shields shall be worn whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated.

6.2.3.5    Gowns, aprons, lab coats, clinic jackets or similar outer garments shall be worn in occupational exposure situations. The type and characteristics will depend upon the task and degree of exposure anticipated.

6.2.3.6    Personal protective equipment will be considered appropriate only if it does not permit blood or other potentially infectious materials to pass through to or reach the employee's work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used.

6.2.3.7    An employee may temporarily and briefly decline wearing personal protective equipment when, in the employee's professional judgment, it prevents the delivery of health care or public safety services or poses an increased hazard to workers. These circumstances would be expected to be life threatening. In general, appropriate personal protective equipment should be used whenever occupational exposure may occur

6.2.3.8    All personal protective equipment shall be removed prior to leaving the work area. When personal protective equipment is removed it shall be placed in an appropriately designated area or container for storage, washing, decontamination or disposal.

6.3    Housekeeping

6.3.1    Each work location will be kept clean and sanitary. The Facilities Division will develop a written cleaning and decontamination schedule. The schedule will be based upon location, type of surface to be cleaned, type of soil present, and tasks or procedures being performed in the area.

6.3.2    The Facilities Division will provide three disposable clean-up kits at each City building for use if there is a spill of potentially infections material. Each kit has instructions for use and all necessary equipment for cleaning and decontamination if it is not possible to reach or wait for the arrival of Facilities personnel..

6.3.3    When possible, Facilities personnel should be called for clean-up and decontamination anytime the presence of blood or other potentially infectious materials on any item or surface exist. To contact Facilities personnel call the Facilities Shop between 6:00 a.m. and 4:00 p.m. at 235-2616 or the Parks Administration Office between 8:00 a.m. and 5:00 p.m. After hours and on weekends contact the Police Department at 235-2600 and they will contact Facilities personnel.

6.3.4    All equipment and environmental and working surfaces shall be cleaned and decontaminated after contact with blood or other potentially infectious materials.

6.3.5    Broken glassware which may be contaminated shall not be picked up directly with the hands. It shall be cleaned up using mechanical means, such as a brush and dust pan, tongs, or forceps.

6.3.6    Reusable sharps which may be contaminated with blood or other potentially infectious materials shall not be stored or processed in a manner that requires employees to reach by hand into the containers where these sharps have been placed.

6.4    Regulated Waste

6.4.1    Contaminated sharps shall be discarded immediately or as soon as feasible in containers that are closable, puncture resistant, leak proof on sides and bottom and labeled or color-coded.

6.4.2    During use, containers for contaminated sharps shall be easily accessible to personnel and located as close as possible to the area where sharps are used or can be anticipated to be found. Containers shall be maintained upright throughout use and replaced before they become overfilled. Filled containers being moved shall be closed prior to removal or replacement to prevent spillage or protrusion of contents during handling, and placed in a secondary container if leakage is possible. The second container shall be closable, constructed to contain the contents and prevent leakage during handling, storage, transport, or shipping.

6.4.3    Reusable containers shall not be opened, emptied, or cleaned manually or in any other manner which would expose employees to the risk of punctures, cuts or scrapes.

6.4.4    Other regulated waste shall be placed in containers which are closable, constructed to contain all contents and prevent leakage of fluids during handling, labeled or color-coded in accordance with labeling provisions, and closed prior to removal to prevent spillage or protrusion of contents during handling. If outside contamination of the regulated waste container occurs, it shall be placed in a second container with the same precautions taken as for the original container.

6.5    Laundry

Contaminated laundry shall be handled as little as possible with a minimum of agitation, and shall be bagged at the locations where it was used and shipped to appropriate laundry facilities. It shall not be sorted or rinsed in the location of use. Contaminated laundry shall be placed and transported in bags or containers labeled or color-coded as explained in section 6.11 of this Policy and Procedure. Wet laundry which may soak through or leak from the bag or container shall be placed and transported in bags or containers that prevent leakage. Contaminated laundry shipped off-site to another facility which does not utilize Universal Precautions in the handling of laundry shall be labeled or color-coded as provided for in section Employees who have contact with contaminated laundry shall wear protective gloves and other appropriate personal protective equipment.

6.6    Hepatitis B Vaccinations

6.6.1    Within ten (10) days of initial assignment, Hepatitis B vaccine and vaccination series or booster dose shall be provided free of charge to employees who have occupational exposure to blood or other potentially infectious materials. Prior to vaccination, employees with occupational exposure shall receive training as outlined in section 6.12 of this Policy and Procedure.

6.6.2    The vaccinations will be provided free of charge to employees and will be given at a reasonable time and place. Vaccinations will be performed by or under the supervision of a licensed health care professional and all laboratory tests will be conducted by an accredited laboratory at no cost to employees. Vaccination may not be required if the employee has previously received the complete hepatitis B vaccination series, or antibody testing reveals that the employee is immune, or medical reasons prevent taking the vaccinations.

6.6.3    Employees eligible for Hepatitis B vaccination may decline vaccination by signing a Declination Form (refer to the Declination Form attached). The employee may request and obtain the vaccination at a later date, and at no cost, if he/she continues to be exposed.

6.7    Exposure Reporting Procedures

6.7.1    Employees involved in a reportable exposure (specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee's duties) will receive or personally conduct appropriate first-aid procedures immediately or as soon as possible after the incident. Appropriate procedures include:

Eyes:    If the eyes are splattered with blood or body fluids, flush immediately with water for at least five minutes, preferably with clean running water.

Mouth:    If blood or other potentially infectious material enters the mouth, rinse mouth with water or saline, if available.

Skin:    If blood or other potentially infectious materials touch the skin, wash well with soap and warm water. Note whether the skin is intact or cut or scraped.

Needlesticks, punctures, or cuts with blood contaminated sharp objects: Induce the wound to bleed by means other than mouth contact, wash the wound thoroughly with soap and water, and cover the wound with a sterile dressing.

Bite or scratch wound that may have had blood or potentially infectious body fluid exposure: Wash the area thoroughly with soap and water and cover the wound with a sterile dressing.

6.7.2    As soon as possible after the exposure incident, the employee should report the incident to the immediate supervisor, who will contact the departmental Exposure Control Officer, other designated department official, or the Human Resources and Risk Management Department if a departmental Exposure Control Officer has not been designated.

6.7.3    The person to whom the exposure incident is reported will initiate an Exposure Incident Report. The Exposure Incident report is included in the Bloodborne Pathogens Medical Evaluation Kit. The employee will document the routes of exposure and the circumstances under which the exposure occurred, including the type of personal protective equipment in use at the time.

6.7.4    The departmental Exposure Control Officer or other designated official, shall then make appropriate post-exposure evaluation and follow up available to the exposed employee through the Valley Medical Center Occupational Health Services or Valley Medical Center Emergency Room. If the employee chooses post-exposure evaluation and follow-up, a Bloodborne Pathogens Medical Evaluation Kit containing a copy of the Exposure Incident Report should be taken by the employee to the medical service provider.

6.7.5    If the employee's injuries resulting from the exposure incident are too serious to be treated by first aid only, the employee should seek appropriate medical attention. If necessary, post-exposure evaluation and follow-up will be postponed until the patient has received treatment.

6.8    Post Exposure Evaluation and Follow-up

6.8.1    Following a report of an exposure incident, the City shall make immediately available to the employee a confidential medical evaluation and follow-up which includes the following elements:

6.8.1.1    Documentation of the route of exposure and the circumstances under which the exposure incident occurred;

6.8.1.2    Identification and documentation of the source individual unless the City can establish that identification is not feasible or prohibited by law;

6.8.2    The source individual's blood shall be tested as soon as possible after consent is obtained. If consent cannot be obtained, the City will provide documentation to establish this circumstance. If consent is not legally required, the source individual's blood, if available, shall be tested and the results documented. If the source individual is already known to be infected with HBV or HIV, tests do not need to be made.

6.8.3    Results of the source individual's test shall be made available to the exposed employee, and the employee shall be informed of applicable laws and regulations concerning disclosure of identity and medical status.

6.8.4    After consent to baseline blood collection, the exposed employee's blood shall be collected as soon as possible and tested. If the employee does not consent to HIV serologic testing at that time, the sample shall be preserved for at least 90 days. Should the employee elect HIV serologic testing during that period, the testing will be done as soon as possible.

6.8.5    When indicated, as recommended by the U.S. Public Health Service, the exposed employee shall receive counseling and/or evaluation of reported illnesses.

6.9    Information Provided to the Healthcare Professional

6.9.1    The City shall provide to the healthcare professional responsible for the employee's Hepatitis B vaccination a copy of the following:

6.9.1.1    Chapter 296-62 WAC,

6.9.1.2    A description of the exposed employee's duties as they relate to the exposure incident.

6.9.1.3    Documentation of the route of exposure and circumstances under which exposure occurred.

6.9.1.4    Results of the source individual's blood testing, if available, and all medical records relevant to treatment of the employee including vaccination status.

6.10    Information Provided by the Healthcare Professional

6.10.1    The City shall obtain and provide the employee with a copy of the healthcare professional's written opinion within 15 days of the completion of the evaluation by the healthcare professional.

6.10.2    The healthcare professional's opinion on Hepatitis B vaccination shall be limited to whether HBV vaccination is indicated for the employee and if the employee has received such vaccination.

6.10.3    The healthcare professional's written opinion for post-exposure evaluation and follow-up shall be limited to the following information:

6.10.3.1    That the employee has been informed of the results of the evaluation;

6.10.3.1    That the employee has been told about any medical conditions resulting from exposure to blood or other potentially infectious materials which require further evaluation or treatment.

6.10.4    All other findings or diagnoses shall remain confidential and shall not be included in the written report.

6.11    Communication of Hazards

6.11.1    Warning labels shall be affixed to containers of regulated waste and other containers used to store, transport or ship blood or other potentially infectious materials

6.11.2    Labels shall be fluorescent orange or orange-red and attached as closely as possible to the container by a method that prevents their loss or unintentional removal.

6.11.3    Red bags or red containers may be substituted for labels.

6.11.4    Individual containers of blood or other potentially infectious materials that are placed in a labeled container during storage, transport shipment or disposal are exempted and need not be separately labeled.

6.11.5    Required labels shall include the following symbol.

6.11.6    Regulated waste that has been decontaminated need not be labeled or color-coded.

6.12    Information and Training

6.12.1    A training program shall be provided by the City for all employees whose duties may lead to an occupational exposure. The details of the training program are in a separate protocol available in the Human Resources and Risk Management Department.

6.12.2    The person conducting the training shall be knowledgeable in the subject matter covered by these elements as it relates to the workplace that the training will address. Departments who have established departmentally specific exposure control plans will conduct the training for department employees. The Human Resources and Risk Management Department will conduct training for employees with occupational exposure not covered by a departmentally specific exposure control plan.

6.13    Recordkeeping

6.13.1    Medical Records

6.13.1.1    The City shall ensure that employee medical records are kept confidential and not disclosed or reported without the employee's express written consent to any person within or outside the workplace except as may be required by law.

6.13.1.2    The City shall maintain the medical records required by WAC 296-62 for the duration of employment plus 30 years.

6.13.2    Training Records

Training records shall be maintained in the Human Resources and Risk Management Department:

6.14    Transfer of Records

The City shall comply with the requirements involving transfer of records set forth in WAC 296-62-052.

6.15    General Administration

6.15.1    Exposure Control Officer

The Human Resources and Risk Management Administrator shall be the Exposure Control Officer for the City of Renton. The duties of the Exposure Control Officer shall include:

6.15.1.1    Overall responsibility for implementing the Exposure Control Plan for the City of Renton

6.15.1.2    Supervision of the provision of the required training at time of appointment and annually thereafter.

6.15.1.3    Supervision of the maintenance of records as required by WAC 296-62.

6.15.1.4    Working with elected officials, department heads, and/or other personnel to develop and administer any additional bloodborne pathogens related policies and practices needed to support the effective implementation of this plan.

6.15.1.5    Coordination of the review, up-date, improvement and refinement of the Exposure Control Plan annually.

6.15.1.6    Collecting and maintaining a suitable reference library on federal and state regulations concerning bloodborne pathogens and other bloodborne pathogens safety and health information.

6.15.1.7    Supervision of periodic facility audits to maintain and up-date the Exposure Control Plan.

6.16    Departmental Exposure Control Officer

The Departmental Exposure Control Officer shall be appointed by the department head to coordinate with the Exposure Control Officer on behalf of the department and to provide departmental Exposure Control Plan services similar to those delineated for the Exposure Control Officer, but on a departmental level.

6.17    Policy & Procedure Attachments

Attachment A        Position Classifications - Significant Risk

Attachment B        Position Classifications - Moderate to Low Risk

Attachment C        Training Program Guidelines

Attachment D        Post-Exposure Medical Opinion Letter

Attachment E        Medical Records and Training Records

Attachment F        Declination Statement

Attachment G        Exposure Incident Report

Attachment H        Exposure Incident Checklist

Attachment I        Service Providers and Other Implementation Guidelines (To be distributed separately.)

ATTACHMENT A

POSITION CLASSIFICATIONS WITH SIGNIFICANT RISK OF OCCUPATIONAL EXPOSURE TO BLOODBORNE PATHOGENS

Airport Maintenance Worker    Empty and clean waste receptacles; clean and disinfect restrooms, including floors and walls; clean and sanitize toilets, urinals and sinks; remove debris and perform general grounds maintenance; remove dead birds and small animals from airport grounds; remove litter and debris from roadways; may be required to administer CPR and/or first aid; may come into contact with contaminated property.

Custodian    Empty and clean waste receptacles; clean and disinfect restrooms including floors, walls, clean and sanitize toilets, urinals, sinks and drinking fountains.

Firefighter    Administer emergency medical care to injured or ill

Fire Lieutenant    patients; rescue victims from hostile environments,

Fire Captain    including burning structures or vehicles, water

Fire Battalion Chief    contaminated atmospheres, or oxygen deficient atmospheres.

Golf Course Maintenance Worker I    Pick up and remove trash and other debris.

Golf Course Maintenance Worker II

Housing Maintenance Worker    Repair and maintain plumbing systems by repairing or replacing faucets, hot water tanks, toilets and drain systems; remove debris and perform general yard maintenance.

Lead Custodian    Empty and clean waste receptacles; clean and disinfect restrooms including floors, walls, clean and sanitize toilets, urinals, sinks and drinking fountains.

Lead Maintenance Custodian    Sweep, scrub and mop floors; wash windows, counters and walls; empty and clean waste receptacles; remove dead rodents, spider infestations and human and animal waste from City and parks facilities.

Maintenance Custodian    Sweep, scrub and mop floors; wash windows, counters and walls; empty and clean waste receptacles; remove dead rodents, spider infestations and human and animal waste from City and parks facilities.

Parks Laborer I    Maintain assigned cares in a clean, safe and orderly

Parks Laborer II    condition.

Parks Laborer III

Parks Maintenance Worker I    Maintain assigned areas in a clean, safe and orderly

Parks Maintenance Worker II    condition.

Parks Maintenance Worker III

Police Identification/Evidence Technician    Contact with contaminated evidence or property.

Police Jailer    Performing CPR; treatment of wounds; contact with combative persons; contact with contaminated evidence of property.

Police Officer    Performing CPR; treatment of wounds; contact with combative persons; contact with contaminated evidence of property.

Police Sergeant    Performing CPR; treatment of wounds; contact with combative persons; contact with contaminated evidence of property.

Police Service Specialist    Performing CPR; treatment of wounds; contact with combative persons; contact with contaminated evidence of property.

Recreation Aquatic Manager    Administer first aid and CPR as needed.

Recreation Attendant

Rec. Community Center Coordinator

Rec. Fitness Room Supervisor

Recreation Gym Attendant

Recreation Harbor Master

Recreation Leader

Recreation Lifeguard I and II

Recreation Program Coordinator

Recreation Program Manager

Recreation Senior Center

Coordinator

Recreation Specialist I

Recreation Specialist II

Solid Waste Maintenance Worker    Remove litter and debris from roadways; remove litter and debris from exhibits, tables and booths following Renton River Days.

ATTACHMENT B

POSITION CLASSIFICATIONS WITH MODERATE TO LOW RISK OF OCCUPATIONAL EXPOSURE TO BLOODBORNE PATHOGENS

Building Maintenance Supervisor    May be required to administer CPR or first aid; may come

in contact with contaminated property.

Building Maintenance Worker I    May be required to administer CPR or first aid; may come

Building Maintenance Worker II    in contact with contaminated property.

Civil Engineer I/Transportation    May be required to administer CPR or first aid; may comein contact with contaminated property.

Custodial Services Supervisor    May be required to administer CPR or first aid; may come in contact with contaminated property.

Engineering Specialist II/Transportation    May be required to administer CPR or first aid; may come in contact with contaminated property.

Engineering Specialist III/Transportation    May be required to administer CPR and/or first aid.

Fire Chief    May be required to administer CPR or first aid.

Fire Deputy Chief

Fire Marshal

Fire Safety Officer/EMC

Fire Training Captain

Fire Training Lieutenant

Golf Course Supervisor    May be required to administer CPR or first aid; may come in contact with contaminated property.

HVAC Technician    May be required to administer CPR or first aid; may come in contact with contaminated property.

May be required to administer CPR or first aid; may come

Lead Maintenance Services Worker    in contact with contaminated property.

Lead Parks Maintenance Worker    May be required to administer CPR or first aid; may come in contact with contaminated property.

Maintenance Services Supervisor    May be required to administer CPR or first aid; may come in contact with contaminated property.

Maintenance Services Worker I    May be required to administer CPR or first aid; may come in contact with contaminated property.

Maintenance Services Worker II

Maintenance Services Worker III

Parks Maintenance Supervisor    May be required to administer CPR or first aid; may come in contact with contaminated property.

Police Captain    May Perform CPR; may treat wounds; may have contact

Police Chief    with combative persons; may have contact with

Police Lieutenant    contaminated evidence or property.

Police Staff Services Manager

Recreation Supervisor    May be required to administer CPR or first aid; may come in contact with contaminated property.

Signal/Electronics Systems Assistant I    May be required to administer CPR or first aid; may come in contact with contaminated property.

Signal/Electronics Systems Assistant II

Signal/Electronics Systems Technician I

Signal/Electronics Systems Technician II

Traffic Maintenance Worker II    May be required to administer CPR or first aid; may come in contact with contaminated property.

Traffic Sign & Paint Supervisor    May be required to administer CPR or first aid; may come in contact with contaminated property.

Transportation Maintenance Supervisor    May be required to administer CPR or first aid; may come in contact with contaminated property.

Transportation Maintenance Manager    May be required to administer CPR or first aid; may come in contact with contaminated property.

Water Meter Reader    May be required to administer CPR or first aid; may come in contact with contaminated property.

Water Quality Technician    May be required to administer CPR or first aid; may come in contact with contaminated property.

Water Utility Maintenance Supervisor    May be required to administer CPR or first aid; may come in contact with contaminated property.

Water Utility Maintenance Technician    May be required to administer CPR or first aid; may come in contact with contaminated property.

ATTACHMENT C

OCCUPATIONAL EXPOSURE TO BLOODBORNE PATHOGENS

TRAINING PROGRAM GUIDELINES

Training will be provided at the time of initial assignment to tasks where occupational exposure may take place and within one year of previous training thereafter. Additional training will be provided whenever changes such as modification of tasks or procedures or the institution of new tasks or procedures affect an employee's exposure, although this training may be limited to addressing the new exposures created.

The person conducting the training shall be knowledgeable in the subject matter covered by the elements contained in the training program as it relates to the City of Renton.

CONTENTS OF THE TRAINING PROGRAM

1.    The places where copies of the regulatory text of the occupational exposure to bloodborne pathogens are located and an explanation of the contents of the standard.

2.    A general explanation of the epidemiology and symptoms of bloodborne diseases.

3.    An explanation of the modes of transmission of bloodborne pathogens.

4.    An explanation of the employer's exposure control plan and the means by which the employee can obtain a copy of the written plan.

5.    An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials.

6.    An explanation of the use and limitations of methods that will prevent or reduce exposure including appropriate engineering controls, work practices and personal protective equipment.

7.    Information on the types, proper use, location, removal, handling, decontamination and disposal of personal protective equipment.

8.    An explanation of the basis for selection of personal protective equipment.

9.    Information on the hepatitis B vaccine, including information on its efficacy, safety, method of administration, the benefits of being vaccinated, and that the vaccine and vaccination will be offered free of charge to employees.

10.    Information on the appropriate actions to take and persons to contact in an emergency involving blood or other potentially infectious materials.

11.    An explanation of the procedure to follow if an exposure incident occurs, including the method of reporting the incident and the medical follow-up that will be made available.

12.    Information on the post-exposure evaluation and follow-up that the employee is required to provide for the employee following an exposure incident.

13.    An explanation of the signs and labels and/or color coding required by section 7a of the standard.

14.    An opportunity for interactive questions and answers with the person conducting the training session.

ATTACHMENT D

To Whom It May Concern:

A City of Renton employee was involved in an incident that resulted in potential occupational exposure to bloodborne pathogens. This person has been sent to you for post-exposure medical evaluation.

As you may know, Washington law requires that the healthcare professional who performs a post-exposure medical evaluation prepare a written opinion to be forwarded to the City within fifteen days of the completion of the evaluation. The City will provide a copy of the written opinion to the exposed employee immediately and retain a copy for the medical records we are required to maintain.

Your written opinion must be limited to the following information:

1.    That the employee has been informed of the results of the evaluation;

2.    That the employee has been told about any medical conditions resulting from exposure to blood or other potentially infectious materials which require further evaluation or treatment.

All other information must remain confidential.

We appreciate your assistance. Please let me know if you have any questions.

Sincerely,

Beverly Nelson Glode
Human Resources and Risk Management Administrator

ATTACHMENT E

OCCUPATIONAL EXPOSURE TO BLOODBORNE PATHOGENS

RECORDS

MEDICAL RECORDS

An accurate record will be maintained for each employee with occupational exposure to bloodborne pathogens. The records shall be kept confidential and will not be disclosed or reported without the employee's express written consent to any person within or outside the workplace except as required by the occupational exposure to bloodborne pathogens standard or as required by law. A copy of an employee's medical records will be provided to the employee upon request.

All medical records will be maintained for at least the duration of employment plus thirty years.

Medical records shall include:

1.    The name and social security number of the employee.

2.    A copy of the employee's hepatitis B vaccination status including the dates of all the hepatitis B vaccinations and any medical records relative to the employee's ability to receive vaccination.

3.    A copy of all results of examinations, medical testing and follow-up procedures including:

·    Documentation of the route(s) of exposure and the circumstances under which the exposure incident occurred;

·    Identification and documentation of the source individual or documentation that identification is not feasible or prohibited by state or local law;

·    Consent of the source individual for a blood test or establishment that the required consent cannot be obtained;

·    The results of the source individual's blood test, if the test was performed, or documentation that the source individual is known to be infected with HBV or HIV;

·    Documentation that the results of the source individual's testing was made available to the exposed employee and the employee was informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual.

4.    The employer's copy of the healthcare professional's written opinion.

5.    A copy of the information provided to the healthcare professional by the employer, including the Exposure Incident Report, the correct class specification, and the results of the source individual's blood testing, if available.

6.    Documentation that the exposed employee consented or did not consent to post-exposure evaluation.

TRAINING RECORDS

Training records will be maintained for three years from the date on which the training occurred.

1.    Training records shall include the following information:

2.    The dates of the training sessions;

3.    The contents or a summary of the training sessions;

4.    The names and qualifications of the person or persons conducting the training

5.    The names and job titles of all persons attending the training sessions.

ATTACHMENT F

CITY OF RENTON

OCCUPATIONAL EXPOSURE TO BLOODBORNE PATHOGENS

DECLINATION STATEMENT

I understand that due to my occupation 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 vaccination 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 exposure to blood or other potentially infectious materials and I want to be vaccinated with Hepatitis B vaccine, I can receive the vaccine series at no charge to me.

________________________________    ____________________

Employee Signature    Date

________________________________    ____________________

Parent Signature if under 18 years of age    Witness

---------------------------------------------------------------------------------------------------------------------------

VACCINATION RECORD

Employee Name __________________________________________

Own Physician _____ Name ________________________________

Health Department _____

Series Started ___________(Date)

2nd Vaccination __________(Date)

3rd Vaccination (if needed) __________(Date)

Series Complete ___________________________    _______________
Administering Physician                    Date

______________________________________    _______________

Employee Signature                    Date

forms:hbvdec

ATTACHMENT G

CITY OF RENTON EXPOSURE INCIDENT REPORT

INSTRUCTION: The form is to be completed when reporting an on the job incident or accident involving possible exposure to bloodborne pathogens. Completion of this form is mandatory. When completed, the form should be forwarded to the Departmental Exposure Control Officer (with a copy to the Human Resources and Risk Management Dept) or to the Human Resources and Risk Management Department if a Departmental Exposure Control Officer has not been designated. A copy of the Exposure Incident Report will be sent to the appropriate medical facility for follow-up.

Employee Name ___________________________________    Sex __________    Date of Birth ______________

Address __________________________________________    City/Zip ______________________________________

Social Security # ___________________________________    Home Phone __________________________________

Department _______________________________________    Job Title ______________________________________

Work Phone ______________________________________

Date of Incident/Accident ____________________________    Time _____________    Location _________________

Names of Witnesses ___________________________________________________________________________________

BODY FLUID TYPE:    ROUTE OF EXPOSURE:

□ Blood                              □ Non-intact skin

□ Semen/Vaginal Fluids     □ Mucous Membrane

□ Amniotic Fluid                 □ Wound/Puncture

□ Wound Secretions          □ Gross Contamination on intact skin

Body fluids visibly contaminated with blood:

□ Nasal Secretions     □ Feces

□ Urine     □ Saliva

□ Vomitus     □ Other

DESCRIBE CIRCUMSTANCES SURROUNDING THE INCIDENT (Explain the duties you were performing , how you think any potential organism may have entered your body; i.e. eyes, laceration, needle, etc.):

_________________________________________________________________________________

_________________________________________________________________________________

List precautions taken at time of incident:

_________________________________________________________________________________

_________________________________________________________________________________

Personal Protective Equipment (i.e. gloves) utilized at time of incident:

_________________________________________________________________________________

_________________________________________________________________________________

_______________________________________    _____________________________

Employee Signature    Date

FOR EXPOSURE CONTROL OFFICER USE ONLY:

Can work practices, eng., controls or PPE be altered to prevent reoccurrence? Yes No

If yes, which ___________________

Is further training indicated? Yes No

If yes, . . .

Who should participate? __________________________________________________________

What topics should be covered? ____________________________________________________

Who should do the training? _______________________________________________________

ACTIONS TAKEN: DATE

forms:exposure

ATTACHMENT H

CITY OF RENTON

EXPOSURE INCIDENT CHECKLIST

CONFIDENTIAL

It is mandatory that this form be completed and forwarded, or a copy of it, to the Human Resources and Risk Management Department

Employee Name__________________________________________________________

Department______________________________________________________________

Completion Date

Employee and Exposure Control Officer or Departmental Exposure

Control Officer complete Exposure Incident Report.    ___________

·    exposed employee's duties as related to exposure incident

·    route of exposure

·    circumstances surrounding incident (PPE used)

·    source individual identified

Source agrees to be tested (make an appointment at Valley Medical Center

Occupational Health Services or Valley Medical Center Emergency Room)

Appointment Date    ___________

Source consent cannot be legally obtained or is not required because

or known medical status    ___________

If exposed employee accepts post-exposure evaluation

Exposed employee sent to medical facility for post-exposure

evaluation/follow-up along with a copy of the City of Renton

Exposure Incident Report    ___________

Report received from medical facility within 15 working days of

completion of the evaluation (that Hepatitis B vaccination was

indicated/received and that employee has been informed of the

results of evaluation and further treatment, if necessary)    ___________

Exposed employee forwarded a copy of physicians written opinion

within 15 working days of the completion of the evaluation.    ___________

If exposed employee declines post-exposure evaluation

I understand that post-exposure evaluation and follow-up treatment is

available at no cost to me through King County Department of Public

Health Clinic or Valley Medical Center. I do not wish to accept this

medical evaluation and treatment.

__________________________________________    ___________

Exposed employee's signature    Date

Exposure Incident Report evaluated for changes in procedures, equipment,

training, etc.    ___________

FOR EXPOSURE CONTROL OFFICER USE ONLY:

Can work practices, eng., controls or PPE be alterd to prevent reoccurrence?    □ Yes    □ No

If yes, which        

Is further training indicated?    □ Yes    □ No

If yes, . . .

Who should participate?    

What topics should be covered?    

Who should do the training?    

ACTIONS TAKEN:    DATE





ATTACHMENT I

Service Providers and Other Implementation Guidelines

City employees who may have been exposed to bloodborne pathogens while on duty shall report the exposure to the immediate supervisor and, as soon as feasible, go to:

Occupational Health Services-Valley Medical Center

220 SW 43rd Street

Renton, WA 98055

(206) 656-5020

6:00 a.m. - 6:00 p.m.

Or

Valley Medical Center Emergency Room

400 S 43rd

Renton, WA 98055

(206) 251-5185

6:00 p.m. - 6:00 a.m. and weekends

The employee shall give the healthcare professional at either location a copy of the post-exposure medical opinion letter (Attachment D to Policy and Procedure 300-55) and a copy of the Exposure Incident Report (Attachment G to Policy and Procedure 300-55). Forms are available in the employee's department or the Human Resources and Risk Management Department. Copies of both forms should be retained by the department and copies of both forwarded to the Human Resources and Risk Management Department.

The services provided by Valley Medical Center include:

·    Acute injury treatment

·    Baseline HIV after counseling and signed consent

·    Baseline Hepatitis screen or Hb Surface Antigen Title (if Hepatitis B series previously given)

·    Begin Hepatitis B series if not previously given

·    Repeat HIV laboratory work in 3 to 6 months, Hepatitis, if indicated Hb Surface Antigen Titer after completion of series

·    Referrals to primary or appropriate infectious disease physicians as indicated for positive serum conversions.