Blood Borne PathogenBlood Borne PathogenExposure Exposure

Update and ProceduresUpdate and Procedures

Adapted and updated from a slide show by;Rebecca Fronberg, BS, CHES

HIV Counseling & Testing CoordinatorUtah Department of Health

By Dorrell Henderson By Dorrell Henderson EMS / Safety and Wellness Div. EMS / Safety and Wellness Div. Salt Lake City Fire DepartmentSalt Lake City Fire Department

Utah EMS LawUtah EMS Law Senate Bill 19 Senate Bill 19

Utah Code Title 34, Chapter 2-0-5Utah Code Title 78, Chapter 29-102

Effective date, May 2, 2005Rule R612-10-1 and Form 350 9/05 adopted by Utah

Labor Commission December 2005Rule in effect on February 1, 2006

Significant Changes Made by SB19Significant Changes Made by SB19

Moves provisions from the Health Code to the Labor Code regarding worker’s compensation presumption for EMS providers

Adds Hepatitis C to the definition of disease for the purposes of disease testing and the presumptions for workers’ compensation

PurposePurpose

To protect the workers compensation benefits of EMS providers who become HIV infected and/or contract hepatitis B or C due to an exposure during their job duties

Presumption & Baseline TestingPresumption & Baseline Testing An EMS worker who contracts HIV, HBV or HCV

is presumed to have contracted the disease on the job if:

They were hired prior to July 1, 1988 or… They were hired after July 1,1998 and were tested

negative for HIV, HBV and HCV at the time of hire. (baseline testing) and…

They test positive during employment or within 3 months after termination.

If they refuse or fail to be tested they are not entitled to this presumption.

Reporting RequirementsReporting Requirements All significant exposures must be reported Significant exposure means:

Exposure of the body of one person to the blood or body fluids visibly contaminated by blood of another person by: Percutaneous injury, including needle stick or cut with a sharp

object or instrument

Contact with an open wound, mucous membrane or non-intact skin because of a cut, abrasion, dermatitis or other damageAny other method of transmission defined by the Utah Department of Health

Potentially Infectious Potentially Infectious Body FluidsBody Fluids

blood amniotic fluid pericardial fluid cerebrospinal fluid vaginal secretions or any other fluid visibly contaminated with

blood (bloody sputum))

peritoneal fluid pleural fluid synovial fluid semen cervical secretions

EMS provider documents on-the-job exposure

EMS provider is tested and becomes infected with HIV, HBV and/or HCV

EMS law presumes the infection(s) is (are)job-related

Employee can be compensated under the Workers Compensation Program

Presumptive EligibilityPresumptive EligibilityProvisionsProvisions

EMS Provider ResponsibilitiesEMS Provider Responsibilities

Know, understand and follow the provisions of your Agency’s Exposure Control Plan

EMS Provider ResponsibilitiesEMS Provider Responsibilities

Complete the Exposure Report Form (ERF)

Assure that a copy of the ERF accompanies the patient to the receiving medical facility and is…

Submitted to an authorized person at the receiving facility

Keep the original or obtain a copy of the ERF for personal record and further distribution

EMS Provider ResponsibilitiesEMS Provider Responsibilities

If unable to submit a copy of the ERF to the receiving facility at the time of exposure You must call in the information needed to

complete the ERF to the authorized person at the receiving facility

Telephone report must be followed by a hard copy of the completed ERF within 3 days of the incident

Hard copy is sent directly to the receiving facility

EMS Provider ResponsibilitiesEMS Provider Responsibilities

Go immediately to your Workers’ Compensation authorized medical facility. Take a copy of the ERF and follow instructions on prophylactic treatment if recommended for your exposure.

(Those with high and moderate risk of HIV exposures should be started on treatment within 2 hours of the exposure.)

Follow your Agency’s policy for reporting an “On the Job Injury” This is an “On the Job Injury”

Post Exposure Prophylaxis (PEP)Post Exposure Prophylaxis (PEP) CDC recommendations :

If indicated, start PEP as soon as possible after an exposure

Re-evaluation of the exposed person should be considered within 72 hours post exposure, especially as additional information about the exposure or source person becomes available

Administer PEP for 4 weeks, if tolerated If a source patient is determined to be

HIV-negative, PEP should be discontinued

Source: MMWR June 29, 2001 / 50(RR11);1-42

EMS Provider ResponsibilitiesEMS Provider Responsibilities

Notify the “Contact Person at Employment / Agency”

Submit a copy of the ERF to the Contact Person within 3 days of the incident

Receiving Facility Receiving Facility ResponsibilitiesResponsibilities

Receiving facility “shall”: (Rule R612-10-1) Establish a system of receiving ERFs and information

telephoned in by exposed EMS provider

Ensure that a designated person is available 24-hours a day to receive the ERFs

Have trained pre-test counselors available or on call for counseling source patients

Complete the Source Patient Information section of the ERF

Receiving Facility Receiving Facility ResponsibilitiesResponsibilities

Obtains permission from source patient to Obtains permission from source patient to test for HIV, HBV and/or HCVtest for HIV, HBV and/or HCV Patient, next of kin or legal guardian may Patient, next of kin or legal guardian may

consentconsent No consent required if under Utah Department No consent required if under Utah Department

of Corrections custody or if deceasedof Corrections custody or if deceased If unable to provide counseling, provide the If unable to provide counseling, provide the

patient with phone numbers for trained patient with phone numbers for trained counseling services within 24 hours (see counseling services within 24 hours (see bottom of form)bottom of form)

Receiving Facility ResponsibilitiesReceiving Facility Responsibilities

Advise patient that they can refuse testing, but EMS agency may seek court order

Notify EMS Agency immediately if patient refuses blood testing.

Draw patients blood and send it with the ERF to a qualified laboratory for testing

Work with the laboratory to assure the charges for the Source Patient are put on the Exposed EMS Providers worker’s Comp. bill.

Laboratory ResponsibilitiesLaboratory Responsibilities

Receives the samples with the accompanying ERF form

Tests the sample(s) for HIV, HBVand/or HCV

“Shall” send test results by Case ID number to the “Contact” at the EMS agency or employer

EMS Agency/Employer EMS Agency/Employer ResponsibilitiesResponsibilities

Provides training (initial and annual) to all EMS providers on this law, procedures for submitting an ERF and provisions of the Agency/Employers’ Exposure Control Plan (OSHA)

Maintains records of disease exposures as per OSHA Blood Borne Pathogen standards (R)

EMS Agency/EmployerEMS Agency/EmployerResponsibilitiesResponsibilities

If appropriate, reports refusal of testing by the source to the EMS provider and assists them in obtaining a court order for source patient blood testing.

Reports testing results immediately by case number, not name, to the exposed EMS provider

Ensures that exposed EMS provider receives a confidential medical evaluation, Post Exposure Prophylaxis (PEP) and follow-up according to OSHA regulations and CDC recommendations.

ResponsibilityResponsibilityfor payment of feesfor payment of fees

The Agency/Employer of the exposed EMS provider is responsible for all medical charges to the EMS provider and the Source Patient. These costs can be addressed by Workers

Compensation and or insurance. Costs billed must be within the Labor Commission

fee schedule

Exposure Control PlanExposure Control Plan

OSHA 1910.1030 OSHA 1910.1030 Title: Bloodborne PathogensTitle: Bloodborne Pathogens 1910.1030(c)(1)(i) “Each employer having an 1910.1030(c)(1)(i) “Each employer having an

employee(s) with occupational exposure as employee(s) with occupational exposure as defined by paragraph (b) of this section shall defined by paragraph (b) of this section shall establish a written Exposure Control Plan establish a written Exposure Control Plan designed to eliminate or minimize employee designed to eliminate or minimize employee exposure.”exposure.”

Exposure Control PlanExposure Control Plan

Who qualifies as an “employer” in this Who qualifies as an “employer” in this regulation?regulation? Utah Labor Commission UOSHA Compliance Utah Labor Commission UOSHA Compliance

Assistant Shaheen Safiullah gives the following Assistant Shaheen Safiullah gives the following definition….definition…. ““As long as employees are paid for their services As long as employees are paid for their services

they are considered employees. They would be they are considered employees. They would be covered by OSHA regulations. The regulations do covered by OSHA regulations. The regulations do not apply If they are purely volunteers ( no not apply If they are purely volunteers ( no payment).”payment).”

Exposure Control PlanExposure Control Plan

If you do not have an Exposure Control If you do not have an Exposure Control Plan… Do Not Despair!!!! This Plan… Do Not Despair!!!! This cancan be be done…done…

By following the information in the StandardBy following the information in the Standard By adapting a plan already writtenBy adapting a plan already written By filling in the blanks of one of the sample By filling in the blanks of one of the sample

Exposure Control Plans available.Exposure Control Plans available.

See resources in your handouts.See resources in your handouts.

Other Regulations that may Other Regulations that may influence your implementationinfluence your implementation

For Fire Departments adopting NFPA StandardsFor Fire Departments adopting NFPA Standards NFPA 1581 “Standard on Fire Department infection Control NFPA 1581 “Standard on Fire Department infection Control

Program” Program” NFPA 1582 “Standard on Medical requirements for Fire Fighters”NFPA 1582 “Standard on Medical requirements for Fire Fighters”

CDC Guidelines “Updated U.S. Public Health Service CDC Guidelines “Updated U.S. Public Health Service Guidelines for the Management of Occupational Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis” for Postexposure Prophylaxis” Information needed by the Healthcare Professional treating the Information needed by the Healthcare Professional treating the

EMS provider EMS provider [Required by 1910-1030(f)(3)(ii)][Required by 1910-1030(f)(3)(ii)]

ConclusionsConclusionsEncourage your EMS providers to..Encourage your EMS providers to..

Observe universal precautions.Observe universal precautions. Report and document all incidents, even if they Report and document all incidents, even if they

are unsure it is necessary are unsure it is necessary Keep forms and instructions at hand (with Keep forms and instructions at hand (with

SMIRFs).SMIRFs). Follow all instructions when exposed.Follow all instructions when exposed. NEVER ASSUME the rest of the system will NEVER ASSUME the rest of the system will

work as planed.work as planed. The most important acronym of all for your The most important acronym of all for your

agency and your people is…agency and your people is…

CYA

Thank You,Thank You,Stay SafeStay Safe

And Have Fun!!And Have Fun!!Salt Lake City Fire Department

Division of EMS/Safety and Wellness

EMT Coordinator Dorrell Henderson