Library: Policy

OKDHS:2-15-32. Exposure Control Plan

Revised 9-15-07

(a) Exposure determination.

(1) Preparation. The local administrator or county director of each workplace prepares an exposure determination that contains separate lists and is delineated by job classifications in which:
- (A) all employees in those job classifications have occupational exposure; and
- (B) some employees in those job classifications have occupational exposure.
(2) Tasks and procedures. The exposure determination:
- (A) lists all tasks and procedures or groups of closely related tasks and procedures in which occupational exposure occurs and which are performed by an employee in a job classification listed in accordance with the provisions of this subsection; and
- (B) is made without regard to the use of personal protective equipment (PPE).

(b) Methods of compliance.

(1) General. Universal precautions are observed to prevent contact with blood or other potentially infectious materials. When differentiation between body fluid types is difficult or impossible, all body fluids are considered potentially infectious materials.
(2) Engineering and work practice controls. Engineering and work practice controls are used to eliminate or minimize employee exposure. Where occupational exposure remains after institution of these controls, PPE is also used.
- (A) Engineering controls are examined and maintained or replaced on a regular schedule to ensure their effectiveness.
- (B) Handwashing facilities are readily accessible to employees. When provision of handwashing facilities is not feasible, an appropriate antiseptic hand cleanser is provided in conjunction with clean towels or antiseptic towelettes. Hands are washed with soap and running water as soon as practicable after cleaning with antiseptic hand cleanser.
- (C) An employee washes his or her hands immediately or as soon as feasible after removal of gloves or other PPE, or as soon as feasible following contact with blood or other potentially infectious materials.
- (D) Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure.
- (E) Food and drink are not kept in refrigerators, freezers, shelves, and cabinets or on countertops or bench tops where blood or other potentially infectious materials are present.
- (F) All procedures that involve blood or other potentially infectious materials are performed in such a manner as to minimize splashing, spraying, spattering, and generation of droplets of these substances.

(1) Provision. When there is occupational exposure, the Oklahoma Department of Human Services (OKDHS) provides, at no cost to the employee, appropriate PPE, such as fluid impervious gloves, gowns, pocket masks, or other ventilation devices.
(2) Use. OKDHS ensures that the employee uses appropriate PPE.
(3) Accessibility. OKDHS ensures that appropriate PPE in the appropriate sizes is readily accessible at the workplace or is issued to the employee. Hypoallergenic fluid impervious gloves, glove liners, powderless gloves, or other similar alternatives are readily accessible to the employee who is allergic to the gloves normally provided.
(4) Cleaning, laundering, and disposal. OKDHS cleans, launders, and disposes of PPE required in this Section at no cost to the employee.
(5) Repair and replacement. OKDHS repairs or replaces PPE, at no cost to the employee, as needed to maintain its effectiveness.
(6) Gloves. Gloves are worn when it can be reasonably anticipated that the employee may have hand contact with blood or other potentially infectious materials, and when handling contaminated surfaces.
- (A) Disposable, single-use gloves are not washed or decontaminated for re-use.
- (B) Utility gloves may be decontaminated for re-use. Gloves are discarded if they have signs of deterioration or when their ability to function as a barrier is compromised.
(7) Masks, eye protection, and face shields. Masks in combination with eye protection devices are worn when eye, nose, or mouth contamination can be reasonably anticipated.
(8) Gowns, aprons, and other protective body clothing. Appropriate protective clothing, such as fluid impervious gowns, lab coats, clinic jackets, or similar outer garments, are worn in occupational exposure situations. The type and characteristics depend upon the task and degree of exposure anticipated.

(d) Housekeeping.

(1) General. OKDHS ensures the workplace is maintained in a clean and sanitary condition. The local administrator or county director determines and implements an appropriate written schedule for cleaning and methods of decontamination based upon the location within the workplace, type of surface to be cleaned, type of soil present, and tasks or procedures being performed in the area.
- (A) All equipment and environmental and working surfaces are cleaned and decontaminated after contact with blood or other potentially infectious materials.
- (B) Contaminated work surfaces are decontaminated with an appropriate disinfectant:
  - (i) after completion of procedures;
  - (ii) immediately or as soon as feasible when surfaces are overtly contaminated or after any spill of blood or other potentially infectious materials; and
  - (iii) at the end of the work shift if the surface became contaminated since the last cleaning.
- (C) Broken glassware that may be contaminated is not picked up directly with the hands. It is cleaned up using mechanical means, such as a brush and dustpan, tongs, or forceps.
- (D) Reusable sharps that are contaminated with blood or other potentially infectious materials are not stored or processed in a manner that requires an employee to reach by hand into the containers where these sharps have been placed.
(2) Regulated waste.
- (A) Contaminated sharps discarding and containment.
  - (i) Contaminated sharps are discarded immediately or as soon as feasible in containers that are:
    - (I) closeable;
    - (II) puncture-resistant;
    - (III) leakproof on sides and bottom; and
    - (IV) labeled or color-coded as a biohazard.
  - (ii) During use, containers for contaminated sharps are:
    - (I) easily accessible to personnel and located as close as feasible to the immediate area where sharps are used or can reasonably be anticipated to be found;
    - (II) maintained upright throughout use; and
    - (III) replaced routinely and not allowed to overfill.
  - (iii) When moving containers of contaminated sharps from the area of use, the containers are:
    - (I) closed immediately prior to removal or replacement to prevent spillage or protrusion of contents during handling; and
    - (II) placed in a secondary container if leakage is possible. The second container is closable; constructed to contain all contents and prevent leakage during handling; and labeled or color-coded as a biohazard.
  - (iv) Reusable containers are not opened, emptied, or cleaned manually or in any other manner that would expose an employee to the risk of percutaneous injury.
- (B) Other regulated waste containment. Regulated waste is placed in containers that are:
  - (i) closable;
  - (ii) constructed to contain all contents and prevent leakage of fluids during handling;
  - (iii) labeled or color-coded as a biohazard; and
  - (iv) closed prior to removal to prevent spillage or protrusion of contents during handling.
(3) Laundry.
- (A) OKDHS employees use universal precautions in the handling of all soiled laundry. Contaminated laundry is handled as little as possible with a minimum of agitation.
- (B) Contaminated laundry is bagged or containerized at the location where it was used and is not sorted or rinsed in the location of use.
- (C) Wet contaminated laundry is placed and transported in bags or containers that prevent soak-through and leakage of fluids to the exterior.
- (D) OKDHS employees who have contact with contaminated laundry wear protective and other appropriate PPE.
- (E) Contaminated laundry not cleaned on-site is shipped in containers that are labeled or color-coded as a biohazard.

(e) HBV vaccination and post-exposure evaluation and follow-up.

(1) Availability. OKDHS makes the hepatitis B virus (HBV) vaccine and vaccination series available to all employees who have occupational exposure, and provides post‑exposure evaluation and follow-up to all employees who have had an exposure incident. All medical evaluations and procedures, including the HBV and vaccination series, and post-exposure evaluation and follow-up, including prophylaxis, are:
- (A) made available at no cost to the employee at a reasonable time and place;
- (B) performed by or under the supervision of a licensed physician or another licensed healthcare professional; and
- (C) provided according to recommendations of the U.S. Public Health Service current at the time the evaluations and procedures take place.
(2) HBV vaccination.
- (A) HBV vaccination is made available after the employee has received the training required in subsection (g) of this Section and within ten working days of initial assignment to all employees who have occupational exposure, unless the employee has previously received the complete HBV vaccination series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicated for medical reasons.
- (B) Participation in a prescreening program is not a prerequisite for receiving HBV vaccination.
- (C) An employee who initially declines HBV vaccination may later decide to accept the vaccination as long as the employee still has occupational exposure. OKDHS makes the vaccination available at that time.
- (D) An employee who declines an HBV vaccination signs the statement in Form 23RS002E, Hepatitis B Vaccination Declination. Signing Form 23RS002E:
  - (i) documents that the vaccination was declined; and
  - (ii) informs the employee that the vaccination is offered at no charge to the employee and will be offered at some future time if the employee initially declines, but continues to have occupational exposure and wants to be vaccinated.
- (E) If the U.S. Public Health Service recommends HBV vaccination at a future date, OKDHS will offer a booster dose of HBV vaccine at no cost to the employee.
(3) Post-exposure evaluation and follow-up.
- (A) The employee reports a possible bloodborne pathogen (BBP) exposure incident to his or her supervisor and completes Form 23RS046E, Employee's Report of Job-Related Accidental Injury or Illness. This type of exposure is handled as a Workers' Compensation claim. Refer to OKDHS:2-15-1.1 for procedures regarding on-the-job accidents and reporting requirements.
- (B) Following a report of an exposure incident, the local administrator or county director immediately makes available to the exposed employee a confidential medical evaluation and follow‑up that includes using Oklahoma State Department of Health (OSDH) Form 207, Communicable Disease Risk Exposure Report, to document:
  - (i) the route(s) of exposure, and the circumstances under which the exposure incident occurred;
  - (ii) the identity of the source individual, unless identification is unfeasible or prohibited by state or local law;
  - (iii) the collection and testing of blood for HBV and human immunodeficiency virus (HIV) serological status;
  - (iv) post-exposure prophylaxis, when medically indicated, as recommended by the U.S. Public Health Service;
  - (v) counseling; and
  - (vi) evaluation of reported illness(es).
- (C) The source individual's blood is tested as soon as feasible, and after consent is obtained, if possible.
- (D) If consent is not obtained, OKDHS establishes that legally required consent cannot be obtained. When law does not require the source individual's consent, the source individual's blood, if available, is tested and the results are documented.
- (E) When the source individual is already known to be infected with HBV or HIV, testing for the source individual's known HBV or HIV status is not required.
- (F) Results of the source individual's testing are made available to the exposed employee, and the employee is informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual.
(4) Collection and testing of blood for HBV and HIV serological status.
- (A) The exposed employee's blood is collected as soon as feasible, and is tested after consent is obtained.
- (B) If the employee consents to baseline blood collection, but does not give consent at that time for HIV serologic testing, the sample is preserved for at least 90 days. If, within 90 days of the exposure incident, the employee elects to have the baseline sample tested, such testing is done as soon as feasible.
(5) Information provided to the healthcare professional. The healthcare professional responsible for the employee's HBV vaccination is provided:
- (A) a copy of this Section [OKDHS:2-15-32];
- (B) a description of the exposed employee's duties as related to the exposure incident;
- (C) documentation of the route of exposure and circumstances under which exposure occurred;
- (D) results of the source individual's blood testing, if available; and
- (E) all medical records, including vaccination status, relevant to the appropriate treatment of the employee.
(6) Healthcare professional's written opinion. The local administrator or county director obtains and provides the employee with a copy of the evaluating healthcare professional's written opinion within 15 calendar days of the completion of the evaluation. Except as described in (A) and (B) of this paragraph, all other findings or diagnoses are confidential and not included in the written report.
- (A) The healthcare professional's written opinion for HBV vaccination is limited to whether:
  - (i) HBV vaccination is indicated for the employee; and
  - (ii) the employee received the vaccination.
- (B) The healthcare professional's written opinion for post-exposure evaluation and follow-up is limited to a statement that the employee was:
  - (i) informed of the results of the evaluation; and
  - (ii) told about any medical conditions resulting from exposure to blood or other potentially infectious materials that require further evaluation or treatment.

(f) Communication of hazards. Warning labels on containers used for blood or other potentially infectious materials are marked BIOHAZARD. The labels are fluorescent orange or orange-red with lettering and symbols in contrasting color. Red bags or red containers may be substituted for labels.

(g) Information and training. All employees with occupational exposure participate in a training program that is provided at no cost during working hours. The person conducting the training is knowledgeable in the subject matter as it relates to the workplace. Training provided to employees at the time of initial assignment to tasks where occupational exposure may take place and at least annually thereafter includes:

(1) a copy of the federal bloodborne pathogen standard per Section 1910.1030 of Title 29 of the Code of Federal Regulations (CFR) [29 CFR 1910.1030];
(2) a general explanation of the epidemiology and symptoms of bloodborne diseases;
(3) an explanation of the modes of transmission of BBP;
(4) an explanation of the OKDHS BBP Exposure Control Plan and a 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 PPE;
(7) information on the types, proper use, location, removal, handling, decontamination, and disposal of PPE;
(8) an explanation of the basis for selection of PPE;
(9) information on HBV vaccine, including efficacy, safety, method of administration, benefits of being vaccinated, and that the vaccine and vaccination are offered free of charge;
(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 is available;
(12) information on the post-exposure evaluation and follow-up that the employer is required to provide for the employee following an exposure incident;
(13) an explanation of the required signs and color coding on labels; and
(14) an opportunity for interactive questions and answers with the person conducting the training session.

(h) Medical records.

(1) OKDHS establishes and maintains for each employee with occupational exposure an accurate medical record that includes:
- (A) a completed OSDH Form 207;
- (B) a copy of the employee's HBV vaccination status report from the facility providing the vaccination;
- (C) a copy of the results of examinations, medical testing, and follow-up procedures;
- (D) a copy of the healthcare professional's written opinion; and
- (E) a copy of the information provided to the healthcare professional.
(2) Medical records are:
- (A) confidential and are not disclosed or reported to any person without the employee's express written consent, except as required by this Section or by law; and
- (B) maintained at least for the duration of employment plus 30 years in accordance with 29 CFR 1910.1020.

(i) Training records.

(1) Employee training records are maintained at the local workplace for three years from the date on which training occurred and include:
- (A) date of the training session;
- (B) contents or summary of the training session;
- (C) names and qualifications of persons conducting the training; and
- (D) names and job titles of all persons who attend the training session; and
(2) Employee training records required by this Section are provided upon request for examination and copying to:
- (A) the subject employee;
- (B) anyone having written consent of the subject employee; and
- (C) the Director and Assistant Secretary of Health and Human Services in accordance with 29 CFR 1910.1020.

(j) Sharps injury log.

(1) OKDHS maintains a sharps injury log to record percutaneous injuries from contaminated sharps. The information on the sharps injury log is recorded and maintained in such manner as to protect the confidentiality of the injured employee, and contains:
- (A) the type and brand of device involved in the incident;
- (B) the department or work area where the exposure incident occurred; and
- (C) an explanation of how the incident occurred.
(2) The sharps injury log is maintained for the period required by 29 CFR 1904.