SECTION E: EXPOSURE PROCEDURES

1. Exposure Precautions (so-called Universal)

   All body fluids are to be assumed to be infected with HBV or HIV and all individuals exposed to direct contact with body fluids must be protected as though such body fluids are known to be infected.

2. Personal Protective Equipment (PPE)

   Personal Protective Equipment shall be worn during all contact with body fluids. Bloodborne pathogens can enter the body through a needle stick injury, through contact of non-intact (i.e. chapped or cut) skin with infectious materials or through a splash of infectious material to the eye, nose or mouth. The PPE listed below must be worn to prevent entry of infectious material to the body.

   1. Gloves
      1. Disposable latex or vinyl gloves shall be worn during activities which may create a potential contact with body fluids. In particular, gloves are required for individuals engaged in healthcare, patient contact or where the need exists for sterile conditions. Gloves shall be discarded and hands washed immediately after each activity.
      2. Housekeeping and laundry personnel shall use utility gloves. Hands shall be washed after use and gloves (If re-used) disinfected with a 1:100 dilution of Clorox or equivalent strength sodium hypochlorite solution prepared fresh each day.
      3. Small, medium and large gloves are available. Individuals shall wear the correct size of glove.

   2. Gowns

      Nurses, Emergency Medical Technicians, Paramedics, etc. shall use fluid-resistant disposal gowns when splashes to the clothing with body fluids may occur such as when drawing blood or when treating an individual with profuse bleeding.

   3. Mask and Eye Protectors

      Masks and eye protection shall be worn when splashes to the face may occur such as when drawing blood or when treating an individual with profuse bleeding.

   4. Pocket breathing masks shall be used by individuals who render emergency resuscitation.
   5. Gloves, masks, eye protection and gowns shall be worn when drawing blood or performing any other functions where splashes of body fluids are a potential.

3. Housekeeping

   1. An Environmental Protection Agency (EPA) approved hospital disinfectant shall be used to decontaminate spills of blood or body fluids. A 1:10 dilution, prepared fresh daily, of Clorox or equivalent strength hypochlorite solution, shall be used for this purpose.
   2. A blood spill shall be wiped up first, then the surface decontaminated with the chlorine solution or other approved disinfectant agent.
   3. Surfaces where procedures involving blood or body fluids have been conducted, such as table tops or bench tops, shall be cleaned and disinfected after each use and also at the end of the work shift.

4. Waste Disposal

   1. Needles shall never be recapped, purposely bent or broken, removed from disposable syringes or in any way manipulated by hand.
   2. All sharps shall be placed in puncture-resistant, closable containers after use.
   3. All waste materials including sharps contaminated with blood or body fluids shall be placed in containers or bags labeled with the word BIOHAZARD (or the biological hazard symbol).
   4. Infectious (Biohazard) waste shall be managed and disposed of in an approved manner. DO NOT place infectious waste in regular trash containers.
   5. Reusable Equipment

      1. Immediately after each use, all reusable equipment which has come into contact with blood or body fluids shall be placed in the cold sterilant solution. The solution container shall be tagged to indicate the presence of Biohazard material.
      2. At the end of each work shift, or as dictated by the immediate situation, all reusable equipment shall be properly autoclaved. As soon as contaminated, equipment shall be tagged as being a Biohazard to alert the personnel performing decontamination to the potential hazard.

   6. Laundry

      1. All linen contaminated with blood or body fluids shall be transported in impervious bags labeled with the word BIOHAZARD.
      2. Soiled linen shall be bagged at the location where it is used and shall not be rinsed or handled before bagging.
      3. If leaking of the primary bag is possible, a second bag shall be used as reinforcement containment.

   7. Hepatitis B Vaccination

      1. All employees who perform duties where exposure to blood or other body fluids is a potential shall be offered Hepatitis B Vaccination. NOTE: Some categories of employees such as custodians, housekeepers, child care workers, lifeguards, etc., fall into a "collateral duty" category and are not required to be offered immunization unless a specific exposure incident occurs.
      2. Vaccinations shall be given at no cost to the applicable employees.
      3. Employees have the right to refuse immunization, but must sign a refusal form (attached) to be kept on file by the respective department.

   8. Follow-up Procedures

      1. Follow-up procedures shall be initiated when any of the following accidents occurs:

         1. If an individual has a needle stick or a cut with a sharp instrument used on a human.
         2. A splash of blood or body fluids to the eyes, nose or mouth occurs to an individual.
         3. Contact of blood or body fluids occurs to individuals with chapped or abraded skin.

      2. Follow-up procedures shall consist of the following:

         1. Documentation of the following:

            1. Route of exposure;
            2. The identity of the source of the body fluid; and
            3. The circumstances of the exposure, i.e. how it happened.

         2. Collection and testing of the source person's blood for HIV and HBV, if possible.
         3. Collection and testing of the exposed person's blood for HIV and HBV immediately.
         4. Medical evaluation of the exposed individual by a physician.
         5. Further follow-up of the exposed person including counseling.
         6. If the initial HIV test of the exposed person is negative, further testing for HIV six weeks, 12 weeks and six months post exposure.
         7. If the employee or student has not been vaccinated against HBV or the antibody response is not adequate, post exposure prophylaxis including treatment with immune globulins and the Hepatitis B Vaccine under the direction of a physician shall be administered.
         8. Records of employee exposure to infectious agents shall be maintained for 30 years following the last date of employment. The records shall be maintained in a secure and confidential manner.

   9. Information and Training

      Individuals who participate in functions that present potential exposure to human blood or other regulated body fluids shall receive training which includes the following:

      1. A copy of the current regulations from Tennessee Occupational Safety and Health Administration (TOSHA).
      2. A general explanation of the epidemiology and symptoms of HIV and HBV.
      3. An explanation of the modes of transmission of HIV and HBV.
      4. An explanation of the infection control program at the University. (Basically, the written program).
      5. An explanation of the importance of exposure precautions to reduce worker exposure.
      6. An explanation of how to determine if activity will fall under this program.
      7. An explanation of the availability, proper use and disposal of personal protective equipment including the specific circumstances under which the PPE is to be worn.
      8. An explanation of the follow-up procedure to implement if actual body contact occurs with blood or body fluids occurs.
      9. An explanation of the labels and signs used.
      10. An explanation of the proper clean-up of spills of blood or other regulated body fluids.
      11. An explanation of proper disposal of contaminated items.
      12. An explanation of the sterilization procedures for reusable equipment.

   10. Recordkeeping

       A record of each training session shall be kept. The record shall include the following information:

       1. The dates of the training session;
       2. A summary of the contents of the session:
       3. The names and qualifications of the trainers; and
       4. The names and job titles of all persons being trained.