CONFIDENTIAL

County of Fresno Communicable Disease Exposure Reporting Procedure

In the event of a medical emergency involving a suspected infectious disease, the supervisor must provide advanced warning to our medical providers.

County employees who believe they have been occupationally exposed to blood, body fluids, Tuberculosis or a disease shall:

1. IMMEDIATELY report an exposure to their immediate supervisor. 2. In the case of a medical emergency, call 9-1-1 and notify them of the potential exposure. 3. The supervisor shall offer medical treatment to the employee. If treatment is accepted, the supervisor shall complete a workers’ compensation claim packet with the employee. 4. The medical treatment authorization form shall be signed and given to the employee after a copy is made and forwarded to the Risk Management Inbox. In the case of COVID-19 exposures, refer to the AIMS adjuster and Kaiser On The Job for telehealth appointments. For all other infectious disease exposure, Concentra is the approved provider during business hours. After hours and weekends, employees should be referred to ER’s. a. CALL AHEAD of the employee’s visit to medical provider. The selected medical treatment provider MUST BE NOTIFIED prior to referring an employee who is suspected to have been exposed to an infectious disease. b. In the case of infectious disease exposure, a call must also be made to Risk Management at (559) 600-1850, as well as to the department Exposure Control Officer. The supervisor will complete the Exposure Control Checklist to determine necessary documentation to be provided 5. The supervisor must complete the Supervisor Investigation Report even if a claim will not be filed by the employee and submit it to the Department Head and Workers’ Compensation Coordinator, Safety Coordinator, as well as to the Risk Management inbox, marked urgent. EMPLOYEE/EMPLOYER SECTION: Completed by supervisor and employee. 2 - 3 Exposure Control Checklist

PHYSICIAN SECTION: Completed by physician. 4 For Bloodborne Pathogens 4 For Aerosol Transmittable Diseases 5 Written Opinion and Summary of Findings

1 Revised 6/1/2020 Exposure Control Checklist

Note to Supervisors: Please complete the checklist and provide all related paperwork to employee prior to referral to the appropriate medical provider. As a reminder, you must call the designated provider prior to sending over employees. In the case of 911 emergency transportation being required, please make sure the medical personnel are aware of the suspected infectious disease exposure and notify Risk Management about any items on this list that were not provided in advance at 559-600-1850.

1. Does the employee believe they have been exposed to blood or bodily fluids?  No  Yes; If you checked yes, please also check Bloodborne Pathogens on the Notification to Treating Physician.

a. Examples can include needle sticks, bites, cuts, abrasions, or contact with blood or fluids through open wounds, and mucous membranes. b. If Yes, please provide employee with the following to give to the medical provider: i. Cal OSHA Title 8 Section 5193 ii. Please have the employee describe the incident and record that information in the field below.

iii. Please describe the employee’s work duties in the field below.

iv. Check with your personnel department for blood- and vaccination-related medical records that may be on file. c. If No, or if you believe that both blood and other potentially infectious diseases may be involved simultaneously, please continue to step 2.

2 Revised 6/1/2020 2. Does the employee believe they have been exposed to an infectious disease or an aerosol transmittable disease (ATD)?  No  Yes; If you checked yes, please also check Aerosol Transmittable Disease on the Notification to Treating Physician.

a. Examples include , Mumps, Covid-19, Tuberculosis, and any disease on Appendix A for employees in high-risk occupations. b. If Yes, please provide employee with the following to give to the medical provider: i. Cal OSHA Title 8 Section 5199 ii. Please have the employee describe the incident and record that information in the field below.

iii. Please describe the employee’s work duties in the field below.

iv. If an ATD case is suspected please immediately follow up with your department HR as additional records are required.

3 Revised 6/1/2020 PHYSICIAN'S SECTION

Note to Treating Physician/Health Care Professional

Please Complete and Return Information in the Fillable Fields

Per CCR, Title 8, Section 5193- Bloodborne Pathogens, and CCR, Title 8, Section 5199 – Aerosol Transmittable Disease, after an employee covered by the regulation is exposed to a BBP, or ATD, employers are required to obtain and provide the employee with a copy of the evaluating Healthcare Professional’s written opinion within 15 days of completion of evaluation. Employees not subject to 5199 may also be noticed without the same deadline.

The Healthcare Professional’s written opinion for post-exposure evaluation and follow-up shall be limited to the following information:

For Bloodborne Pathogens:  Applicable? 1. Is the Hepatitis B vaccination needed for this employee and has the employee received this vaccination?  No  Yes 2. Has employee been informed of the results of the evaluation?  No  Yes 3. Has employee been told about any medical conditions resulting from exposure to blood or OPIM which require further evaluation or treatment?  No  Yes

For Aerosol Transmittable Diseases:  Applicable? 1. What is the employee’s TB test status or applicable RATD test status for the exposure of concern?  Negative  Positive 2. What is the employee’s infectivity status?  Not Infected  Infected 3. Has the employee been informed of the results of the medical evaluation?  No  Yes 4. Has the employee been offered any applicable vaccinations, prophylaxis, or treatment?  No  Yes 5. Has the employee been told about any medical conditions resulting from exposure to TB, other RATD, or ATP-L that require further evaluation/treatment?  No  Yes 6. Has the employee has been informed of treatment options?  No  Yes 7. Are there any recommendations for precautionary removal from the employee’s regular assignment?  No  Yes If Yes, for what duration? Days

4 Revised 6/1/2020 PHYSICIAN'S SECTION

Required Written Opinion and Summary of Findings: Please provide a brief summary of findings from the above questions in written form to include necessary follow-up treatment, infectivity scenario and diagnosis in the box below.

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

Please email this form report to: mailto:[email protected] mailto:[email protected]

5 Revised 6/1/2020 Appendix A – Aerosol Transmissible Diseases/Pathogens (Mandatory)

This appendix contains a list of diseases and pathogens which are to be considered aerosol transmissible pathogens or diseases for the purpose of Section 5199. Employers are required to provide the protections required by Section 5199 according to whether the disease or pathogen requires airborne infection isolation or droplet precautions as indicated by the two lists below.

Diseases/Pathogens Requiring Airborne Infection Isolation Aerosolizable spore-containing powder or other substance that is capable of causing serious human disease, e.g. Anthrax/Bacillus anthracis Avian influenza/Avian influenza A (strains capable of causing serious disease in ) Varicella disease (, )/Varicella zoster and Herpes zoster viruses, disseminated disease in any patient. Localized disease in immunocompromised patient until disseminated infection ruled out Measles (rubeola)/Measles /Monkeypox virus Novel or unknown pathogens Severe acute respiratory syndrome (SARS) (variola)/Varioloa virus Tuberculosis (TB)/Mycobacterium tuberculosis -- Extrapulmonary, draining lesion; Pulmonary or laryngeal disease, confirmed; Pulmonary or laryngeal disease, suspected Any other disease for which public health guidelines recommend airborne infection isolation

Diseases/Pathogens Requiring Droplet Precautions Diphtheria pharyngeal Epiglottitis, due to Haemophilus influenzae type b Haemophilus influenzae Serotype b (Hib) disease/Haemophilus influenzae serotype b -- Infants and children Influenza, human (typical seasonal variations)/influenza viruses Meningitis Haemophilus influenzae, type b known or suspected Neisseria meningitidis (meningococcal) known or suspected Meningococcal disease sepsis, pneumonia (see also meningitis) Mumps (infectious parotitis)/Mumps virus Mycoplasmal pneumonia infection (erythema infectiosum) Pertussis (whooping cough) Pharyngitis in infants and young children/Adenovirus, Orthomyxoviridae, Epstein-Barr virus, virus, Pneumonia Adenovirus Haemophilus influenzae Serotype b, infants and children Meningococcal Mycoplasma, primary atypical Streptococcus Group A Pneumonic plague/Yersinia pestis

6 Revised 6/1/2020 virus infection (German measles)/ Severe acute respiratory syndrome (SARS) Streptococcal disease (group A streptococcus) Skin, wound or burn, Major Pharyngitis in infants and young children Pneumonia in infants and young children Serious invasive disease

Viral hemorrhagic fevers due to Lassa, Ebola, Marburg, Crimean-Congo fever viruses (airborne infection isolation and respirator use may be required for aerosol-generating procedures) Any other disease for which public health guidelines recommend droplet precautions

7 Revised 6/1/2020