Health Services-Employee Manual

Volunteer State Community College | Student Services Division

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General Information | New Employee | Manuals | Faculty/Staff

Health Services hours are: 8:00 a.m. - 4:30 p.m.
Early and Late appointments can be scheduled through Health Services

View the Bloodborne Pathogen Video

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BLOODBORNE PATHOGENS

HIV/AIDS | HEPATITIS B | INFECTIOUS CONTROL

ALL BLOOD OR BODY FLUIDS WILL BE TREATED AS IF THEY ARE INFECTED WITH A VIRUS.

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VOLUNTEER STATE COMMUNITY COLLEGE

BLOODBORNE PATHOGEN EXPOSURE PROGRAM

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PURPOSE

IT IS THE PURPOSE AND GOAL OF VOLUNTEER STATE COMMUNITY TO ADEQUATELY PROTECT ALL EMPLOYEES FROM THE RISK OF TRANSMISSION OF COMMUNICABLE DISEASES IN THE WORKPLACE.

The OSHA Standard on Bloodborne Pathogens is published in the Federal Register.  The OSHA’s Compliance Assistance Guideline on enforcement procedures has become our guideline.

All employees who are directly exposed or whose jobs have the likelihood of exposure to blood or other potentially infectious materials incur risk of infection and subsequent illness are referred to as “high-risk”.  The purpose of this manual is to inform and reduce workers exposure incidents to bloodborne pathogens, such as HBV and HIV. 

The information received from the Center Disease Control (CDC) indicates that instructors, clerical workers, administrators, who have virtually no risk of contact with blood, body fluids or other infectious materials as a result of their employment; are at no greater risk of contracting bloodborne diseases than other members of the general population, and would not necessarily need to receive the Hepatitis B vaccine.   UNIVERSAL PRECAUTIONS should always be practiced in all areas of our life.   These include but are not limited to good hygiene techniques specifically:  handwashing before and after eating, after removing gloves, smoking and after using the restroom and treating all body fluids as if they are infected with a virus. 

VSCC has identified the following positions as having the likelihood of occupational exposure: (High-Risk Personnel)

SCHOOL NURSE

SECURITY OFFICERS

COACHES, ASSISTANT COACHES AND TRAINERS/MANAGERS

INSTRUCTORS IN PHYSICAL EDUCATION

INSTRUCTORS IN ALLIED HEALTH 

MAINTENANCE/CUSTODIAL PERSONNEL

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The Plan For High-Risk Employees

1. VSCC has identified all employees who are exposed to blood and body fluids as a regular part of their jobs. 

2. All high-risk employees will be provided protective equipment, such as gloves, at no cost and will be taught how and when to use them.

3. All high-risk employees will be trained, at least annually, in use of equipment, methods of avoiding coming into contact with blood, methods for clean-up and disposal of waste, and rules for reporting any situations where employees do contact someone else's blood or body fluids.  In addition they will be provided information about the risks involved with contact with blood as well as about the diseases themselves.

4. VSCC Health Services, free of charge, will provide all high-risk employees a vaccination for Hepatitis- B.

5. Any employee who has a direct exposure will receive free medical evaluation and treatment, if needed.

6. VSCC will mark anything that contains blood or body fluids   with labels and/or color-coding and will provide bags and boxes for proper disposal of items containing blood.

7. VSCC must keep records of all training offered as well as medical records associated with the Plan.

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TRAINING AND EDUCATION OF EMPLOYEES

Volunteer State shall ensure that all employees will receive Bloodborne Pathogen training at the time of employment.  These will be conducted at no cost to the employee at the time of orientation and yearly to all High-Risk employees hereafter from the designated person(s).

Material that is appropriate in content and vocabulary to the educational level, literacy and language background shall be used.

The training manual shall consist of the following components:

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BLOODBORNE PATHOGEN

Bloodborne pathogens are microscopic bacteria in the bloodstream that can cause disease.   Although they are very small, they can carry many diseases, including the biggest health concern today - the HIV virus that causes AIDS, and the HBV virus or the Hepatitis B virus.

WHERE ARE BLOODBORNE PATHOGENS FOUND?

Bloodborne pathogens are found in blood and blood products, including:

• blood
• urine
• semen
• tears
• vaginal secretions
• other body fluids
• breast milk
• tissue cultures
• saliva
• organ cultures

Although small traces of HIV can be found in tears, saliva, urine and perspiration, extensive studies have shown that there is not enough of the virus or the virus is not strong enough to be transmitted.     Only blood, semen, vaginal secretions, and breast milk have been proven to transmit the HIV virus and Hepatitis B.    HIV cannot be passed on by casual contact.

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YOU CANNOT GET HIV FROM THE FOLLOWING:

• By sharing food, drinking glasses or towels
• From sinks or toilets in the bathroom
• By sharing personal protective equipment such as goggles, respirators     or clothing
• By sharing tools
• Insects such as mosquitoes have not been proven to carry the HIV virus

There is no documented evidence that dried blood on a surface is strong enough to transmit HIV, but Hepatitis B can be transmitted from dried blood.

HIV and HEPATITIS B can only be transmitted if both of the following are true:

1. exposed blood is infectious.
2. blood is allowed to enter directly into the body through any of the          following ways:

Unprotected openings in the skin such as cuts, scrapes and dermatitis
Unprotected mucus membrane openings such as the eyes, nose and mouth
Penetration into the skin by a sharp object such as broken glass, a needle, or knife blade.

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HIV VIRUS

AIDS

The Acquired Immunodeficiency Syndrome (AIDS) was first reported in the United States in 1981.   The Human Immunodeficiency Virus (HIV) is apparently the cause of this disease.  In its most severe form, this virus destroys the body's ability to resist a wide variety of infections.   Most of these secondary infections pose little or no risk to persons with normal immune systems.   HIV is transmitted through body fluids, mainly blood and semen.   You can develop AIDS from 2 to 10 years or more after being infected with HIV.   In some cases, the virus can be present in the body for 10 or more years before any symptoms occur.   You do not have to have AIDS, show any symptoms, or even be ill to infect another person with HIV.   Presently, there is no vaccine or cure for AIDS.

WHAT ARE THE SYMPTOMS OF HIV/AIDS?

Early symptoms include. . . .
swollen glands
chronic fatigue
diarrhea
fever 
yeast infections
loss of appetite and weight
night sweats

The AIDS patient may suffer from one of many different diseases due to the immune system's inability to fight off infections.   These diseases include forms of cancer and pneumonia.  Casual contact with persons in high-risk groups for AIDS  (e.g., homosexuals, IV drug abusers) does not place you at risk for acquiring AIDS.   No cases of AIDS have been identified among non-sexual household contacts of patients with AIDS.  Although HIV is mainly transmitted through sexual contact and sharing needles, any situation in which blood is present in the work environment is an area of concern.   If the infectious blood enters directly into the other person's body, there is the possibility of transference.   This may occur due to 1) unprotected opening in the skin such as cuts, scrapes and dermatitis; 2) unprotected mucus membrane openings such as the eyes, nose and mouth or penetration into the skin by a sharp object such as broken glass or a needle or knife blade.

HEPATITIS-B (HBV)

Hepatitis B is a disease/inflammation of the liver.   It can be caused by a number of agents, including bacteria, drugs, toxins, and excess alcohol.  Hepatitis that results when any of the several hepatitis viruses infect the liver brings serious concern.   You can get the virus and not show any symptoms.   In this situation, you are still contagious and could pass the disease on to someone else.   You also have a greater risk of liver diseases such as cirrhosis or liver cancer.

Symptoms appear gradually if at all.   Many people who are infected have no symptoms and you cannot tell a person is infected by the way he/she looks or feels.  Only having a blood test can identify often-infected persons.   While most patients recover, HBV can be a very serious and sometimes-fatal disease for which there are no specific treatments and no known cure.   At the time of exposure to blood or body fluid of a known Hepatitis B carcinoma, Hepatitis B Immune Globulin may be administered which may reduce the likelihood of infection.

WHAT ARE THE SYMPTOMS OF HEPATITIS B?

Symptoms include . . . .

• flu-like symptoms in the early stages
• jaundice, an abnormal yellowing of the skin, eyes, and urine
• weakness or fatigue
• lack of appetite
• vomiting
• abdominal pain
• diarrhea

Those who have the disease build up antibodies, or a natural protection against further occurrences.  Ten percent of Hepatitis B cases are chronic, meaning repeated illnesses. About 2 to 3 percent of Hepatitis B cases are fatal.

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DIFFERENT TYPES OF

VIRAL HEPATITIS

HEPATITIS A - formerly called "infectious hepatitis"

Hepatitis A virus is excreted in the feces.   Infected people can spread the virus by neglecting to wash their hands after eliminating solid body waste.   The virus may be passed along when these individuals handle food or other items that are placed in the mouth.   Hepatitis A virus also can be spread through direct contact with infected people.   In addition, hepatitis epidemics occur when Hepatitis A virus has contaminated drinking water or food (including raw or steamed clams, oysters, or mussels).   Hepatitis A outbreaks also occur quite commonly in day-care centers or nurseries where an infected child may transmit the disease to others quite rapidly.   Hepatitis A often produces fever, however, the disease is generally resolved without any long-term effects.

HEPATITIS B - formerly called "serum hepatitis"

Hepatitis B virus is found in all body fluids of infected people, including blood, semen, saliva, and urine.   The principle ways of spreading the Hepatitis B virus includes intimate contact with infected people or exposure to body fluids from these individuals.  Piercing of the skin by contaminated instruments such as those used for tattooing, ear piercing, acupuncture and dental or medical procedures poses a serious risk of passing Hepatitis B virus to others.   This disease also can be spread when illicit drug users share equipment.   In addition, hepatitis B virus may be transmitted sexually, when contaminated body fluids come into contact with mucous membranes or tiny breaks in the skin.   Hepatitis B may also be transmitted to infants born to women who are highly infectious at the time of delivery.     Hepatitis B may have a broad range of clinical symptoms including complete recovery for most people, death due to fulminant (severe) hepatitis (less than 1 percent of the cases) or chronic liver disease which may progress to liver cancer (5-10 percent).

HEPATITIS C - formerly called "non-A, non-B hepatitis"

Hepatitis C virus, until recently, was known as non-A, non-B hepatitis because it could not be traced to A,B, or D viruses.   In the late 1980's genetic sequences of the virus were isolated and cloned and a test for identifying an antibody to the virus was developed.   The virus was designated Hepatitis C.   Transfused blood is one source of the transmission of this disease.   Most hepatitis cases that occur as a result of blood transfusions are hepatitis C.  Hepatitis C also may be spread through intimate contact with an infected person.   People who acquire Hepatitis C stand a 50-60 percent chance of developing lifelong liver disease.

HEPATITIS D - also known as "delta hepatitis," an infection that exists only in combination with Hepatitis B virus.

Hepatitis D virus cannot initiate an infection by itself.   A person must have acquired Hepatitis B before becoming infected with Hepatitis D.   These viruses together usually produce a disease more severe than that caused by the Hepatitis B virus alone.   Hepatitis D virus is spread in the same ways as the Hepatitis B virus.   In the United States , infections with Hepatitis D occur primarily among those who must receive blood products frequently, such as dialysis patients, hemophiliacs, or among those who inject illicit drugs.    Hepatitis D, in conjunction with Hepatitis B, is the most severe known form of viral hepatitis and generally progressed into chronic active disease or death due to severe hepatitis.

HEPATITIS E - formerly known as "epidemic" or "waterborne non-A, non-B hepatitis"

Hepatitis E virus is acquired when water or food contaminated with human feces is ingested.   It is among the leading causes of acute viral hepatitis in young to middle-aged adults in developing countries.   It has a high mortality rate - nearly 20 percent - in infected pregnant women.

Complete recovery from any form of hepatitis may take four months or longer.   Many people say that they are not themselves for years after infection.   In certain cases, individuals do not regain their former levels of energy and stamina; sometimes they are forced to take less demanding jobs and discontinue many aspects of their previous lifestyle.

Hospitals and blood banks are required to test all blood drawn for transfusion with very sensitive tests for Hepatitis B and Hepatitis C viruses.   Many hospitals are testing staff members, patients being prepared for surgery, kidney patients, and pregnant women for evidence of Hepatitis B infection, as well.   In some areas, testing of all patients admitted to the hospital for signs of Hepatitis is done on a routine basis.

A major advance in the control of Hepatitis B occurred in 1981 with the introduction of a hepatitis vaccine.   For people at high risk of acquiring hepatitis, vaccination is recommended. 

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Hepatitis B Vaccination

Hepatitis B vaccines currently being used are produced by recombinant DNA technology using common bakers yeast.  The recommended series of three intramuscular doses administered only in the deltoid muscle of adults induces a protective antibody response in above 90% of healthy adults.  Hepatitis B vaccines have been shown to be safe when administered to adults.  It confers protection against chronic Hepatitis B infection and carrier state.  For adults whose immune status is normal, booster doses of vaccine are not recommended, nor are serological testing to assess antibody levels necessary.  Any presumed risk of adverse events possibly associated with Hepatitis B vaccination must be balanced against the expected risk of acute and chronic liver disease due to Hepatitis B virus. 

If you desire the immunization, complete the form entitled:  HEPATITIS B VACCINE ACCEPTANCE and return it to Health Services.  The vaccine will be ordered and you will be notified to return to Health Services for the injection.

If you do not want to take the immunization or if you have received the vaccine from another source, complete the form entitled:  WAIVER FORM FOR HEPATITIS B IMMUNIZATION and return the form to Health Services.

TAKING THE VACCINE IS NOT MANDATORY!!!!!

INSTRUCTIONS FOR HEPATITIS B IMMUNIZATION FOR EMPLOYEES

The following instructions are for the employees whose primary employer is Volunteer State Community College and whose job has been designated as one of potential high risk of becoming exposed to blood or blood products.  If you are employed at another business the business that employees you for the most hours is responsible for providing the Hepatitis B vaccine.  Designated employee positions that have been classified as potential high risk exposure to blood or blood products are:

Hepatitis B vaccine, a series of three intramuscular doses, will be given:

IF YOU DECIDE TO TAKE THE VACCINE:       complete the form entitled:

Hepatitis B Vaccine Acceptance and return it to Health Services.   The vaccine will be ordered and you will be notified to return to Health Services for the vaccination.

IF YOU DO NOT WANT THE VACCINE:  complete the form entitled: Waiver Form for Hepatitis B Immunization and return the form to Health services.

IF YOU HAVE PREVIOUSLY RECEIVED THE VACCINE:  complete the waiver form portion that states you have received the vaccine.  You will need to present a copy of your immunization record and any titer tests you have taken.

If you sign a waiver form now and for any reason decide in the future to take the vaccine, you may sign an acceptance form and receive the vaccine.    A designated time in the Fall Semester each year will allow high-risk personnel to accept the hepatitis vaccine.  All other personnel who work in areas of low risk will be offered the vaccine at their own expense at cost.

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TUBERCULOSIS (TB)

Tuberculosis is a chronic, recurrent infection most common in the lungs, but any organ may be affected.   Once infection is established (a positive TB skin test), clinical TB may develop within months, or it may be delayed for years or even decades.   

TB refers to the disease caused by Mycobacterium tuberculosis, M. Boris, or M. Africanum.   Although other mycobacterium cause diseases that mimic TB, the infections are not communicable and most respond poorly to drugs that are very effective for TB.

Infection is virtually always airborne.  It occurs almost exclusively by inhalation of organisms dispersed as droplet nuclei from a person with positive pulmonary TB.   The organisms may float in room air for several hours, increasing the chance of infecting an unsuspecting contact.   Ten to fifteen million people are infected in the United States .   More than 25,000 active TB cases were reported in 1990.

Signs and symptoms of active TB are:

• Prolonged cough (over 2 weeks)
• Cough with sputum or blood
• Fatigue
• Loss of appetite
• Weight loss
• Fever

Treatment:

*  Multiple antibiotics for 6-9 months

*  Treatment must be completed to be effective!

*  Drug resistant TB results from active TB being repeatedly not treated with

the full cycle of antibiotic therapy.

TRANSMISSION:

Inhalation of droplets of mycobacterium TB

INCREASING FACTORS:

Poor ventilation

Prolonged shared air

VSCC PLAN /PROTOCOL FOR TUBERCOLOSIS:

Gallatin Health Department has determined Sumner County to be in the Minimal-Risk Category.   This is based on the number of TB cases in our county area.   Therefore, VSCC will abide by the Minimal-Risk Requirements.

Any employee requesting a TB ( PPD ) skin test will be given one without charge.

Any employee whose symptoms warrant testing will be offered the TB skin test or referred to their private physician

Any employee with a reading of positive TB skin test 48-72 hours after being given the PPD skin test will:

EMPLOYEES OR STUDENTS WILL NOT BE ADMITTED TO CAMPUS UNTIL THEY HAVE BEEN RELEASED BY HEALTH DEPARTMENT

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REVIEW EXERCISE

1. You touch blood on a co-worker's cut arm, and you do not have cuts on your hand.  It is found later that the co-worker is HIV positive.

a.       exposed                 b.       not exposed

2. After touching blood, you realize you have a cut on your hand.  The source blood is found no to be infected?

a.       exposed                 b.       not exposed

Assuming that the source blood is contaminated, in which of the following situations could an exposure occur?

3. A worker falls into a plate glass and cuts himself.  When a co-worker leans down to help, a blood soaked piece of glass cuts his hand.

a.       exposed                 b.       not exposed

4. An HIV infected worker on scaffolding is perspiring heavily.  As he hands a hammer down to the worker below sweat drops into the co-worker's eye.

a.       exposed                 b.       not exposed

5. A janitor with unprotected cuts on his hands reaches into a trash can to compress paper.  When he pulls his hand out, it is bloodstained.

a.       exposed                 b.       not exposed

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ANSWERS

1&2   neither of these situations would result in an exposure.  In the first example, there was no route of entry.  In the second example, the blood was not infected.  Yet, by touching blood without wearing gloves, you are taking a risk.  What if you have a cut on your hand you are unaware of?  How can you tell whose blood is infected?  Always wash your hands immediately after contact with blood.

3&5  There is an exposure because the blood soaked glass penetrated into the second worker's skin.  #5. there is exposure because blood entered through unprotected cuts.

4.  No exposure.