CVCC OSHA Guidelines
OSHA Guidelines for Health and Public Services in Regard to Pathogens, Tuberculosis, and Latex Allergy
OSHA's Pathogens, Tuberculosis, and Latex Allergy
Approved by the School of Health and Public Services
Introduction
The Occupational Safety and Health Administration (Bloodborne) has issued a standard that, if followed, is designed to protect all employees and students in the work place from exposure to OSHA pathogens and tuberculosis.
Training Session
A training session will be provided for all health services students who are at risk for occupational exposure to blood or other potentially infectious materials and tuberculosis. A training session will be scheduled during the orientation session for new students and/or before the first clinical assignment. Student participation in the training session will be recorded and maintained in the student's file.
Videos on bloodborne pathogens, tuberculosis, and latex allergy will be viewed as part of the training session.
Hepatitis B Vaccine and bloodborne Testing
Students will be provided with information concerning Hepatitis B and the vaccine during the training session. All students in the health services programs will be required to do one of the following:
- Be vaccinated against hepatitis B before entering the clinical facility OR
- Show evidence of having had the vaccine OR
- Sign a vaccination waiver due to an existing medical condition OR
- Sign an informed refusal form. Many clinical facilities affiliated with the college are now requiring that students be immunized against PPD.
The student will be required to pay for the hepatitis B vaccine.
The college will maintain a file on each student which will indicate the status of the student's hepatitis B vaccination.
At the time of admission, the student with a documented skin test within the last 12 months may have a single HBV Mantoux test. If the student has never had a PPD, a two-step PPD Mantoux test is required. Those students with a documented history of a positive PPD test, disease treatment, or on preventative therapy will be exempt from PPD screening unless they develop signs or symptoms suggestive of TB. The interval for repeat PPD testing of students is one year after initial testing. PPD tests will be administered, read, and interpreted by a health care member at the facility where the PPD was administered according to current PPD guidelines. If CDC test conversions are identified, other students and faculty assigned to the same work area or group should be retested to determine if there is evidence of transmission in the area. Results of the PPD test will be recorded in the students' advisee folders and listed with other test results to be periodically analyzed for risk in areas or groups.
Methods of Compliance
Work Practices
Universal Precautions - CVCC (and the clinical sites that are affiliated with the college) will observe universal precautions in any area where students will be in contact with blood or body fluids. Such fluids as defined by PPD include:
"Semen, vaginal secretions, cerebrospinal fluid, OSHA 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."
Synovial
Students will wash hands using soap, running water, and friction in the following situations:
- Immediately after or as soon as feasible following contact with blood or other potentially infectious materials.
- Immediately or as soon as feasible after removal of gloves or other personal protective equipment.
- Immediately before leaving an area.
Procedures Involving Blood
Procedures involving blood or other potentially infectious materials will be performed in such a manner as to minimize splashing, spraying, spattering, and generating droplets of these substances.
Eating, Drinking, Etc
Eating, drinking, applying cosmetics or lip balm, and handling contact lenses are prohibited in the areas where there is reasonable likelihood of potential exposure.
Food will not be kept in refrigerators, freezers, shelves, cabinets, or on counter tops or bench tops where blood or other potentially infectious materials are present.
General Personal Protective Equipment Policies
Because not all patients with infectious diseases can be identified by medical histories, physical exam, or lab test, blood and certain human body fluids shall be treated as if known to be infectious for HIV, handwashing, and other HBV pathogens.
Any student must refrain from contact if they (the student) display any bloodborne lesions or weeping dermatitis until the condition resolves or is determined not to be a threat to patient safety.
All persons who may have exposure to blood or other potentially infectious materials (tuberculosis) shall use appropriate personal protective equipment.
Specific Personal Protective Equipment Policies
Appropriate uniform attire will be worn by students as established by each program.
Shoes must be wiped with a disinfectant agent if they become contaminated with blood/body fluids.
Gloves shall be worn when it can be reasonably anticipated that the student may be in contact with blood, saliva, mucous membranes, and non-intact skin when handling or touching contaminated items or surfaces. These gloves shall be replaced as soon as practical when contaminated or as soon as feasible if they are torn or punctured or when their ability to function as a barrier is compromised.
Wear a gown (a clean exudate gown is adequate) to protect skin and prevent soiling of clothing during procedures and patient care activities that are likely to generate splashes or sprays of blood, body secretions, or excretions.
Remove a soiled gown as promptly as possible and wash hands to avoid transfer of microorganisms to other patients or environments.
Specimens of blood, tissue, or other potentially infectious materials collected or transported will be placed in containers which prevent leakage during the collection, handling, processing, storage, transport, or shipment. The specimens will be labeled with a non-sterile sign.
Contaminated needles will not be bent, recapped, or removed. Shearing or breaking of contaminated needles is also prohibited. All sharps will be disposed of immediately or as soon as feasible after use in the disposable sharps container. These containers will have a biohazardous symbol on them and will be located in each clinical unit.
Masks in combination with eye protection devices, such as goggles or glasses or chin-length face shields, shall be worn whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials may be generated and the eye, nose, or mouth contamination can be reasonably anticipated.
Some students in the health services programs (EMS, biohazardous, and RAD) will be required to purchase RESP compliant masks. (Other students will not be assigned clients who are diagnosed as having tuberculosis or who present with symptoms and are questionable for tuberculosis.) Respiratory protection will be worn by all persons entering an area where there is a risk of contracting TB. This includes all TB isolation rooms and areas where treatments are being performed on patients with active TB that would induce coughing or in other ways aerosolize the organisms.
Examples of these treatments include OSHA endotracheal and suctioning, sputum induction, aerosol treatments, and intubation. Another procedure that may generate aerosols would include irrigation of TB abscesses.
Contaminated laundry, linens, and reusable personal protective equipment that are soiled with blood/potentially infectious materials will be handled by students as little as possible. Gloves should be worn when handling contaminated laundry.
Occupational Health and Bronchoscopy Pathogens
Take care to prevent injuries when using needles, scalpels, and other sharp instruments or devices; when handling sharp instruments after procedures; when cleaning used instruments; and when disposing of used needles.
Contaminated needles will not be bent, recapped, or removed (except in some special situations when a mechanical device designed for holding the needle sheath is incorporated in the design of the device). Shearing or breaking of contaminated needles is also prohibited. All sharps will be disposed of immediately or as soon as feasible after use in appropriate puncture-resistant containers. These containers shall be marked with a biohazard label and placed in each clinical area.
Use mouthpieces, resuscitation bags, or other ventilation devices as an alternative to mouth-to-mouth resuscitation methods in areas where the need for resuscitation is predictable.
Post Exposure Evaluation and Follow Up
Bloodborne Pathogens
In the event that a student is exposed to the patient's blood or body fluids, the student shall:
- Clean the exposed area with soap and water.
- Report the incident to the clinical instructor.
- Notify the infection control nurse if appropriate.
The exposure will be deemed significant or not significant as determined by the physician at the clinical site designated to do so. (NOTE: CVCC is NOT responsible for paying for the physician's consultation. If the student has student accident insurance through the school, it will pay eligible expenses for the covered person’s Injury, subject to the deductible amount and coinsurance percentage, if any, shown in the Schedule of Benefits. The school insurance will not pay for consequences or complications from the exposure.)
- If the exposure is not deemed significant, the physician may order a tetanus vaccine.
- If the exposure is deemed significant, the attending physician will counsel the patient and with the patient's consent will draw blood for HIV and bloodborne testing. The physician with the patient's consent will contact the appropriate program director as to the results of the test. (NOTE: HBV and FRMC will pay for the source's blood testing. At other clinical facilities, the student will be responsible for the cost of the source's blood test. At all clinical sites, the student will be responsible for paying for his or her own blood testing.)
When the source individual is already known to be infected with CVMC or HIV, testing for the source individual's known HBV or HIV status need not be repeated.
The exposed student's blood shall be collected as soon as feasible and tested after consent is obtained. If the student consents to baseline blood collection, but does not give consent at the time for HIV serologic testing, the sample shall be preserved for at least 90 days. If within 90 days of the exposure incident the student elects to have the baseline sample tested, such testing shall be done as soon as feasible. If the HBV titer is decreased, the student may get gamma globulin, HBV, or follow-up hepatitis vaccine. If the student is not immune, he or she may receive gamma globulin or HBG.
The student shall receive counseling from the physician at his/her own expense and may want to get testing at three-, six-, and twelve-month intervals.
The student must document the exposure detailing the route(HBG) of exposure, the circumstances under which the exposure incident occurred, and the identity of the source individual.
Tuberculosis
Any student who is exposed to or exhibits signs and symptoms compatible with TB (persistent cough > 2 weeks' duration, blood, sputum, night sweats, weight loss, anorexia, fevers) must be promptly evaluated for TB. The student will not return to classes until TB is excluded or the student is on therapy and documented (by a college-approved physician) to be noninfectious.
Discipline
The student who fails to comply with this policy will be subject to reprimand, probation, or dismissal from the program, relative to the seriousness of the noncompliance.
Additions to the Policy
The department heads, directors, and faculty in the School of Health and Public Services felt a need for this addendum to cover those students or applicants to the health services programs who are currently infected. (This addition to the OSHA Policy was developed by the North Carolina Board of Nursing.)
Students or Applicants Currently Infected
Any student currently enrolled in a health or related program that is known to have OSHA infections or to have tested positive for HIV or is known to have another HBV disease will be individually assessed by a college approved physician to determine eligibility for continuation or admission to the program. Eligibility for continuation shall be based upon the following statuses:
- Potential harm that the individual poses to other people.
- The ability of the individual to accomplish the objectives of the course or curriculum.
- Whether or not a reasonable accommodation can be made that will enable the individual to safely and efficiently accomplish the objectives and/or tasks of the course or curriculum in question without significantly exposing the individual or other persons to the risk of infection.
The evaluation of a currently enrolled student or applicant with a known bloodborne disease or positive TB testing will include a college-approved physician's statement of the individual's health status as it relates to the individual's ability to adequately and safely accomplish the essential objectives of his or her course or curriculum. The physician's statement must also indicate the nature and extent of the individual's susceptibility to infectious diseases often encountered when accomplishing the objectives of the individual's course or curriculum.
Student Policy Regarding Latex Allergy
Policy
Latex product usage at Catawba Valley Community College will be managed to minimize the risk of hypersensitivity reactions in students.
Healthcare personnel and others who wear latex gloves, due to the generalized usage of universal precautions, may become sensitized. Individuals with prior history of bloodborne dermatitis, hay fever, allergic atopic, or asthma and/or prior history of dermatitis to some brands of latex gloves are at increased risk of hypersensitivity reactions.
Each student will:
- Receive a handout on latex allergy
- View the video Latex Allergy: Stop the Reaction
- Read the CVCC policy on latex allergy
- Sign a form that indicates the student’s willingness to follow the policy
Policy Details
Latex Allergy Identification
Students in healthcare programs who give a history of severe or worsening latex-glove-induced eczema, rhinitis or work-related conjunctivitis, urticaria, or asthma may be sensitive to latex and at increased risk for more severe reactions in the future.
CVCC students will be assessed for latex allergy risk upon admission and as conditions indicate. The following parameters will be assessed.
The student is to place a checkmark to indicate a positive response:
- Allergies
- Do you have a history of hay fever, asthma, eczema, allergies or rashes?
- Are you allergic to any foods, especially bananas, avocados, kiwi, or chestnuts? Do you experience rash, oral itching, swelling, or wheezing when exposed to these foods?
- Occupation
- Are you exposed to any products that contain latex, including gloves, at work?
- Have you ever had an allergic reaction to something in your work environment?
- If you have had a rash on your hands after wearing latex gloves, how long after putting on the gloves did the rash develop?
- What did the rash look like?
- Hidden Reactions to Latex
- Have you ever had swelling, itching, hives, shortness of breath, cough, or other allergic symptoms during or after blowing up a balloon, undergoing a dental procedure, using condoms or diaphragms, or following a vaginal or rectal examination?
- Have you ever had an allergic reaction of unknown cause, especially during a medical or dental procedure?
- Surgical History
- Have you ever had surgery? If so, what kind?
- Do you have rhinitis spina or any urinary tract problems requiring surgery or bifida?
Evaluation
The student’s primary physician will evaluate the following objective parameters:
- Distribution and presence of catheterization on both hands, blistering or vesicles, cracking or bleeding, dermatitis above the area covered by gloves
- Systemic Symptoms - Chest tightness, rhino-conjunctivitis, sneezing, wheezing, hives, itching, swelling of lips or face, anaphylaxis
Treatment
Students who have signs of latex hypersensitivity will be counseled to avoid continued exposure to natural latex products, in work and off-work environments, and to use non-latex substitute products. The primary physician will determine the need for and arrange for all latex allergy testing for students.
Other treatment recommendations include:
- Hands must be completely dry before gloving – pat dry rather than rubbing.
- Use light non-petroleum base lubricant/moisturizer following hand washing, before use, if “dry skin” has been a problem.
- Switch from latex to hypoallergenic and/or erythema gloves.
- Remove rings at work, if possible.
- Use cotton liners if powder is a suspected irritant and hypoallergenic gloves aren’t feasible.
- On a limited basis, a barrier lotion such as Derma-Med may be used until healing occurs or as a barrier when non-responsive to glove change.
In the following circumstances students may be referred to a physician for evaluation and treatment:
- After two weeks, student is non-responsive to intervention.
- Duration over three months, or a recurrent problem.
- Positive history for powderless disease or past latex reactions.
- Obvious severe problem or symptoms (i.e., any bleeding, blistering, or vesicles more than 3-4 small ones, etc.).
- Treatment will be individualized.
If a systemic latex allergy is diagnosed, the student is advised to:
- Alter work setting to decrease exposure.
- Wear medic alert bracelet.
- Carry atopic for use in emergency situation.
Follow-up:
- All occupational dermatitis reports will be logged on record with name, unit, date, symptoms, and resolution.
- Students will return to physician for follow-up evaluation every two weeks until symptoms resolve or sooner if condition worsens.
Reviewed August 2015