Exposure Control Plan & Hepatitis B Control

Each staff at reasonably anticipated risk of exposure in job classes enumerated in “A: Positions that Usually Do Have Occupational Exposure” and “B: Positions that May Have Occupational Exposure” sections of the main page of this Plan will, within ten (10) days of employment or assignment, be scheduled an appointment with the Employee Health Nurse and will do at least one of the following:

• Provide evidence of having received three doses of Hepatitis B vaccine

• Provide evidence of a positive anti-HBs laboratory marker

• Sign a form consenting to be vaccinated or to finish an incomplete vaccination series

• Specifically decline vaccination by signing a declination form.

For those who do not have an immunocompromised medical condition, booster doses of vaccine are not currently recommended except when there is exposure to a HbsAg (Hepatitis B Surface Antigen) positive source. Thus, dates and results of anti-HBs testing should be recorded as well as dates of vaccine doses for use in case of exposure. A positive anti-HBs in a person never having received vaccine is due to natural infection and is considered permanent.

It is the responsibility of the employer/local health department to purchase Hepatitis B Vaccine for its staff.

• If the employee consents to be vaccinated, s/he will be evaluated to ascertain that there are no medical contraindications to vaccination. These include hypersensitivity to yeast or an adverse reaction to a previous dose of Hepatitis B vaccine. The Kentucky Department for Public Health’s, Division of Epidemiology, will be consulted in these cases and will advise on how to proceed. 

• If no contraindications exist, then the employee will receive three (or the remaining) doses of hepatitis B vaccine at zero, one and six months.

• Two months following the last dose, a test for anti-HBs will be ordered through Kentucky Laboratory Services. If negative (a non-responder), current ACIP (Advisory Committee on Immunization Practices) and CDC (Center for Disease Control) recommendations will be followed.

• A Patient Encounter form will be initiated and entered to account for vaccine used.

• If the employee declines vaccination, s/he must sign a declination form. S/he will be informed quarterly for one year that if s/he changes her/his mind, s/he may return and consent for vaccination at any time.

When an NKY Health employee experiences an incident involving parenteral contact or contact of eyes, mouth, other mucous membrane, or non-intact skin with a bodily fluid the following will be done.

All Information Can Be Found on the Google Drive:

1.    Employees-Workplace Safety Site/Safety Manual/Bloodborne Pathogens Exposure Control Plan 

2.    Supervisors-Workplace Safety/Safety Manual/Safety Manual: Incident Management/Supervisor’s Procedures for Reporting Incidents

3.    Worker’s Compensation Information-Workplace Safety Site/Safety Manual: Incident Management/Worker’s Compensation

4.    Tuberculosis-Workplace Safety Site/Safety Manual/Prevention of TB/Post-Exposure Retesting/Screening

1. The source blood will be sent to St. Elizabeth Healthcare Laboratory for testing for HIV, Hepatitis C, and Hepatitis B accompanied by a St. Elizabeth Laboratory Requisition form checked for the following tests: Hepatitis B Core IGM, Hepatitis B Surface Antigen, Hepatitis C Antibody, and HIV Antibody. In the Comments/Special Instructions section of the form check the Stat box and write “Exposure Panel – Source” in the comments section.

Consent will already have been secured on Post-Exposure Incident Consent - Exposed Employee (except in the case of anonymous HIV testing); in addition, consent from all source individuals must be obtained on NKY Health’s Post-exposure Incident Consent - Source Individual form, Source Individual. Appropriate information sheets must be given.

The laboratory will notify the designated person at NKY Health of the result (by telephone if positive; in writing if negative).

2. Blood is sent via 24-hour St. Elizabeth Courier by calling 859-301-2170 and requesting a courier.

3. Blood is to be labeled as follows (may call St. Elizabeth Lab at 859-301-2170 for more information) and placed in two SST tubes:

·         Each specimen received in the Laboratory must be labeled to include:

o   Patient's first and last name

o   Medical Record Number (MRN)/Patient Number if available

o   Date of Birth (DOB) or last four digits of the Social Security Number (SSN)

o   Patient location

o   Date and time of collection

o   Initials of collector

·         After collection and labeling:

o   Place the specimen inside a biohazard ziplock bag

o   Place the requisition form inside the pocket

o   Use a separate bag for each patient’s samples

Forms to be sent with blood specimen:

1) St. Elizabeth Exposure Lab Requisition -Source Patient and Employee-https://sites.google.com/nkyhealth.org/workplace-safety-site/safety-related-forms/post-exposure-forms#h.49yaetn3286k

2) Post-Exposure Incident Consent Form-Source Individual: Source Individual Form

St. Elizabeth Lab and Courier:  859-301-2170 and https://www.testmenu.com/stelizabeth

Exposure to Other Potentially Infectious Material (OPIM):

Per OSHA, OPIM includes semen, vaginal secretions, synovial fluid, saliva in dental procedures, pleural fluid, and any body fluid visibly contaminated with blood

1. Immediately wash exposed area with soap and water. If the exposure has occurred in the eyes, wash eyes with water for 15 minutes.

2. Report exposure to the following:

a. Employee Health Nurse (ext. 2059)

b. Supervisor/Manager

c.    The managers/supervisors will follow the Supervisor’s Procedures for Reporting Incident in the “Incident Management” section of the “Workplace Safety Site” manual: Supervisor's Procedures for Reporting Incidents

3.    Depending on type of exposure (ex: sputum, vomit, etc.), the Employee Health Nurse will explain follow-up

Exposure to Blood Borne Pathogen:

1. Immediately wash exposed area with soap and water. If the exposure has occurred in the eyes, wash eyes with water for 15 minutes.

2.    Report exposure to the following:

a.    Employee Health Nurse (ext. 2059)

b.    Supervisor/Manager

c.    The managers/supervisors will follow the Supervisor’s Procedures for Reporting Incident in the “Incident Management” section of the “Workplace Safety Site” manual: Supervisor's Procedures for Reporting Incidents

3. Exposed employee must go to St. Elizabeth Business Health on Mineola Pike to have blood drawn.

Phone number:  (859) 301-2999

Address: 4123 Olympic Blvd #150, Erlanger, KY 41018

4. If exposure happens on a weekend, then exposed employee must go to the nearest ER within two hours of exposure

5.    Employee should take these forms to Business Health or the ER:

1)    St. Elizabeth Exposure Lab Requisition --Source Patient and Employee: Exposure Lab Requisition - Source Patient and Employee

2)    Physician Letter of Treatment form: Physician Letter Treatment Form

6. The employee will need to complete the following forms:

a) Incident Reporting Form  

b)    Post-Exposure Incident Consent Form -Exposed Employee

c) Worker’s Compensation Form

7. The Physician’s Letter of Treatment should be sent back to the Employee Health Nurse.

8. The Employee Health Nurse will follow up with employee as required by OSHA standards.

9. For more information about the Workers Compensation Plan: Workers Compensation Plan Details

Management will be based on the most recent CDC recommendations. For exposure to HBV, HCV or HIV, refer to “Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, HIV and Recommendations for Postexposure Prophylaxis” in the MMWR,Vol. 50,No. RR-11, dated June 29, 2001.

Currently recommended treatment for HIV exposure is available to NKY Health employees at each of the five Northern Kentucky hospital emergency departments.

The employee will be offered baseline HIV, HBV and HCV testing regardless of the availability of results of testing on source blood following an exposure. NKY Health's Post-Exposure Incident Consent - Exposed Employee form must be reviewed with the employee and appropriate information sheets for HIV, HBV and HCV given to the employee.

Exposures are considered worker’s compensation cases and will be managed by the worker’s compensation carrier.

When the source individual’s HIV, HBV and HCV status is unknown, follow the general Supervisor's Procedures for Reporting Incident.