Winona State University Athletic Training

Blood Borne Pathogen

Policies and Procedures Document

Revised 10/16/03

Purpose–

Definitions-

• Blood Borne Pathogens are pathogenic micro-organisms present in human blood and can cause 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).

• Body Fluids are fluids that have been recognized by the Centers for Disease Control and Prevention (CDC) as directly linked to the transmission of HIV and/or HBV and/or to which universal precautions apply: blood, blood products, semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pericardial fluid, amniotic fluid, and concentrated HIV or HBV viruses.

• Contamination occurs when blood or other potentially infectious materials are present or reasonably anticipated to be present on an item or surface.

• 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 one’s duties. Non-intact skin includes skin with dermatitis, hangnails, cuts, abrasions, chafing, acne, etc.

• Personal Protective Equipment (PPE) is specialized clothing or equipment worn by an individual for protection against a hazard. Some examples include protective gloves, eye protection, face shield, gowns, and CPR mask.

• Sharps are any object that can penetrate the skin, including but not limited to, needles, scalpels, wood applicators, and any objects with the potential to become sharps such as glass.

• Source individual is any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee.

• Universal Precautions is an approach to infection control where all human blood and certain human body fluids (i.e. semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pericardial fluid, amniotic fluid) are treated as if known to be infectious for HIV, HBV, HCV, and other blood borne pathogens.

Administration Policies-

• Emergency phone numbers - Available in the ATR - ME 140.

Equipment-

• Rubber/latex gloves
• Gowns
• Face shields
• Eye protection
• Gauze
• Band-aids
• Infectious waste bags
• Biohazard containers
• Sharps containers
• CPR mask or other “Breathing Barrier”

Policies & Procedures-

• Exposure Determination

• The potential of being exposed to blood borne pathogens exists in the athletic training room, practice sites, or competition sites. Individuals at risk include certified athletic trainers and athletic training students treating or caring for any open wound, sore, or body fluid that is present.

• Methods of Compliance

• Universal Precautions - All individuals with the potential for exposure should use universal precautions when coming in contact with blood or body fluids. Universal Precautions is the belief that all blood or other potentially infectious body fluids are considered infectious regardless of the perceived status of the source individual. When dealing with blood or other body fluids, protective gloves should always be worn along with any other PPE deemed necessary.

• Personal Protective Equipment (PPE) - Personal protective equipment includes gloves, CPR masks, gowns, face shields, and eye protection. This equipment will be purchased and maintained by the athletic training staff. PPE’s shall be used when available and deemed necessary when coming in contact with blood or other body fluids.

Gloves

•  Gloves shall be worn when it can be reasonably anticipated that the employee may have hand contact with blood, other potentially infectious materials, mucous membranes, and non-intact skin
•  Disposable (single use) gloves shall be replaced as soon as practical when contaminated or as soon as feasible if they are torn, punctured, or when their ability to function as a barrier is compromised.
•  Gloves are removed inside out aseptically
•  Gloves should be removed and discarded into a properly marked foot-operated biohazard container lined with a leak-proof color-coded biohazard bag. Any glove used to clean bodily fluids shall never be washed and reused. Biohazard containers are located in the wound care and taping area of the athletic training room.
• Gloves are available in the athletic training room and in each individual sport kit.

Masks, Eye Protection, Face Shields :

•  Masks and eye protection should be used whenever there is potential for splashes, sprays, spatter or droplets of blood or other infectious materials into the eyes, nose or mouth.
• When contamination occurs, eyewear and face shields are to be cleaned with a 1:10 bleach dilution, then washed, rinsed and dried.
• Eye protection and face shields are available in the athletic training room. 
•  CPR masks or other breathing barriers are located in the athletic training room and in each individual sport kit.
•  Any breathing barrier will only be used once and then discarded.
• Hand Washing - All individuals shall wash hands and any other exposed skin with soap and warm running water for a minimum of 30 seconds after removing gloves. In the event that soap and warm running water are not readily available, an antiseptic hand sanitizer shall be used. When an antiseptic hand sanitizer is used, hands shall be washed with soap and warm running water as soon as feasible. Hands should also be washed between all patient contacts.

• Disposal of Sharps - All contaminated sharp objects, including but not limited to, needles, syringes, and scalpels, are to be discarded immediately into a properly marked, puncture-resistant, leak-proof container. The sharps container is located in the wound care and taping area of the athletic training room. The container should never be filled to a point where the sharp protrudes from the top or it is not easy to drop the sharp into the container.

• Autoclave - Reusable equipment, including but not limited to unwrapped instruments, which is contaminated is to be sterilized in the athletic training room autoclave according to the guidelines outlined in the equipment user manual. Equipment that has been used should be placed into a separate holding container and not used again until sterilization in the autoclave is complete.

• Work Area Restrictions - In the athletic training room, it is prohibited to eat or smoke. Food is only allowed in the athletic training on occasions deemed appropriate by the certified athletic training staff outside of scheduled treatment times for WSU student-athletes. Food and drink shall not be kept in the vicinity of blood or other potentially infectious materials.

• General housekeeping - This is the responsibility of the building supervisor and the custodial staff. They will ensure that the athletic training facility is maintained in a clean and sanitary condition.
  • Tables should be cleaned by the athletic training staff daily and as needed. A 1:10 bleach to water solution or other appropriate disinfectant should be used for cleaning.
  • Water bottles used at practice or games are disinfected every day with betadine , or other appropriate disinfectant, and warm running water and the bottle tops are to be opened and placed nipple down in a 1:10 bleach to water solution. If the bottle tops are heavily soiled, they should be washed with betadine and then placed in the bleach water solution. If the water bottles or tops are exposed to blood or other body fluids, they should be cleaned with a disinfectant like alcohol or hydrogen peroxide.
  • If blood or other potentially infectious materials are present on the tables, counters, or gymnasium floor, it should be cleaned with a 1:10 bleach to water solution or other appropriate disinfectant.
  • If blood or other potentially infectious materials is present on carpet, paper towels or gauze should be used to soak up any excess fluids in the area. A germicide will be used to disinfect the area that should be allowed to dry overnight. Carpet can be shampooed if needed or a 3% hydrogen peroxide solution can be used to remove discoloration.

• Disposal of Biohazard Materials - Biohazard materials will be taken to Pasteur Hall room 218 to be disposed of properly by infectious waste personnel.
  • Biohazard bags will be removed from the biohazard containers and properly closed.
  • Pasteur 218 will be called from the athletic training room to determine if biohazard materials can be taken over. The phone number is (507) 457-5288.
  • The biohazard materials will then be taken over to Pasteur 218 for proper disposal.

• Laundry Procedures-
•  Uncontaminated laundry shall be laundered every evening after the athletic training facility closes. Before leaving for the evening, an athletic training staff member will take the laundry bag to the laundry room where it will be laundered. The laundry room is located in the basement of Memorial Hall at the bottom of the stairs by the pool. It is next to the women’s general locker room.
•  All laundry (ace wraps, towels, or pillow cases) coming in contact with bodily fluids shall be considered contaminated. Contaminated laundry shall be soaked in a 1:10 bleach to water solution for five minutes and then laundered as usual.
•  If a uniform or other clothing should become contaminated, hydrogen peroxide will be used to remove the bodily fluid, and then shall be laundered as usual.

• Exposure Incidents-

• Provide Immediate Care to the Exposure Site:
  • If exposure to blood or other bodily fluid occurs, the affected area must be washed immediately with soap and warm water. If affected area is the eye, mouth, or nose, flush area with water for 15 minutes.

• Report the Exposure to a Certified Athletic Trainer

• Call Joanne Rosczyk, WSU Director of Telecommunication and Safety at 457-5053 for immediate action that needs to be taken.

• Determine Risk Associated with Exposure by:
  • Type of fluid (e.g., blood, visible bloody fluid, other potentially infectious fluid of tissue, and concentrated virus) and
  • Type of exposure (i.e., percutaneous injury, mucous membrane or non-intact skin exposure, and bites resulting blood exposure)

• Evaluate Exposure Source:
  • Identify and document the source individual
  • Assess the risk of infection using available information
  • Obtain consent and have source individual tested as soon as possible for HBs Ag, anti-HCV, and HIV antibody
  • For unknown sources, assess risk of exposure to HBV, HCV, and HIV infection
  • If the source individual is already known to be HIV, HCV and/or HBV positive, new testing need not be performed

• Evaluate the Exposed Person:
  • Assess immune status for HBV infection by history of hepatitis B vaccination
  • Evaluate risk of infection. If transmission of infection is a possibility, or if further evaluation is desired, report to the Community Memorial Hospital Emergency Department. The emergency department staff will evaluate the exposure and will determine a post-exposure plan based on the exposure risk.
  • Post-exposure prophylaxis should be initiated within 1 to 2 hours of the exposure.
  • The exposed individuals consent is required for collection of blood for HBV and HIV serological status. If immediate testing is denied, the exposed person should provide consent to have blood drawn and stored for a period of 90 days. The individual has the option of providing consent for testing within the 90 days.

• Document Incident:
  • Document the exposure by completing the OSHA 300 and 301 forms and the WSU incident report form. Forms are available in the athletic training facility. Document the route of exposure and the circumstances under which the exposure occurred.
  • Complete exposure report forms are kept in the health service personnel file
  • Notify the WSU Director of Telecommunication and Safety (Joanne Rosczyk) at 457-5053 and complete the forms required by that department.

• Perform follow-up testing and provide counseling:
  • Exposed person should seek medical evaluation for any acute illness occurring during follow-up.
  • Informed exposed individuals of source individual’s test results and of applicable disclosure laws and regulations concerning the identity and infectious status of the source individual.
• Vaccinations-

• The Hepatitis B vaccination series needs to be taken before admittance into the athletic training educational program.
• Certified athletic trainers also should receive the Hepatitis B vaccination series before beginning work at Winona State University .
• If anyone refuses the Hepatitis B vaccination series, a Hepatitis B Vaccine Declination form must be filled out by that individual stating the refusal to receive the vaccine. This form will be kept on file for a minimum of three years after a students termination from the program.
• The Hepatitis B vaccination is a series of three shots given at specific intervals from the time of the first shot. Booster shots may be needed at some time in the future.
• HCV and HIV have no known vaccine at this point in time.
• Signs and Labels

• The athletic training staff will make sure that biohazard containers are correctly labeled with the orange or orange-red universal biohazard symbol. The label must be visible at all times on the outside of the container. The container will be lined with a labeled biohazard bag.
• Visiting teams will be supplied with a biohazard waste container at the competition site.

• Information and Training-

• The athletic training staff shall provide training to all individuals who could potentially be in a situation where they are exposed to blood borne pathogens. Training should be done every 12 months and cover the following information:
  • A discussion of the epidemiology and symptoms of blood borne diseases
  • An explanation of the modes of transmission of blood borne pathogens
  • An explanation of the Blood Borne Pathogen Exposure Control Plan (this document), and a method for obtaining a copy
  • The recognition of tasks that may involve exposure
  • An explanation of the use and limitations of methods to reduce exposure, for example engineering controls, work practices, and PPE’s
  • Information on the types, uses, location, removal, handling, decontamination, and disposal of PPE
  • An explanation of the basis of selection of PPE
  • Information on the Hepatitis B vaccination, including efficacy, safety, method of administration, benefits
  • Information on the appropriate actions to take and persons to contact in an emergency involving blood or other potentially infectious materials
  • An explanation of the procedures to follow if an exposure incident occurs, including the method of reporting and medical follow-up
  • Information on the evaluation and follow-up required after an exposure incident
  • An explanation of the signs, labels, and color-coding systems

• Record Keeping-

Training Records

• Records shall be kept in the office of the program director for all individuals that have received training on dealing with blood borne pathogens. Records will be kept for 3 years from the date of training.
• The following information will be documented:
  • The dates of the training sessions
  • Description of the material presented
  • Names and qualifications of persons conducting the training
  • Names and job titles of all persons attending the training

• Availability

• All athletic training staff records shall be made available to the individual in accordance with 29 CFR 1910.20.
• All staff records shall be made available to the Assistant Secretary of Labor for the Occupational Safety and Health Administration and the Director of the National Institute for Occupational Safety and Health (NIOSH) upon request.

•  Transfer of Records

•  If the athletic training facility at Winona State University is closed or there is no successor employer to receive and retain the records for the prescribed period, the Director of the NIOSH shall be contacted for final deposition.

• Evaluation and Review

• The athletic training staff is responsible for reviewing this document annually and its effectiveness and for updating this document as needed.

 Outside Contractors

• All consulting physicians and health care practitioners are requested and encouraged to participate in the practice of Universal Precautions. It is understood and acknowledged that these persons accept professional liability and responsibility for their professional actions.

Note: This document has been adapted to specifically address issues at Winona State University . Modifications have been made from the Blood Borne Pathogens Exposure Control Plan from the Winona State University Student Health Services, Utah Schools for the Deaf and the Blind and the University of Findlay . Information was also taken from U.S Department of Labor Occupational Safety and Health Administration website.