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This plan supersedes all existing Exposure Control Plans in effect as of the above date.

Policy

The Union Hill Volunteer Fire Department is committed to provide a safe and healthful work environment for our entire staff. In pursuit of this endeavor, the following Exposure Control Plan (ECP) is provided to eliminate or minimize occupational exposure to bloodborne pathogens in accordance with OSHA Bloodborne Pathogens Standard, Title 29 code of Federal Regulations 1910.1030.

The ECP is a key document to assist our department in implementing and ensuring compliance with the standard, thereby protecting our employees. This ECP includes:

I. Employee exposure determination

II. The procedures for evaluating the circumstances surrounding and exposure incident, and

III. The schedule and method for implementing the specific sections of the standard, including:

-Methods of compliance

-Hepatitis B Vaccination and post-exposure follow-up

-Tuberculosis Immunization, exposure and post-exposure follow-up

-Training and Communication of hazards to employees

-Record Keeping

The Union Hill Fire Chief is responsible for the implementation of this ECP. The Chief will maintain and update the written ECP at least annually and whenever necessary to include new or modified tasks and procedures.

Those employees who are reasonable anticipated to have contact with or exposure to blood or other potentially infected materials are required to comply with the procedures and work practices outlined in this ECP.

The President of the Association and the Board of Directors will have the responsibility for written housekeeping protocols and will ensure that effective disinfectants are purchased.

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The Deputy Chief of Ambulance Operations will be responsible for ensuring that all medical actions required are performed and that appropriate medical records are maintained.

The Chief's office will be responsible for training, documentation of training, and making the written ECP available to employees, OSHA and NIOSH representatives.

The Deputy Chief of Ambulance Operations will maintain and provide all necessary personnel protective equipment (PPE), engineering controls (I.e. shar containers, etc.), labels, and red bags as required by the standard. The Deputy Chief of Ambulance Operations will ensure that adequate supplies of the aforementioned equipment are available.

Part I: Employee Exposure Determination

As a part of the exposure determination section of our ECP, the following is a list of all job classifications at our establishment in which all employees have occupational exposure:

Ambulance Medic

Ambulance Driver

Firefighter - Interior

Firefighter - Exterior

Fire Police

Firefighter - driver

Maintenance Technicians

All exposure determinations are made without regard to the use of PPE.

Part II: Methods of Implementation and Control

UNIVERSAL PRECAUTIONS:

As of March 6, 1992 all employees will utilize Universal Precautions. Universal Precautions is an infection control method which requires employees to assume that all human blood and specified human body fluids are infectious for HIV, HBV and other bloodborne pathogens (See Appendix A) and must be treated accordingly.

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Part III: EXPOSURE CONTROL PLAN (ECP)

Employees covered by the Bloodborn Pathogens Standard will receive and explanation of the ECP during their initial training sessions. It will also be reviewed in their annual refresher training. If refresher training is done by Video, a representative will be available to answer questions and explain department policy. All employees will have an opportunity to review this plan at any time as it is kept on file in the Emergency Plans book located in the dispatch office. Employees with questions about the plan may contact the Chief, Ambulance Training Director, or the Deputy Chief of Ambulance Operations. Employees seeking copies of the plan may contact the Chief's Office. A copy of the Plan will be made available free of charge and within 15 days of the request.

The Chief's office will also be responsible for reviewing and updating the ECP annually or sooner if necessary to reflect any new or modified tasks and procedures which affect occupational exposure and to reflect new or revised employee positions with occupational exposure.

Part IV: Engineering Controls and Work Practices

Engineering controls and work practice controls will be used to prevent or minimize exposure to bloodborne pathogens. The specific engineering controls and work practice controls we will use and where they will be used are listed below:

Sharps: All sharps will be secured by the ALS Technician using the sharp. The sharps will be placed in Sharp containers that are located in both ambulances. The sharp containers will be replaced as needed disposing of the entire container at an approved medical facility (local emergency rooms). Sharps found in the ambulances will be secure in the Sharps container located in the ambulance bays, which will be replaced as outlined above.

Sharps are to be stored in sealed containers that are sealed on all sides and have a non-openable top. Sharps containers must be of a type that will prevent sharps from coming out of the container if the container is tipped over. The container must be appropriately marked. Sharps containers must be easily accessible to personnel and located as close as feasible to the immediate area where sharps are used or can be reasonable anticipated to be found. Sharps containers also must be kept upright throughout use, replaced routinely, closed when moved, and not allowed to overfill. The containers must not be opened.

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Gloves: Gloves will be disposed of in Red Infectious disease bags which are kept in both ambulances. A supply of Red bags will always be maintained on both ambulances and in the ambulance bay. Red bags will be disposed of at the hospital when the patient is off loaded at the facility. Red bags at the ambulance base will be placed inside a second red bag in the ambulance and transported to a medical facility for destruction. A steady supply of gloves is to be available in both ambulances and readily accessible to all personnel.

Regulated waste and contaminated materials must be placed in bio-hazard (red) bags. These bags will be disposed of at an approved medical facility (hospital). The bags must be placed in a container that is solid and will not leak. If the container is contaminated it must be cleaned immediately or placed in a red bag for destruction. The container must then be replaced.

Laundry/other materials: Laundry and other materials (first aid equipment) will be maintained and cleaned as outlined in this plan.

New technology for needles and sharps will be evaluated and implemented whenever possible to further prevent accidental needle sticks and cuts. Our engineering controls will be inspected and maintained or replaced by the Deputy Chief of Ambulance Operations on a monthly basis (minimum).

Examples of engineering controls include, but are not limited to:

Shelf sheathing needles and puncture resistant disposal containers for contaminated sharps, glass, etc.

Examples of work practice controls include, but are not limited to:

-Providing hand washing facilities;

-Washing hands immediately or as soon as feasible after removal of gloves;

-Antiseptic towelettes and paper towels are provided for emergency scene

cleaning;

-Washing body parts as soon as possible after skin contact with blood or other potentially infectious materials occurs;

-Prohibiting the recapping or bending of needles;

-Breaking or shearing of contaminated needles is prohibited;

-Smoking, eating, drinking, applying cosmetics or lip balm or handling contact lenses in work areas where there is a likelihood of occupational exposure is prohibited.

-Food and drinks are prohibited from being kept on shelves, cabinets or on counter tops or bench tops where blood or other potentially infectious materials are or were present;

-All procedures involving blood or other potentially infectious materials shall be performed in such a manner as to minimize splashing, splattering, and generation of droplets of these substances;

-All equipment will be examined which may be contaminated with blood or other potentially infectious materials prior to servicing or shipping. Equipment will be decontaminated if necessary.

Part V: Personal Protective Equipment (PPE)

Personal protective equipment must also be used if occupational exposure remains after instituting engineering and work practice controls or if controls are not feasible. Training will be provided by the Chief's office in the use of the appropriate personal protective equipment of employees specific job classifications and tasks/procedures they will perform.

Additional training will be provided, whenever necessary, such as if an employee takes a new position of if new duties are added to their current position.

Appropriate personal protective equipment is required when employees are contacting patients or victims at any emergency scene. Appropriate equipment includes: gloves, face shields, eye protection and protective suits if necessary.

These items are in quantity on both ambulances and all personnel will be issued their own set of eye protection. Gowns, coats, face shields, masks, and resuscitation bags are kept on the ambulances.

PPE items include:

Gloves, gowns, shields, masks, eye protection (splash-proof goggles, safety glasses with side shields, etc.), resuscitation bags and mouthpieces.

As a general rule, all employees using PPE must observe the following precautions:

-Wash hands immediately or as soon as feasible after removal of gloves or other personal protective equipment;

-Remove protective equipment before leaving the work area and after a garment becomes contaminated;

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-Place used protective equipment in appropriately designated areas or containers when being stored, washed, decontaminated, or discarded.

Protective equipment is located on both ambulance and in the ambulance bay. Contaminated laundry and equipment is to be cleaned as soon as possible to minimize the potential for contamination to other employees.

-Wear appropriate gloves when it can be reasonable anticipated that you may have contact with blood or other potentially infectious materials and when handling or touching contaminated items or surfaces. Replace gloves if torn, punctured, contaminated, or if their ability to function as a barrier is compromised.

-Following any contact of body areas with blood or any other infectious materials, you must wash your hands and any other exposed skin with soap and water as soon as possible. Employees must also flush exposed mucous membranes (eyes, mouth, etc.) with water.

-Utility gloves may be decontaminated for reuse if their integrity is not compromised. The decontamination procedure will consist of washing the gloves in HOT (140 degrees) water in a laundry solution. Discard utility gloves when they show signs or cracking, peeling, tearing, puncturing, or deterioration.

-Never wash or decontaminate disposable gloves for reuse or before disposal.

-Wear appropriate face and eye protection such as a mask with glasses with solid side shields or a chin-length face shield when splashes, sprays, spatters, or droplets of blood or other potentially infectious materials pose a hazard to the eye, nose, or mouth.

-If a garment is penetrated by blood and/or other potentially infectious materials, the garments must be removed immediately or as soon as feasible,

-Repair and/or replacement of PPE will be at no cost to the employees.

Refer to Appendix I for additional information on PPE.

Part VI: Training

All employees who have or are reasonably anticipated to have occupational exposure to bloodborn pathogens will receive training conducted by the Chief's Office.

The Chief's office will provide training on the epidemiology of bloodborne pathogen diseases. This training shall be held annually and will be completed by all members who fit into any exposure category. In addition, the training program will cover, at a minimum, the following elements:

-An explanation of the standard;

-Epidemiology and symptoms of bloodborne pathogens;

-Modes of transmission;

-Our ECP and how to obtain a copy;

-Methods to recognize exposure tasks and other activities that may involve exposure to blood;

-Use and limitations of Engineering Controls, Work Practices, and PPE;

-PPE - types, use, location, removal, handling, decontamination and disposal;

-PPE - the basis for selection;

-Hepatitis B Vaccine - Offered free of charge. Training will be given prior to vaccination on its safety, effectiveness, benefits, and method of administration;

Tuberculosis Vaccination - Offered free of charge. Training will be given prior to vaccination on its safety, effectiveness, benefits, and method of administration;

-Emergency procedures - for blood and other potentially infectious materials

-Exposure incident procedures

-Post exposure evaluation and follow up

-Signs and labels - and/or color coding

-Questions and Answer session.

An employee education and training records will be completed for each employee upon completion of training. This document will be kept with the employee's records in the Chief's office.

Part VII: Hepatitis B. Vaccination

The Union Hill Fire Department will provide information on Hepatitis B Vaccinations addressing its safety, benefits, efficacy, methods of administration and availability. A general overview of these considerations is given in Appendix L for review. The Hepatitis B. Vaccination series will be made available at no cost within 10 days of initial assignment to employees who have occupational exposure to blood or other potentially infectious materials unless:

-The employee has previously received the series

-antibody testing reveals that the employee is immune;

-medical reasons prevent taking the vaccination; or

-the employee chooses not to participate.

All employees are strongly encouraged to receive the Hepatitis B vaccination Series. However, If an employee chooses to decline HB vaccination, then the employee must sign a statement to this effect.

Employees who decline may request and obtain the vaccination at a later date at no cost. Documentation of refusal of the HB vaccination will be kept in the Chiefs Office with the employees other medical records.

Other Hepatitis B information:

Participation in pre-screening is not a prerequisite for receiving Hepatitis B vaccination

Booster doses and administration of the series is in accordance with the US public Health Service protocols and recommendations.

Part VIII: Post Exposure Evaluation and follow-up procedures for Reporting, Documenting and Evaluating the Exposure

Should an exposure incident occur, contact the Deputy Chief of Ambulance Operations immediately. Each exposure must be documented by the employee on an "Exposure Report Form". The Deputy Chief of Ambulance Operations will ensure that the form is completed properly.

An immediately available confidential medical evaluation and follow-up will be conducted by emergency room staff of the hospital in which the patient was transported; or, in the event there was no transport at Rochester General Hospital.

The Exposure Incident Report, Request for Source Individual Evaluation, Employee Exposure Follow-up Report will be provided to the employee so they can bring them with them to the medical examination.

The Deputy Chief of Ambulance Operations will review the circumstances of the exposure incident to determine if procedures, protocols and/or training need to be revised.

Part IX: Housekeeping

The Union Hill Fire Department has developed and implemented a written schedule for cleaning and decontaminating work surfaces as indicated by the standard.

The ambulances, the equipment kept there-in and all laundry associated with a call will be cleaned with an appropriate disinfectant after each call. The ambulance bays and the contents there in will be kept in a clean condition at all time. All equipment, including backboards and other items which must be cleaned after a call will be cleaned immediately after the call - at the hospital if possible, if not possible, than back at quarters. A 50/50 mixture of Clorox and water will be used to clean these articles. Contaminated cleaning articles will be disposed of in biohazard bags.

All work surfaces will be cleaned immediately if they are contaminated with the Clorox solution.

-All cleaning containers and pails will be cleaned on a regular basis and immediately after they have been contaminated by an infectious material. Clorox and warm water is recommended to clean all surfaces.

-Mechanical means, such as tongs, forceps, or a brush and a dust pan will be used when picking up contaminated broken glassware; never pick up with hands even if gloves are worn.

Protective equipment - masks, gloves, eye protection must be worn when handling contaminated materials or when cleaning any item that has been contaminated or that it can be reasonably assumed was contaminated.

Part X: Laundry

The following contaminated articles will be laundered:

-All ambulance linen that is not paper (paper items will be destroyed in the red "biohazard" bags)

-All bunk room linen

Laundering will be performed by the duty crew at the conclusion of each call for ambulance linen, and at the beginning of the tour of duty for all bunk duty linen.

The following procedures will be used:

-Handle contaminated laundry as little as possible and with a minimum of agitation;

-Use appropriate personal protective equipment when handling contaminated laundry;

-Place bio-hazard contaminated laundry in leak-proof, labeled or color-coded containers before transporting. The bags should not leak. Laundry will be washed in hot water and will be washed with detergent in water at least 140F-160F for 25 minutes;

-Bag contaminated laundry at its location of use;

-Never sort or rinse contaminated laundry in areas of its use.

-Contaminated laundry should be transported in red "biohazard" bags. Laundry may also be destroyed in biohazard bags at the discretion of the crew.

-When handling contaminated laundry, employees will wear full eye, respirator, and hand protection.

-Sharps containers must be accessible in the event that a sharp is found in the laundry;

Part XI: Labeling

The Union Hill Fire Department will placed all contaminated materials in Red bio-hazard bags.

The Deputy Chief of Ambulance Operations will ensure that warning labels are affixed to red bags and will ensure that there is an adequate supply of red bags in the ambulances and ambulance bay area. Employees are to notify the Deputy Chief of Ambulance Operations if they discover unlableled regulated waste containers. The red bags will contain the biohazard symbol and word "biohazard" in a contrasting color and be closed after the items are placed therein.

Part XII: Record Keeping

Medical records are maintained for each employee with occupational exposure in accordance with 29CFR 1910.120

The Deputy Chief of Ambulance Operations is responsible for maintenance of the required medical records and they are kept in the Chief's office.

In addition to the requirements of 29CFR 1910.20 the medical records will include:

-The name and social security number of employee;

-A copy of the employee's hepatitis B vaccinations and any medical records relative to the employee's ability to receive vaccination;

-Other medical records will be kept by the Department Physician.

All employee medical records will be kept confidential and will not be disclosed or reported without the employees express written consent to any person within or outside the work place except as required y the standard or as may be required by law.

Employee medical records shall be maintained for at least the duration of employment plus 30 years in accordance with 29CFR 1910.20

Employee medical records shall be provided upon request of the employee or to anyone having written consent of the employee within 15 working days.

Part XIII: Training Records

Bloodborn pathogens training records will be maintained by the Assistant Chief in charge of training in the Chief's office of the Union Hill Volunteer Fire Department.

The training record shall include:

-the dates of the training sessions;

-the contents or a summary of the training sessions;

-the names and qualifications of persons conducting the training

-the names and job titles of all persons attending the training sessions.

Training records will be maintained for a minimum of three years from the date on which the training occurred.

Employee training records will be provided upon request to the employee or the employees authorized representative within 15 working days.

Part XIV: First Aid Providers

This section only applies to employees who are designated to render first aid assistance, but this assistance is not their primary work assignment. First aid providers who are not in coolateral duty categories at this facility are listed below for easy reference and also on page 2.

Designated first aid providers:

-Ambulance medics (second medics and trainees)

-fire police;

-ambulance drivers;

-apparatus drivers;

-department instructors; and

-department dispatchers

Our facility has decided to offer pre-exposure vaccination to all of these categories.

In the event of a first aid incident where blood or other potentially infectious materials are present, the employees providing the first aid assistance are instructed to report to the Deputy Chief of Ambulance Operations as soon as possible.

The Deputy Chief of Ambulance Operations will maintain a report which describes names of the first aider, date, time and description of the incident.

The Deputy Chief of Ambulance Operations will ensure that any first aider that desires the vaccine series after an incident involving blood or other potentially infectious materials will receive it as soon as possible, but not later than twenty four hours after the incident.

The Deputy Chief of Ambulance Operations will train first aid providers on the specific of the reporting procedures, in addition to all the training required in the training section of this plan.

Part XV: Tuberculoses Policy:

The Union Hill Fire Department shall offer TB skin tests (at no cost to the employees) to all current potentially exposed employees and to all new employees prior to exposure. The TB test will be offered at a time and location convenient to workers. Follow-up and treatment evaluations are also offered at no cost to the employees.

Training

Training and information to ensure employee knowledge of such issues as the mode of TB transmission, its signs and symptoms, medical surveillance and therapy and site specific protocols including the purpose and proper use of controls shall be provided to all current employees and to new workers upon hiring. Training will be repeated annually.

Employees shall be trained to recognize, and report to a designated person, any patients with symptoms suggestive of infectious TB and instructed on the post exposure protocols to be followed in the event of an exposure incidents.

Exposure Determination

All employees identified on page 2 are recognized to also be as risk for TB exposure and will be offered immunization.

Respirators

Respirators (HEPA) masks will be made available to all employees who may come in contact with TB patients. Employees will fit test these respirators on a annual basis and will be trained in the proper application and disposal of the mask after use. Universal precautions and disposal of contaminated materials as outlined in this standard also apply to TB exposure. The respirators will be kept in both ambulances and will be checked weekly to insure the are available and in apparent good working order. The masks will be kept sealed in the bag until they are used.

HEPA masks will be NIOSH approved or certified under 42 CFR part 84 subpart K.

Employees will wear the respirators when:

-entering rooms or a building where individuals with suspected or confirmed infectious TB are present;

-transporting an individual with TB in the ambulance or other vehicle.

Record Keeping

OSHA form 200 will be completed for all employees who have a positive TB test.

The Director of Health and the EMS coordinator will be notified of TB exposures by the Deputy Chief of Ambulance Operations.

By Order Of:

Brian M. Ball, Chief

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