The focus in Week Two is on infection control. This excerpt is from The Infection Control Manual for Outpatient Settings, authored by Gwen M. Rogers, DBA, RN, CIC.
Her book explains the steps that physicians and staff at outpatient facilities should take to protect patients, employees, and the environment and to prevent the spread of infectious diseases, though safety pros who work at hospitals may also find this excerpt useful. It looks at the OSHA Bloodborne Pathogen Standard and what should be done when one of your employees is exposed to blood or other potentially infectious material (OPIM).
Are your employees familiar with the Bloodborne Pathogen Standard from OSHA? They should be; it is one of the key documents for healthcare best practices in preventing the spread of and bloodborne pathogens (BBP). It is important for you to maintain a safe work environment for yourself and your employees, and to provide documentation that you have done so, especially because agencies such as OSHA and The Joint Commission are narrowing their scrutiny of the physician's office environment. Representatives from these and other groups want to see whether physician practices have a plan in place to educate and train employees in enacting an infection control plan.
The goal of OSHA's Bloodborne Pathogens Standard, published in 1991 in the Federal Register, is to guide you in minimizing exposure. A good way to introduce employees to the concept of the standard is simply to tell them that they must assume that any needle and any specimen (i.e., anything relating to blood or bodily fluids) should be considered infectious. The standard applies to all employees who have occupational exposure to blood or other potentially infectious material. Occupational exposure is defined as “reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or OPIM that may result from the performance of the employee's duties."
As employers, physician practices are required by OSHA to take precautions to protect staff members likely to be exposed to blood or OPIM while on the job. Separate but dependent sets of rights and responsibilities were established for both employees and employers within the OSHA standards. Employees are obligated to follow office rules, wear personal protective equipment (PPE), and report hazardous conditions. Meanwhile, employers are required to become familiar with all OSHA standards, communicate them to employees, and enforce them in the workplace.
So, what steps must be taken when an employee is exposed to BBP?
Employees should follow a certain protocol after bona fide BBP exposure has occurred. Protocols for evaluation and management of an employee or patient exposure to the blood (or other potentially infectious material) of a patient need to be outlined in the exposure control plan. Any response should begin with providing immediate first aid.
What information must the employer provide to the healthcare professional following an exposure incident? The healthcare professional must be provided with a copy of the standard, as well as the following information:
What serological testing must be done on the source individual?
The employer must identify and document the source individual if known, unless the employer can establish that identification is not feasible or is prohibited by state or local law. The source individual's blood must be tested as soon as is feasible, after consent is obtained, to determine HIV and HBV infectivity. The information on the source individual's HIV, HBV, and Hepatitis C testing must be provided to the evaluating healthcare professional. Also, the results of the testing must be provided to the exposed employee. The exposed employee must be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual.
What if consent cannot be obtained from the source individual?
If consent cannot be obtained and is required by state law, the employer must document in writing that consent cannot be obtained. When law does not require the source individual's consent, the source individual's blood, if available, shall be tested and the results documented.
When is the exposed employee's blood tested?
After consent is obtained, the exposed employee's blood is collected and tested as soon as is feasible for HIV and HBV serological status. If the employee consents to the follow-up evaluation after an exposure incident but does not give consent for HIV serological testing, the blood sample must be preserved for 90 days. If, within 90 days of the exposure incident, the employee elects to have the baseline sample tested for HIV, testing must be done as soon as is feasible.
What information does the healthcare professional provide to the employer following an exposure incident?
The employer must obtain and provide to the employee a copy of the evaluating healthcare professional's written opinion within 15 days of completion of the evaluation. The healthcare professional's written opinion for hepatitis B is limited to whether hepatitis B vaccination is indicated and whether the employee received the vaccination. The written opinion for post-exposure evaluation must include information that the employee has been informed of the evaluation results and has been told of any medical conditions resulting from exposure that may require further evaluation and treatment. All other findings or diagnoses must be kept confidential and must not be included in the written report.
What type of counseling is required following an exposure incident?
The standard requires that post-exposure counseling be given to employees following an exposure incident. Counseling should include U.S. Public Health Service recommendations for transmission and prevention of HIV. These recommendations include refraining from blood, semen, or organ donation; abstaining from sexual intercourse or using measures to prevent HIV transmission during sexual intercourse; and refraining from breastfeeding infants during the follow-up period. In addition, counseling must be made available regardless of the employee's decision to accept serological testing.
What should be done with an employee's confidential medical records? Records of all employees with occupational exposure must be maintained for 30 years after the employee terminates employment. These records should be stored separately from patient records, and access to the records requires the employee's written permission. The medical records include a copy of the employee's vaccination status and copies of the results of all medical examinations and tests. Post-exposure records must include the employee's name, Social Security number, hepatitis B vaccination status, results of follow-up procedures to exposure incidents, and a copy of the evaluator's written opinion.
exerpted from Hospital Safety Insider