Blood Borne Pathogen Exposure Update and Procedures

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Blood Borne PathogenExposure Update and
Procedures
By Dorrell Henderson EMS / Safety and Wellness
Div. Salt Lake City Fire Department
Adapted and updated from a slide show by Rebecca
Fronberg, BS, CHES HIV Counseling Testing
Coordinator Utah Department of Health
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Utah EMS Law Senate Bill 19

• Utah Code Title 34, Chapter 2-0-5
• Utah Code Title 78, Chapter 29-102
• Effective date, May 2, 2005
• Rule R612-10-1 and Form 350 9/05 adopted by Utah
  Labor Commission December 2005
• Rule in effect on February 1, 2006

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Significant Changes Made by SB19

• Moves provisions from the Health Code to the
  Labor Code regarding workers 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

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Purpose

• 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

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Presumption 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.

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Reporting 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 damage
• Any other method of transmission defined by the
  Utah Department of Health

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Potentially Infectious Body 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

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Presumptive EligibilityProvisions

• 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

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EMS Provider Responsibilities

• Know, understand and follow the provisions of
  your Agencys Exposure Control Plan

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EMS 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

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EMS 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

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EMS 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 Agencys policy for reporting an On
  the Job Injury
  This is an On the Job Injury

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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
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EMS 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

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Receiving Facility Responsibilities

• 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

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Receiving Facility Responsibilities

• Obtains permission from source patient to test
  for HIV, HBV and/or HCV
• Patient, next of kin or legal guardian may
  consent
• No consent required if under Utah Department of
  Corrections custody or if deceased
• If unable to provide counseling, provide the
  patient with phone numbers for trained counseling
  services within 24 hours (see bottom of form)

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Receiving 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 workers Comp. bill.

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Laboratory 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

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EMS Agency/Employer Responsibilities

• 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)

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EMS Agency/EmployerResponsibilities

• 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.

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Responsibilityfor 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

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Exposure Control Plan

• OSHA 1910.1030
• Title Bloodborne Pathogens
• 1910.1030(c)(1)(i) Each employer having an
  employee(s) with occupational exposure as defined
  by paragraph (b) of this section shall establish
  a written Exposure Control Plan designed to
  eliminate or minimize employee exposure.

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Exposure Control Plan

• Who qualifies as an employer in this
  regulation?
• Utah Labor Commission UOSHA Compliance Assistant
  Shaheen Safiullah gives the following
  definition.
• As long as employees are paid for their services
  they are considered employees. They would be
  covered by OSHA regulations. The regulations do
  not apply If they are purely volunteers ( no
  payment).

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Exposure Control Plan

• If you do not have an Exposure Control Plan Do
  Not Despair!!!! This can be done
• By following the information in the Standard
• By adapting a plan already written
• By filling in the blanks of one of the sample
  Exposure Control Plans available.
• See resources in your handouts.

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Other Regulations that may influence your
implementation

• For Fire Departments adopting NFPA Standards
• NFPA 1581 Standard on Fire Department infection
  Control Program
• NFPA 1582 Standard on Medical requirements for
  Fire Fighters
• CDC Guidelines Updated U.S. Public Health
  Service Guidelines for the Management of
  Occupational Exposures to HBV, HCV, and HIV and
  Recommendations for Postexposure Prophylaxis
• Information needed by the Healthcare Professional
  treating the EMS provider Required by
  1910-1030(f)(3)(ii)

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ConclusionsEncourage your EMS providers to..

• Observe universal precautions.
• Report and document all incidents, even if they
  are unsure it is necessary
• Keep forms and instructions at hand (with
  SMIRFs).
• Follow all instructions when exposed.
• NEVER ASSUME the rest of the system will work as
  planed.
• The most important acronym of all for your agency
  and your people is

CYA
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Thank You,Stay Safe

• And Have Fun!!

Salt Lake City Fire Department Division of
EMS/Safety and Wellness EMT Coordinator Dorrell
Henderson
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Contact Information

• Rebecca Fronberg, BS, CHES
• HIV Counseling Testing Coordinator
• Utah Department of Health
• [phone]
• rfronberg_at_utah.gov
• State of Utah Labor Commission
• Division of Industrial Accidents
• 160 E 300 S, 3rd FloorP O Box 146610
• Salt Lake City, UT 84114-6610
• [phone](800) 530-5090Fax [phone]