ADMINISTRATIVE INSTRUCTION Communicable Disease III-5-8 SUBJECT: NUMBER: Exposure Control Plan

EFFECTIVE DATE: July 25, 2005 (R) PAGE: 1 of 20

I. Purpose

The purpose of the Communicable Disease Exposure Control plan is to protect employees who may be exposed to bloodborne, airborne, and waterborne diseases on the job, and to comply with Cal-OSHA Standard CFR 1910.1030, as part of the City’s Injury and Illness Prevention Program.

The intent of the plan is to eliminate or reduce employee occupational exposures to bloodborne, airborne, and waterborne diseases, including the Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Human Immunodeficiency Virus (HIV), and other bloodborne diseases, as well as Hepatitis A, a non-bloodborne disease; Tetanus, and airborne exposures to . To assure compliance with this plan the City will:

1. Provide protection for employees whose job classifications may frequently or occasionally place them in contact with bloodborne, airborne or waterborne diseases; through training, a voluntary vaccination program, engineering controls, work practice controls, housekeeping controls, and use of personal protective equipment where applicable.

2. Provide protection for all employees whose job classifications do not place them in contact with bloodborne, airborne, or waterborne diseases, but may on rare occasion encounter bloodborne, airborne, or waterborne disease exposures while at work, through awareness training, including how to safeguard themselves’ in the event of bloodborne airborne, or waterborne disease exposures while at work or at home.

3. Provide appropriate testing, treatment, follow up, and counseling to employees who have been exposed to bloodborne, airborne, or waterborne diseases while performing their duties for the City.

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II. Scope

It is the City's intent to inform all employees of the Communicable Disease Exposure Control Plan so that they are aware of what bloodborne, airborne, or waterborne disease exposures may exist on the job, and how to protect themselves.

Providing up-to-date information starts with initial training for all new employees and continues with annual refresher training by Risk Management for those employees in primary job classifications or, by the Fire Department Designated Officer for Sworn Fire and Police employees, or by the Aquatics Staff for the Swim Center. (Ref. appendix A)

The majority of job classifications at the City have little or no exposure to bloodborne, airborne, or waterborne diseases. Job classifications that have a higher risk of exposure, some of which include Firefighters, Police Officers, Swim Instructor / Lifeguards, Wastewater Collection employees, and Custodians have been identified as primary job classifications; requiring in-depth training, a voluntary program for Hepatitis A and Hepatitis B virus vaccinations, engineering controls, work practice controls, housekeeping controls, and the use of personal protective equipment, when applicable on the job.

III. Definition

Bloodborne refer to microorganisms present in human blood that are capable of causing disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV), Hepatitis C virus (HCV), and Human Immuno¬deficiency virus (HIV).

Hepatitis B is a viral infection of the liver caused by the hepatitis B virus (HBV). Hepatitis B is spread by direct or indirect contact with infected blood or other body fluids. Complications of HBV infection include cirrhosis of the liver, liver cancer, liver failure, and death. Infection from Hepatitis B can be prevented, by taking the 3 shot series Hepatitis B vaccine. The yeast derived Hepatitis B vaccine will be offered to those employees in primary job classifications free of charge. ADMINISTRATIVE INSTRUCTION Communicable Disease III-5-8 SUBJECT: NUMBER: Exposure Control Plan

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Hepatitis C is a viral infection of the liver caused by the hepatitis C virus (HCV) which is found in the blood of persons who have the disease. HCV is spread by direct or indirect contact with the blood of an infected person. Approximately 50% of infected persons develop chronic liver disease. There Is no HCV vaccine available at this time.

The Human Immunodeficiency Virus (HIV) is a virus that attacks the immune system and destroys its ability to fight infection. HIV that progresses to the later stages of disease is called AIDS (acquired immuno¬deficiency syndrome). In prospective studies of workers, the average risk of HIV transmission after a percutaneous exposure to HIV-infected blood has been estimated to be approximately 0.3% and after a mucous membrane exposure, approximately 0.09%. There is no FDA approved vaccine currently available for HIV.

Non-bloodborne diseases include Hepatitis A, a viral infection of the liver caused by the hepatitis A virus (HAV). Hepatitis A is not spread via blood. Transmission occurs through direct person-to-person contact, through exposure to contaminated water, ice, or shellfish, or from fruits, vegetables, or other foods eaten uncooked that were contaminated during harvesting. A yeast-based HAV vaccine is available for those employees in primary job classifications.

Tuberculosis (TB) is a bacterial airborne disease spread through the air from person- to-person when a person with TB disease of the lungs coughs or sneezes. Most people with strong immune systems who breathe in TB bacteria are able to fight off the bacteria and never develop tuberculosis. Repeated exposures to TB bacteria in people with weakened immune systems are the highest risk factor for developing tuberculosis.

Waterborne diseases that may be found in grey water, stagnant water, and sewer water include cholera, polio, dysentery, and Hepatitis A. Cholera for example, is a bacterial infection spread by drinking dirty water or ingesting contaminated food, affecting the intestines and dehydrating it’s victims. Hydration that includes clean water, and essential nutrients like glucose and salt, is the cure.

ADMINISTRATIVE INSTRUCTION Communicable Disease III-5-8 SUBJECT: NUMBER: Exposure Control Plan

EFFECTIVE DATE: July 25, 2005 (R) PAGE: 4 of 20

Tetanus is a bacterial disease that affects the nervous system. It is contracted through a cut or wound from a sharp object, like a rusty nail or knife that has tetanus bacteria from soil, dust, or manure. There is a combination shot called a Td vaccine that provides protection from tetanus.

IV. Responsibilities

The City Manager and Department Heads are responsible for supporting the overall intent of the Communicable Disease Exposure Control Plan, which is to eliminate or reduce employee occupational exposures to bloodborne, airborne, and waterborne diseases while at work.

The responsibility for the effective implementation and maintenance of the City's Communicable Disease Exposure Control Plan include:

− Risk Control Officer − Designated Officer for Sworn Employees − Designated Officer for Non-Sworn Employees − Department Managers and Supervisors − Education/Training Instructors − City Employees

Risk Control Officer The Risk Control Officer from the Risk Management Division will be responsible for the development, support, annual regulatory review and revision if necessary, of the communicable disease exposure control plan.

Designated Officer for Sworn Employees The EMS Educator of the Fire Department will serve as the Designated Officer of the Communicable Disease Exposure Control Plan for sworn employees at the Fire Department and Police Department. Responsibilities include liaison duties between City employees and treating medical facilities and physicians regarding communicable disease exposures and post-exposure management.

ADMINISTRATIVE INSTRUCTION Communicable Disease III-5-8 SUBJECT: NUMBER: Exposure Control Plan

EFFECTIVE DATE: July 25, 2005 (R) PAGE: 5 of 20

Designated Officer for Non-Sworn Employees The Workers’ Compensation Administrator from the Risk Management Division will serve as the Designated Officer of the Communicable Disease Exposure Control Plan for non-sworn employees. Responsibilities include liaison duties between City employees and treating medical facilities and physicians regarding bloodborne, airborne, and waterborne disease exposures and post-exposure management.

Department Managers and Supervisors Department Managers and Supervisors are responsible for informing employees of the City’s exposure control plan. They may work directly with the Risk Control Officer and / or Designated Officers to ensure that training programs, personal protective equipment, medical equipment (where applicable), and exposure control procedures are in place and available to employees. Current information regarding the exposure control plan may be given out at new employee orientation, during annual training where applicable, and at Departmental/ Divisional safety meetings, or via the City’s Safety Committees.

Education/Training Coordination The Human Resources Department, Risk Control Officer, Fire Department and outside contractors may all contribute to employee training for the exposure control plan. Training may be given through new employee orientation, current bloodborne, airborne, and waterborne disease information from handouts and booklets, safety meetings and through safety committees.

Technical training for the primary job exposure classifications will be provided by the Risk Control Officer, the Fire Department Designated Officer, Aquatic Staff, and/or outside consultants. Primary job exposure classifications will be given annual refresher training on current information regarding bloodborne, airborne, and waterborne diseases, and regulatory changes to the law.

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V. Procedures and Responsibilities

There are a number of areas that must be addressed in order to effectively eliminate or minimize exposure to bloodborne, airborne, and waterborne diseases in City operations. The City's plan covers:

− The use of Universal Precautions and Body Substance (BSI) − Establishing appropriate Engineering Controls − Implementing appropriate Work Practice Controls − Wearing the required Personal Protective Equipment − Implementing appropriate Housekeeping Procedures

Universal Precautions involves treating all blood, blood products, and body fluids containing blood encountered on the job as if they were infectious, as well as encountering and handling persons with chronic coughing as if they were infectious. Body substance isolation is a practice of isolating all body substances of individuals undergoing medical treatment. This includes the mandatory use of protective barriers that may include barrier creams, respirator masks, aprons, gloves, glasses and face shields.

Engineering Controls One of the key aspects of the Communicable Disease Exposure Control Plan is the use of engineering controls to eliminate or minimize employee exposure to blood and airborne diseases. The Risk Control Officer works with Department Managers and Supervisors to review tasks and procedures performed by employees called Job Safety Analyses. Those tasks that may bring the employee into contact with blood or blood products will be evaluated to ensure that the best personal protective equipment, latest medical equipment, disinfectants, bio-hazard disposal, vacuums/exhausts, fume hoods, and other engineering controls are considered to eliminate or reduce employee exposure. Engineering controls may include:

− Leak proof sharps* containers for contaminated sharps, that are color coded and labeled with a biohazard logo. * Sharps are any needle, syringe, or razor type of implement.

ADMINISTRATIVE INSTRUCTION Communicable Disease III-5-8 SUBJECT: NUMBER: Exposure Control Plan

EFFECTIVE DATE: July 25, 2005 (R) PAGE: 7 of 20

− Engineered sharps delivery systems for medication administered to patients being serviced by Fire Department Paramedics.

− Hand washing facilities supplied with disinfectant cleansers, barrier creams, and/or packages of antiseptic wipes for areas where water is not readily available. − Environmentally controlled rooms to isolate, filter, and remove airborne contaminants or diseases, or blood stained clothing.

− Disposal sites for bio-hazardous wastes generated from a blood clean up or medical waste other than sharps. Disposal sites may include Santa Monica and / or St Johns Hospital.

Work Practice Controls In addition to engineering controls, the City has developed a set of work practice controls as part of the Code of Safe Work Practices handbook. These controls are in place to help eliminate or minimize employee exposure to blood and airborne diseases.

− Upon bodily contact with blood, or products that may contain blood, like wastewater; employees are instructed to wash contact areas with soap and water, antiseptic solutions, or antiseptic wipes.

− Contaminated clothing and personal protective equipment must be removed and placed in a yellow biohazard bag with a red biohazard label, or container for disposal or decontamination. (Also see section on Personal Protective Equipment for further information)

− Contaminated equipment must be inspected and tagged with a bio- hazardous warning label until it can be disinfected. (Also see section on Personal Protective Equipment for further information)

− Contaminated sharps used as medicinal delivery systems must be safely disposed of in a sharps container after use. The sharps container must be disposed of when the container is or reaches 3/4 full, but in no case may the sharps container be on-site longer than 30 days. (Also see section on Personal Protective Equipment for further information) ADMINISTRATIVE INSTRUCTION Communicable Disease III-5-8 SUBJECT: NUMBER: Exposure Control Plan

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− A Sharps Injury Log must be maintained as a record of each exposure incident involving a sharp, and logged within 14 days of notice to the Department, and will include:

ƒ Date and time of the exposure incident ƒ Type and brand of sharp involved in the exposure incident ƒ Description of the incident including:

- What is the job classification of exposed employee? - The Department / Division of exposed employee? - Where is the work area where the exposure occurred? - What procedure was the employee was performing at time of incident? - How did the incident occur? - What body part was involved in the exposure incident? - Did the sharp involved have an engineered sharp protective mechanism and was it used or not? - Does the exposed employee have an opinion on whether any engineering, administrative, or work practice control could have prevented the injury?

− Storage or consumption of food, application of lip balms, or eye, ear, nasal or throat medicinal products, and all cosmetics is prohibited in work areas where a potential for exposure to blood diseases may exist. Areas where this may apply include paramedic vehicles, Police property storage room, Police jail work areas, Police ID Tech work areas, and areas containing sharps containers and other bio-hazardous waste products.

− When new or transferred employees are introduced into a work area that may include the possibility of exposure to blood and airborne diseases, the Supervisor will discuss the work practice controls that apply in that area and provide training to the employee in the City’s communicable disease exposure control plan.

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Personal Protective Equipment The use of disposable personal protective equipment is required to be worn by the primary job classifications when they perform tasks that involve exposure to blood, blood products, or body fluids containing blood. Disposable personal protective equipment may include but is not limited to:

− Antiseptic barrier creams or lotions − Latex, nitrile, or vinyl gloves impervious to biohazards − Safety glasses, goggles, and face shields − Mask or respirators impervious to biohazards − Coveralls, lab coats, and aprons impervious to bio-hazards

Managers and Supervisors who have employees in primary job classifications, susceptible to blood exposures and disease, are responsible for ensuring that all work areas (including vehicles) have the appropriate personal protective equipment and disposal equipment available for use during blood exposure situations.

To ensure that personal protective equipment are not contaminated by blood, or blood products, the following work practices apply:

− All personal protective equipment is to be inspected immediately after use and disinfected, repaired, or replaced as necessary to maintain its effectiveness.

− All personal protective equipment that has been used in the past must be inspected prior to reusing the equipment for possible contamination or defects. The personal protective equipment must be decontaminated or disposed of properly if damaged beyond use.

− Single use personal protective equipment must be removed and disposed of properly after use. Masks, shields, and aprons are to removed first, followed by removal of gloves. Gloves are to be removed properly in a manner to prevent further contamination. Gloves should be turned inside out to protect exposed skin during removal and disposed of properly.

ADMINISTRATIVE INSTRUCTION Communicable Disease III-5-8 SUBJECT: NUMBER: Exposure Control Plan

EFFECTIVE DATE: July 25, 2005 (R) PAGE: 10 of 20

To ensure that personal protective equipment is used properly, the following work practices apply:

− Latex, nitrile, or vinyl gloves impervious to biohazards must be worn whenever employees come upon the scene of a blood exposure, or anticipate hand contact with blood, blood products, or bodily fluids containing blood. A paramedic response call would be a time when hand contact with blood would be anticipated.

− Latex, nitrile, or vinyl gloves must be inspected when donned to make certain that the barrier is not compromised by a puncture or tear. If the barrier has been compromised, another pair of gloves must be used.

− Masks, glasses, goggles and face shields must be inspected prior to use if they are not single use personal protective equipment to determine if the protection they provide is still effective and that they are free from contamination.

− Clothing that has been penetrated by blood or blood products must be removed immediately or as soon as practical to avoid contact with the skin. Clothing must be disposed of properly or decontaminated. Saturated clothing must be disposed of in a bio-hazardous bag or container, or stored in a yellow bio-hazardous bag with a red bio-hazardous label or container for decontamination.

Housekeeping Practices In work areas for the primary job classifications such as a Paramedic vehicle, Police vehicle, Police ID Tech Lab, Police Property Room, Police Jail, and Santa Monica Swim Center, maintaining these areas in a clean and sanitary condition is an important part of the City’s exposure control plan. When a work area has been exposed to or contaminated by blood or blood products:

ADMINISTRATIVE INSTRUCTION Communicable Disease III-5-8 SUBJECT: NUMBER: Exposure Control Plan

EFFECTIVE DATE: July 25, 2005 (R) PAGE: 11 of 20

− The affected work area is required to be cordoned off to the public, disinfected by trained employees using approved disinfectants and personal protective equipment, thoroughly cleaned up with a spill kit or other appropriate absorbent material while wearing appropriate personal protective equipment before re-opening the area to the public. The contaminated material must be safely stored in a bio-hazardous waste container and taken to a local hospital for disposal.

− Contaminated sharps or broken glassware must be picked up by mechanical means such as broom and dustpan, forceps, or tongs and placed in an approved sharps container. Bare or gloved hands may not be used to pick up contaminated sharps or broken glassware.

Biohazard Containers and Labels Biohazard Sharps containers and biohazard bags are red in color and identified by the biohazard warning label. Containers of this regulated waste are placed in areas where blood waste may be generated, and easily accessible to employees. Disposing of blood and blood product waste from sharps containers and biohazard bags are to be handled by qualified employees.

The Fire Department and local can handle certain blood and blood product wastes from sharps containers and biohazard bags. Yellow bio- hazardous bags with red bio-hazardous labels are provided to store clothing that needs to be decontaminated. Biohazard labels may also be placed on storage sites such as Police Property Room refrigerators to warn employees when blood evidence is stored within. Storage refrigerators for blood evidence cannot store food or other consumable products.

Disease Vaccination Program The City has in place a voluntary Hepatitis A and Hepatitis B vaccination program for employees whose primary job classifications place them at greater risk of exposure to these diseases. The vaccination program consists of two immunizations over a six-month period for Hepatitis A, and a series of three immunizations over a six-month period for Hepatitis B. Both of the vaccines are yeast-based and contain no blood or blood products. Those employees in primary job classifications who decline to participate in the Hepatitis A or the Hepatitis B vaccination program must sign a declination form. (See appendix B) ADMINISTRATIVE INSTRUCTION Communicable Disease III-5-8 SUBJECT: NUMBER: Exposure Control Plan

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Employees who are in primary job classifications may make an appointment to receive the Hepatitis A and / or Hepatitis B vaccinations at a local facility by contacting the City’s Human Resources Department.

Post-Exposure Evaluation and Follow-Up If an employee is involved in an incident where they are exposed to blood or blood products as determined by a treating physician based on the facts of the incident, counseling will be made available to the employee regarding testing protocols, treatment options, and other employee concerns and needs. Documentation is important, and a number of forms must be completed including:

− The Communicable Disease Exposure and Notification Report are available from Departments that have primary job classifications, in Police squad cars, in Fire Department vehicles, or through Risk Management. (See appendix C for a copy of this report) This report and other workers’ compensation reports generated will remain confidential.

− Employee workers’ compensation claim forms, available through the employee’s Supervisor. In order for the City to provide prompt follow up on possible blood and airborne disease exposures, it is the employee’s responsibility to completely fill out this form detailing the circumstances surrounding the exposure.

− Supervisor Report of Accident Investigation Employee Injury/Illness form is available on-line or internally through the Department or Division. The Supervisor will complete this form after investigating the circumstances surrounding the exposure.

Medical Recordkeeping The Risk Management Division will maintain all medical records pertaining to blood exposures in confidence. Medical records will only be released with the consent of the employee involved in the exposure or as required by law.

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Other medical records regarding vaccination histories, annual physical examinations, or other medical information may be stored at Risk Management, the Human Resources Department, or the Department where the employee works.

VI. Information and Training

Knowledge is a key component in preparing employees to handle the tasks they are assigned to perform as part of their job responsibilities in the City. Nowhere is that more important than those primary job classifications that are at greater risk of exposure to bloodborne diseases. All employees who have the potential for exposure to bloodborne diseases will be provided in depth training and annual refresher training with the latest information available regarding diseases, routes of entry, personal protective equipment, safe work practices and procedures, vaccinations, medical treatment and post-exposure management.

All employees shall have access to this policy as part of the Injury and Illness Prevention Program at the City, whose goal is to provide a safe and healthy work environment for all employees.

VII. Appendices

A. Primary Job Classifications

B. Hepatitis B Vaccination Declination Form

C. Communicable Disease and Exposure Notification Form

D. Definitions

E. Post Exposure Management Procedure

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VIII. Sources of Additional Information

A. Risk Management - Risk Control Officer

B. Fire Department – EMS Educator

C. Human Resources Department

D. Title 8, California Code of Regulations, Section 5193

IX. Authorized by

______Susan E. McCarthy City Manager

III-5-8 Page 15 of 20 APPENDIX A

Primary Job Classifications

Santa Monica Police Department: Animal Control Office Supervisors Animal Control Care Attendants, and Animal Control Officers Police Captains, Police Lieutenants, and Sergeants Police Officers, Police Officers- Lateral, and Police Officers-Pre Service Lead Airport Services Officer Community Service Officers I, II ID Technicians, Forensics Specialist, and Forensic Section Supervisor Fingerprint Clerks Property Evidence Clerk, and Supervisor Property Evidence Clerk Park Rangers Range Master Pier & Harbor Guards Jailers and Jail Manager

Santa Monica Fire Department: Resource Management Battalion Chiefs Airport Maintenance Worker Fire Captains Airport Maintenance Supervisor Fire Engineers Firefighter / Paramedics

Environmental & Public Works Management: Lead Hazardous Materials Technicians Wastewater Crew Leader Hazardous Materials Technicians Transfer Station Assistant Industrial Waste Environmental Inspectors Transfer Station Supervisor Senior Transfer Station Assistant Wastewater Supervisor Sewer Maintenance Workers I, II Maintenance Workers I, II Custodial Workers I, II and Custodial Supervisors Mechanic I, II Plumbing Crew Leader, Plumbers, and Pipe Fitters Fleet / Welders Beach Maintenance Supervisor Mall Maintenance Supervisor

Community & Cultural Services: Chief Pool Lifeguards, Pool Lifeguards, and Swim Instructor Lifeguards Principal Community Services Supervisor - Aquatics Custodial Workers I, II and Custodial Supervisors Aquatics Maintenance Workers Civic Event Attendants I, II, III Civic Auditorium Maintenance Supervisor Civic Auditorium Operations Superintendent

Transportation: Bus Motor Coach Cleaners, Transit Maintenance Workers, Transportation Mechanic Supervisors, Transportation Mechanics I, II. Transit Vehicle Maintenance Superintendent. III-5-8 Page 16 of 20 APPENDIX B

Vaccination Declination Form

Date: ______

Employee Name: ______

Employee SS#: ______

I understand that due to my occupational exposure to blood, blood products, bodily fluids containing blood, or other potentially infectious materials; that I may be at risk of acquiring blood disease, some of which include the Hepatitis A virus and Hepatitis B Virus for which yeast based vaccines are available.

I have been given the opportunity by the City to be vaccinated with either or both of these vaccines, at no cost to myself. However, I decline to be vaccinated at this time with:

Hepatitis A vaccine ______

Hepatitis B vaccine ______

I understand that by declining either or both of the above vaccines at this time, that I continue to be at risk of acquiring one or both of the above Hepatitis diseases, with Hepatitis B being the more serious disease, one that can be life threatening.

If in the future if I wish to participate in the City’s Hepatitis vaccination program I understand that I will be able to do so, at no cost to myself.

______Employee Signature Date

______Name of City Representative

______City Representative Signature Date III-5-8 Page 17 of 20 APPENDIX C

COMMUNICABLE DISEASE EXPOSURE AND NOTIFICATION REPORT

Employee Name Employee # / Serial #

Employee Contact Telephone # Employee Supervisor

EMS Report Seq. # Incident # / DR# Unit # Date & Time of Exposure

CHECK PERSONAL PROTECTIVE EQUIPMENT (PPE) USED:

None Exam Gloves Eye Glasses Goggles Surgical Mask N-95 or N-100 Mask Gown Turnouts Brush Jacket Other ______

CHECK TYPE OF EXPOSURE:

Blood splash to skin non-intact skin (cut, rash, abrasion) intact skin Blood splash to eyes Blood splash to mouth/nose Contact with Other Body Fluids WITH visible blood Contact with Other Body Fluids with NO visible blood Airborne Exposure Suspect TB Suspect Meningitis Needle Stick Other ______

DESCRIBE HOW EXPOSURE / INJURY OCCURRED:

Source Patient Name & DOB Parent Transported To

Patient Address Patient Phone No.

Reported Exposure to Receiving Facility Physician - Dr. ______

Name of Health Care Facility Health Care Facility Employee Receiving Report (PRINT NAME)

Employee Signature Date

White – Hospital Infection Control Nurse Canary – Department Pink – Risk Management Goldenrod -- Employee

RM-EXP-02 REV 2004 III-5-8 Page 18 of 20

Appendix D Definitions

Blood means human blood, human blood components, and products made from human blood.

Bloodborne Pathogens means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV).

Body substance isolation is a practice of isolating all body substances (blood, urine, feces, tears, etc.) of individuals undergoing medical treatment, particularly emergency medical treatment of those who might be infected with illnesses such as HIV, or hepatitis so as to reduce as much as possible the chances of transmitting these illnesses. BSI is similar in nature to universal precautions, but goes further in isolating substances.

Contaminated means the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface.

Contaminated Laundry means laundry, which has been soiled with blood or other potentially infectious materials or may contain sharps.

Contaminated Sharps means any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires.

Decontamination means the use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point where they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.

Engineering Controls means controls (e.g., sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate or remove the bloodborne pathogens hazard from the workplace.

Exposure Incident means a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee's duties.

HBV means hepatitis B virus.

HCV means hepatitis C virus.

HIV means human immunodeficiency virus.

Needleless Systems means a device that does not use needles for (1) the collection of bodily fluids or withdrawal of body fluids after initial venous or arterial access is established; (2) the administration of medication or fluids; or (3) any other procedure involving the potential for occupational exposure to bloodborne pathogens due to percutaneous injuries from contaminated sharps.

III-5-8 Page 19 of 20

Occupational Exposure means reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties.

Other Potentially Infectious Materials means (1) The following human body fluids: , vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; (2) Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and (3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV- containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.

Parenteral means piercing mucous membranes or the skin barrier through such events as needle sticks, human bites, cuts, and abrasions.

Personal Protective Equipment is specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes (e.g., uniforms, pants, shirts or blouses) not intended to function as protection against a hazard are not considered to be personal protective equipment.

Regulated Waste means liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials.

Sharps with Engineered Sharps Injury Protections means a non-needle sharp or a needle device used for withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids, with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident.

Source Individual means any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee. Examples include, but are not limited to, hospital and patients; clients in institutions for the developmentally disabled; trauma victims; clients of drug and alcohol treatment facilities; residents of and homes; human remains; and individuals who donate or sell blood or blood components.

Universal Precautions is an approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.

Work Practice Controls means controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g., prohibiting recapping of needles by a two-handed technique). III-5-8 Page 20 of 20 Appendix E Santa Monica Fire Department Santa Monica Police Department

Post Exposure Management Procedure

Request to Medical Facility for Source Patient Testing

The Santa Monica Fire and Police Departments request that the following tests be ordered on any source patient involved in an occupational exposure to blood and/or body fluids to our personnel.

1. Hepatitis B Antigen 2. Hepatitis C Antibody 3. Rapid HIV if available 4. HIV 1 & 2 Antibody

Dr. Wally Ghurabi, Medical Director

Jodi Nevandro MSN, RN, Designated Infection Control Officer Office: 310-458-4929 Pager: 310-201-1071