Bloodborne pathogens are pathogenic microorganisms such as viruses or bacteria which are carried in the blood and body fluids and can cause disease in people. There are many different bloodborne pathogens, but the Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and the Human Immunodeficiency Virus (HIV) are the three viruses that pose the greatest concern to people. These diseases are specifically addressed by the OSHA Bloodborne Pathogen standard.

HEPATITIS B VIRUS (HBV)

Hepatitis means inflammation of the liver. Hepatitis B is a virus that can infect the liver. This inflammation can lead to more serious conditions such as chronic liver disease, cancer, or death. More than 5,000 people die annually from HBV-related liver disease.

Symptoms may include fatigue, abdominal pain, loss of appetite, nausea and vomiting. Symptoms of jaundice, a distinct yellowing of the skin and eyes, and darkened urine will often occur as the disease progresses. Half of those infected show no symptoms and others may show symptoms as soon as 2 weeks or as long as 6-9 months after infection.

Hepatitis B is the most easily transmitted bloodborne pathogen. The only way to confirm it is by blood test. There is no cure or specific treatment for HBV, but fortunately there is an effective vaccine.

HEPATITIS C VIRUS (HCV)

The Hepatitis C Virus (HCV) can also cause a liver infection. It is estimated that 3.5 million Americans are living with an active, chronic Hep C infection. In 2014, there were 19,659 deaths from HCV related infections.

Symptoms are frequently non-specific, but may include jaundice, abdominal pain, fatigue, dark urine, loss of appetite and nausea. Hep C may lead to cirrhosis of the liver and liver cancer.

There is no vaccine for HCV, but there are anti-viral drugs that are used for those who have contracted the disease.

HUMAN IMMUNODEFICIENCY ViIRUS (HIV)

Human Immunodeficiency Virus (HIV) attacks the body’s immune system, weakening it so that it cannot fight other deadly diseases. Approximately 1.2 million people in the United States are HIV positive. 1 in 8 people may not be aware that they are infected.

The HIV virus is very fragile and will not survive very long outside of the human body. It is primarily a concern to employees who provide first aid in situations involving fresh blood. Even though the chance of contracting HIV in the workplace environment is low and the number of new cases is on the decline, because it is such a devastating disease, all precautions against exposure should be taken.

Transmission of Bloodborne Pathogens

To be exposed to a bloodborne pathogen such as Hepatitis B, Hepatitis C or HIV, infected blood must get into your bloodstream. Exposures occur primarily through needlesticks, sharps injuries, mucous membrane and non-intact skin.

In the workplace, you can be exposed to Hepatitis B, Hepatitis C and HIV by coming in contact with body fluids contaminated with blood. This can happen when you directly touch contaminated blood while performing first aid or when you touch an object or surface contaminated with blood and then transfer the virus to your mouth, eyes, nose or non-intact skin. Feces, urine, vomit, nasal secretions, sputum, sweat, tears and saliva are not considered infectious unless they contain visible blood. Remember the virus must get into your bloodstream for you to get sick. You cannot become infected with these viruses through casual contact. Employees are urged to take advantage of available personal protective equipment and follow work practice controls to prevent exposure to blood and other body fluids.

Recognizing and Preventing Bloodborne Pathogen Exposures

Knowing these steps will help you prevent exposures to body fluids that are potentially infectious:

1. Know the Exposure Control Plan. It is based on the guidelines for workplace safety according to OSHA standards. A copy is located at each RSS site and can be accessed using the button below.

Exposure Control Manual

2. Follow universal precautions and always be prepared for an emergency. Have Personal Protective Equipment (PPE) with you at all times. Although you may instinctively want to help a student or co-worker, make sure that you first protect yourself properly.

3. Know how to properly discard bloody materials and disinfect contaminated surfaces. Biohazard labels and bags are available at every RSS site for disposal of items saturated with blood. Contact custodial staff immediately to ensure proper cleaning of contaminated surfaces.

4. Practice good handwashing techniques. This is the most important defense against the spread of disease.

UNIVERSAL PRECAUTIONS

An approach to infection control used to protect employees from exposure to all human blood and other potentially infectious materials.

• treat all human blood and body fluids as if they are infectious

• observe universal precautions in all situations when there is a potential for contact with blood or other potentially infectious materials
• use personal protective equipment in all situations involving blood or body fluids

WORK PRACTICE AND ENGINEERING CONTROLS

Used to prevent and minimize exposure to bloodborne pathogens.

HANDWASHING

• handwashing facilities should be readily accessible

• antiseptic hand cleanser can be used if handwashing facilities are not accessible - handwashing with soap and water should be done as soon as possible

• wash hands immediately after removing gloves or other Personal Protective Equipment (PPE)

• if skin or mucous membranes come into contact with potentially infectious materials, the area should be washed/flushed as soon as possible

HANDWASHING PROCEDURE

1. HANDS SHOULD BE PLACED UNDER RUNNING WATER

2. APPLY SOAP

3. SCRUB ALL SURFACES OF THE HANDS & WRISTS VIGOROUSLY (Pay special attention to the areas between fingers)

4.RINSE THE HANDS THOROUGHLY & DRY WITH A PAPER TOWEL

5. TURN THE FAUCET OFF WITH THE PAPER TOWEL

Link to hand washing video

DISPOSAL OF CONTAMINATED SHARPS

• needles/sharps should not be bent or recapped; do not break the contaminated needle

• sharps shall be placed immediately in a puncture resistant, leak-proof, properly labeled container (do not overfill container)

• the containers will be provided by the school system

• when container is full and properly sealed, it can be disposed of in regular trash

PERSONAL PROTECTIVE EQUIPMENT (PPE)

Use available PPE. Every RSS site has PPE available. Replacements can be obtained through Student Services.

All personal protective equipment should be:

• removed before leaving the workplace
• disposed of in an appropriately designated area, after removal
• removed as soon as possible if your clothing becomes saturated with blood or body fluids

GLOVES

• wear gloves when it is possible that your hands may come into contact with blood or body fluids or if you have cuts, scratches, or other breaks in the skin

• the gloves are single use; do not wash or reuse

• should be removed if they become torn or damaged

MASKS, EYE PROTECTION, FACE SHIELDS

Use whenever splashes, sprays, spatters or droplets of blood or other body fluids may contaminate your eyes, nose or mouth.

GOWNS AND APRONS

Gowns and aprons should be worn when splashes, sprays, spatters, or droplets of blood may contaminate your clothing.

Personnel Protective Equipment: Donning Gown and Other Equipment

• There should be no eating, drinking, applying cosmetics, or handling contact lens in work area

• Biohazard labels should be applied to all contaminated materials. Custodial staff should be called for assistance with all clean up of contaminated areas.

• Any ideas for improvements in work practice controls should be directed to the Student Services Director

Housekeeping/Environmental Issues

Housekeeping/custodial responsibilities include the major tasks of cleaning and disposal of potentially infectious materials. To minimize exposures the following housekeeping measures should be implemented:

• Notify custodial staff to clean any equipment or surfaces contaminated with blood or body fluids.

• Broken glass should always be treated as contaminated and never be picked up with unprotected hands. Always use mechanical means to pick up glass such as a broom and dustpan. Call your custodial staff for assistance and clear the area of students.

• Never push or compact trash with your hands. Hold it away from you and shake down.

• Contaminated laundry should be placed in a leak proof container. Only school personnel shall wash contaminated laundry.

• Place items, heavily soiled with blood, in a regular trash bag and attach a BIOHAZARD LABEL to the outside of the bag. Immediately notify your custodian when potentially infectious trash needs to be disposed.

• Regular inspection and disinfection of reusable containers.

• Only school-approved disinfectants are to be used. DO NOT BRING CLEANERS FROM HOME.

WHAT TO DO IF AN EXPOSURE OCCURS

Rowan-Salisbury Schools shall make post exposure evaluation and follow-up, including prophylaxis, available to all employees who have an exposure incident.

Definitions:

• Exposure incident: coming into contact with blood or other potentially infectious materials via the eyes, mouth, mucous membranes, non-intact skin, or parenterally during the performance of an employee’s duties

• "Non-intact" skin: includes skin with dermatitis, hangnails, cuts, abrasions, chafing, acne, etc..

• Parenteral : piercing mucous membranes or the skin barrier through events such as needle sticks, human bites, cuts, and abrasions

In the event of an exposure, employees are required to:

• Wash exposed areas with soap and water. Immediately flush exposed mucous membranes with water.

• Immediately report the exposure incident to your immediate supervisor and first position secretary.

• Complete the Exposure Incident Forms and return them to your supervisor and first position secretary immediately. No more than 24 hours after exposure.

• First Position secretaries will provide appropriate paperwork and instructions for seeking medical attention.

• Follow procedures for follow-up as outlined in the Exposure Control Plan for the Rowan Salisbury School System. Follow up will be completed by the Risk Management Department.

Hepatitis B Vaccine

The Hepatitis B vaccination series is available free of charge to all employees who are considered at risk or on a post-exposure basis. RSS employee vaccines will be administered by the Rowan County Health Department. Student Services will assist employees throughout the vaccine series.

The Hepatitis B vaccine is given in three separate doses as an injection in the muscle of the upper arm, over a period of six months. The Hepatitis B vaccine series is given only once. A vaccine, like any medicine, is capable of causing serious problems, such as an allergic reaction. The risk of Hepatitis B vaccine causing serious harm is extremely small. Most people who receive the Hepatitis B vaccine do not experience adverse reactions. A Vaccine Information Sheet is given to the employee at the time the vaccine is administered.

At Risk Employees

At risk employees perform invasive tasks or procedures on a daily basis that could result in an exposure to blood or body fluids through mucous membranes or non-intact skin.

The following positions are considered At Risk Employees:

• Athletic Trainers
• Health Care Professionals (School Nurses)
• Custodians
• Teachers/Teacher Assistants who perform invasive procedures on a daily basis
• Personnel designated to administer first-aid for the entire school on a daily basis

Every employee in the above classifications should complete BBP training upon hire and yearly. If an employee changes job classifications throughout the school year, they will also have to complete the BBP training. A Hepatitis B Vaccine Acceptance Form or Declination Form should be completed upon hire. This form is to be sent to Student Services immediately after completion. This process must be completed within 10 working days of beginning the work assignment. The Acceptance and Declination forms are available from your site based trainer or the Student Service Department.

The Hepatitis B vaccination is available to At Risk Employees whom have initially declined the series, but at a later date decide to accept the vaccination.

COLLATERAL EMPLOYEES

Collateral and other employees that experience an exposure will be offered the Hep B vaccine post exposure. Those interested in receiving the vaccine can contact their personal health care provider for recommendations on the vaccine.

3/2005- Staphylococcus aureus is a bacteria commonly referred to as staph. It is found on the skin, usually inside the nose and in the armpit, groin, and genital area. There can be a colonization of staph present in a healthy individual and it does not cause an illness. In most cases with colonization, there are no symptoms but if any problems do occur, they are generally minor skin irritations such as pimples or boils. In some instances, staph can create a more serious infection.

8/2020 - COVID in the Workplace

Know how COVID spreads: · The virus is thought to spread mainly from person-to-person. · Between people who are in close contact with one another (within about 6 feet). · Through respiratory droplets produced when an infected person coughs, sneezes or talks. · These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. · Studies have suggested that COVID-19 may be spread by people who are not showing symptoms. Infection control measures to help prevent the spread of COVID-19: Face Covering: Wear a cloth face covering at all times: · while on school property· while in public · when around people outside of their household · when other social distancing measures are difficult to maintain Wear your Face Covering Correctly: · Wash your hands before putting on your face covering · Put it over your nose and mouth and secure it under your chin · Try to fit it snugly against the sides of your face · Make sure you can breathe easily

Cloth face coverings are not considered personal protective equipment (PPE) and do not replace the need for 6ft social distancing. Cloth face coverings should be washed after each use. It is important to always remove face coverings correctly and wash your hands after handling or touching a used face covering. Staff who have a medical exemption from wearing a cloth face covering are required to wear a face shield that wraps around both sides of the face and below the chin. Hand Washing: Washing hands can keep you healthy and prevent the spread of respiratory and diarrheal infections from one person to the next. Hand hygiene (hand washing) should be performed frequently, either with soap and water for 20 seconds or a hand sanitizer that

contains at least 60% alcohol. Germs can spread from other people or surfaces when you: · Touch your eyes, nose, and mouth with unwashed hands · Prepare or eat food and drinks with unwashed hands · Touch a contaminated surface or objects · Blow your nose, cough, or sneeze into hands and then touch other people’s hands or common objects During the COVID-19 pandemic, you should also clean hands:

· After you have been in a public place and touched an item or surface that may be frequently touched by other people, such as door handles, tables, gas pumps, shopping carts, or electronic cashier registers/screens, etc. · Before touching your eyes, nose, or mouth because that’s how germs enter our bodies. · https://www.cdc.gov/handwashing/when-how-handwashing.html Social (Physical) Distancing: Spread of COVID-19 happens when an infected person coughs, sneezes, or talks, and droplets from their mouth or nose are launched into the air and land in the mouths or noses of people nearby. The droplets can also be inhaled into the lungs. It is important to stay at least 6 feet away from others when possible, even if you—or they—do not have any symptoms. To practice social distancing the following guidelines should be implemented: · Stay at least 6 feet from other people who are not from the same household, in both indoor and outdoor spaces. · Maintaining distance of at least 6 feet from other adults, and from students even while wearing a cloth face covering. Cleaning and Disinfecting Cleaning is the use of soap and water to reduce the number of germs, dirt and impurities on the surface of an object. · Practice routine cleaning of frequently touched surfaces daily. High touch surfaces include such as tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, sinks, etc. Disinfecting is the use of EPA-registered household disinfectants to kill germs on

surfaces. · Use an EPA-registered household disinfectant approved for use by RSS Operations department. · Follow the instructions on the label to ensure safe and effective use of the product. Many products recommend to keep a surface wet for a period of time (see product label). · Precautions such as wearing gloves and making sure you have good ventilation during use of disinfectant products. · Never eat, drink, breathe or inject these products into your body or apply directly to your skin as they can cause serious harm. · Special considerations should be made for people with respiratory conditions and they should not be present when cleaning and disinfecting is happening as this can trigger symptoms. Items which have been used by a suspected or confirmed COVID-19 should ideally be allowed a wait time of 24 hours, or as long as practical, before handling. If necessary to handle immediately, disposable gloves should be worn and hands must be washed immediately upon removal of gloves. When handling potentially soiled clothing: · Do not shake dirty laundry

· Launder items as appropriate in accordance with the manufacturer’s instructions and RSS guidelines. If possible, launder items using the warmest appropriate water setting for the items and dry items completely on high heat.. · Place clothing that is potentially soiled in a bag with a liner that can be laundered or thrown away. · Wash hands thoroughly after handling soiled clothing or shoes. PPE use to help prevent the spread of COVID-19: Gloves: Provided for staff designated to perform activities that will expose them to body fluids which may contribute to the spread of COVID-19. Gloves are not a substitute for hand hygiene.

Hands should always be washed after removing gloves. The best way to protect yourself from germs is to regularly wash your hands with soap and water for 20 seconds or use hand sanitizer with at least 60% alcohol. Disposable gloves should not be disinfected or reused after use. Gloves are not typically necessary for activities during the school day. Use gloves when: · cleaning and disinfecting. · providing care to someone who is sick. · when touching or having contact with blood, stool, or body fluids, such as saliva, mucus, vomit, and urine. Face Mask: Face masks such as those used for surgery or medical procedures are provided for staff who are designated to care for students suspected, presumed or confirmed of having COVID-19. Gown: Non Sterile, disposable isolation gowns, which are used for routine patient care in healthcare settings, are appropriate for use by school staff providing care for students presumed, suspected or confirmed COVID-19. Disposable gowns are used to prevent soiling of clothes as a result of a body fluid splash. Gowns should be used for the following activities: · During COVID care activities where splashes and sprays are anticipated, which typically includes aerosol generating procedures · During the following high-contact COVID care activities that provide opportunities for transfer of pathogens to the clothing of staff, such as: o Providing personal hygiene, changing clothes soiled with body fluids, assisting with toileting, or uncontrolled vomiting.

B. Consideration for prolonged use of PPE and Use of Infection Control Resources by school employees caring for presumed, suspected or confirmed COVID-19Re-use of face masks Limited re-use of facemasks is the practice of using the same facemask by one person for multiple encounters with different people, removing it after each encounter. As it is unknown what the potential contribution of contact transmission is for SARS-CoV-2, care should be taken to ensure that staff do not touch outer surfaces of the mask during wear, and that mask removal and replacement be done in a careful and deliberate manner. · The facemask should be removed and discarded if soiled, damaged, or hard to breathe through. · Not all facemasks can be reused. o Facemasks that fasten to the provider via ties may not be able to be undone without tearing and should be considered only for extended use, rather than re-use. o Face Masks with elastic ear hooks may be more suitable for reuse. · Leave Isolation room if removal of the facemask is necessary. · Face coverings should be carefully folded so that the outer surface is held inward and against itself to reduce contact with the outer surface during storage. · The folded mask can be stored between uses in a clean sealable paper bag or breathable container. Prioritize facemasks for selected activities such as: · During care activities where splashes and sprays are anticipated · During activities where prolonged face-to-face or close contact with a potentially infectious patient is unavoidable · For performing aerosol generating procedure When No Facemasks Are Available, Options Include: · Exclude staff at increased risk for severe illness from COVID-19 from contact with known or suspected COVID-19 patients. · During severe resource limitations, consider excluding staff who may be at increased risk for severe illness from COVID-19, such as those of older age, those with chronic medical conditions, or those who may be pregnant, from caring for patients with confirmed or suspected COVID-19 infection. · Use a face shield that covers the entire front (that extends to the chin or below) and sides of the face with no facemask. Cloth face covering: In settings where facemasks are not available, staff might use homemade cloth face

covering (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect is unknown. Caution should be exercised when considering this option for use as PPE. Cloth face coverings should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face. · Ensure appropriate cleaning and disinfection when reusable face shields are used. Extended use of eye protection Extended use of eye protection is the practice of wearing the same eye protection for repeated close contact encounters with several different patients, without removing eye protection between patient encounters. Extended use of eye protection can be applied to disposable and reusable devices. · Eye protection should be removed and reprocessed if it becomes visibly soiled or difficult to see through.

o If a disposable face shield is reprocessed, it should be dedicated to one staff member and disinfected whenever it is visibly soiled or removed (e.g., when leaving the isolation area) prior to putting it back on. See protocol for removing and reprocessing eye protection below. · Eye protection should be discarded if damaged (e.g., face shield can no longer fasten securely to the provider, if visibility is obscured and reprocessing does not restore visibility). · Staff should take care not to touch their eye protection. If they touch or adjust their eye protection they must immediately perform hand hygiene. · Staff should leave COVID care area if they need to remove their eye protection. See protocol for removing and reprocessing eye protection below. If there is no date available on the eye protection device label or packaging, facilities should contact the manufacturer. The user should visually inspect the product prior to use and, if there are concerns (such as degraded materials), discard the product. Prioritize eye protection for selected activities such as: · During care activities where splashes and sprays are anticipated, which typically includes aerosol generating procedures. · During activities where prolonged face-to-face or close contact with a potentially infectious student or staff is unavoidable. Consider using safety glasses (e.g., trauma glasses) that have extensions to cover the side of the eyes. However, protective eyewear (e.g., safety glasses, trauma glasses) with gaps between glasses and the

face likely do not protect eyes from all splashes and sprays. Exclude staff at increased risk for severe illness from COVID-19 from contact with known or suspected COVID-19 patients. · During severe resource limitations, consider excluding staff who may be at increased risk for severe illness from COVID-19, such as those of older age, those with chronic medical conditions, or those who may be pregnant, from caring for patients with confirmed or suspected COVID-19 infection. Adhere to recommended manufacturer instructions for cleaning and disinfection. When manufacturer instructions for cleaning and disinfection are unavailable, such as for single use disposable face shields, consider: 1. While wearing gloves, carefully wipe the inside, followed by the outside of the face shield or goggles using a clean cloth saturated with neutral detergent solution or cleaner wipe. 2. Carefully wipe the outside of the face shield or goggles using a wipe or clean cloth saturated with EPA-registered hospital disinfectant solution. 3. Wipe the outside of face shield or goggles with clean water or alcohol to remove residue. 4. Fully dry (air dry or use clean absorbent towels). 5. Remove gloves and perform hand hygiene. Gowns should be prioritized for the following activities: · During COVID care activities where splashes and sprays are anticipated, which typically includes aerosol generating procedures · During the following high-contact COVID care activities that provide opportunities for transfer of pathogens to the clothing of staff, such as: o Providing personal hygiene, changing clothes soiled with body fluids, assisting with toileting, or uncontrolled vomiting.

5-2022 – NC DHHS Strong Schools Toolkit: Guidance for controlling the spread of COVID in the school setting. https://covid19.ncdhhs.gov/media/164/open

After viewing the sessions, contact your site based trainer if you have any questions or to clarify information pertaining to bloodborne pathogen procedures.

If you have no questions, print and complete the Training Acknowledgement Form and return it to the site-based trainer.

BBP TRAINING ACKNOWLEDGMENT FORM