What to Include in Your Exposure Control Plan and Work Practice Controls

The following guidelines are based on the Centers for Disease Control and Prevention, Occupational Safety and Health Administration, Veteran's Administration and Federal Register recommendations and requirements.

1 Remove particulate matter from surfaces and instruments using one of these disinfecting agents. Don't get them in anyone's eye(s):

1.   3% hydrogen peroxide

2. 10% household bleach/water solution

3. 70% or higher concentration of ethanol or isopropanol (alcohol)

4. other solutions proven clinically effective

2 Wash your hands for at least 10 seconds with antibacterial soap before and after physical contact with a patient and after restroom use.

3 Never recap needles with two hands. Use the "scoop" method or a recapping device.

4 Contaminated non-disposable "sharps" (needles, etc.) and other instruments shall be disinfected with the autoclave. Place instruments waiting to be autoclaved in a shallow, well-marked container such as a stainless steel or plastic tray. Instruments should lie flat so no one risks a "stick" from a non-sterile instrument.

5 Contaminated disposable sharps shall be discarded in a labeled red sharps container. These containers should be non-crushable. No sharps shall be bent, recapped, or broken off.

6 Eating, drinking, smoking, applying cosmetics or lip balm, or handling contact lenses are prohibited where there's a reasonable likelihood of occupational exposure (primarily in the exam rooms). Contact lens dispensing is not included and is necessary, but no person should dispense contact lenses if they have an open cut on their hands or fingers. Contact lenses should be dispensed only once they're disinfected.

7 Do not keep food or drinks where blood or potentially infectious materials are present.

8 All procedures involving blood or potentially infectious materials (including tears and saliva) shall be performed in a manner that minimizes splashing, spraying, splattering and generation of droplets. When it can be expected that such will occur, use protective gear (goggles, gloves, aprons or lab coats, resuscitation bags, pocket masks, other ventilation devices).

9 Place specimens of potentially infectious material (such as cultures) in a container that doesn't leak during collection, handling, processing, storage, transport or shipping.

10 Employees shall remove immediately, or as soon as feasible, any garments penetrated by blood or other potentially infectious materials --whether it's their own or a patient's.

11 Employees shall wear gloves when it can be anticipated that there may be hand contact with blood or other infectious materials. Gloves don't protect against puncture injuries; prolonged use may result in small holes. Manufacturers may supply defective gloves.Inspect them before use. Don't reuse or disinfect them. Maintain the work site in a clean and sanitary condition.

12 A written schedule may be used to specify which staff person has responsibility for a given office area.

13 All equipment plus environmental and working surfaces shall be cleaned and decontaminated using an approved germicidal agent. Certain instruments require special procedures -- see manufacturer's manual.

1. Contaminated work surfaces shall be decontaminated: after completion of procedures; immediately or as soon as practical, when visibly contaminated; after any spill; at the end of the work day, by the person the doctor or office manager assigns to that area.

2. Soiled linens or towels shall be handled as little as possible and must be placed in a plastic bag in the area of use. All plastic bags will be considered to contain potentially infectious material. They should be clearly marked or unique in a way that ensures that they're known to contain biohazardous materials or waste.

3. Employees in contact with soiled linens must wear gloves and/or other appropriate personal protective equipment. Hypoallergenic gloves, glove liners, powderless gloves or similar alternatives shall be available to those with latex allergies.

14 Remove protective coverings (plastic wrap, aluminum foil, or paper) used to cover equipment and environmental surfaces as soon as feasible when they become overtly contaminated.

15 All bins, pails, cans and similar receptacles intended for reuse that have a likelihood of contamination with blood or other potentially infectious materials shall be inspected and decontaminated on a regularly scheduled basis and immediately upon visible contamination. They should be a different color than regular (paper) waste containers.

16 Employees should obtain the following appropriate immunizations. An exception could be granted in the case of allergies or other known adverse reactions for which a person might be at risk.

1. Seasonal influenza

2. Hepatitis B

3. Hepatitis A

4. Tetanus/diphtheria

17 Post-exposure procedures:

1. Administer first aid to yourself or the patient.

2. Report to the office manager as soon as practical for evaluation and prophylaxis.

   1. HIV post-exposure prophylaxis is best started within 2 hours of at-risk exposure and can include azidothymidine (AZT) (Zidovudine) 600 mg x 4 weeks and (3TC) combivir with AZT (Lamivudine) 150 mg bid x 4 weeks

   2. Route of exposure and circumstances under which it occurred must be documented.

   3. The source individual should have a blood test as soon as feasible.

   4. HBV post-exposure prophylaxis includes Hepatitis B immunoglobulin and HBV immunization as indicated.

18 Definitions (Source is the Federal Register 29 CFR Part 1910.1030):

1. Occupational exposure: reasonably anticipated skin, eye, mucous membrane or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties.

2. Other potentially infectious materials:

   1. i. The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva, blood. When in doubt, treat the fluid as if it's potentially infectious.

   2. ii. Any unfixed tissue or organ (other than intact skin) from a human (living or dead).

   3. iii. HIV-containing cell or tissue cultures, organ cultures and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.

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

4. HIV: human immunodeficiency virus.

5. HBV: hepatitis B virus.

6. Blood: human blood, human blood components and products made from human blood.

7. Blood-borne pathogens: pathogenic microorganisms that are present in human blood and cause disease in humans.

8. Contaminated: the presence or the reasonably anticipated presence of blood or other potentially infectious materials.

9. Contaminated sharps: any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, and broken capillary tubes.

10. Decontamination: the use of physical or chemical means to remove, inactivate, or destroy blood-borne pathogens on a surface or item until they're no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal.

11. Exposure incident: 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 an employee's duties.

12. Universal precautions: an approach to infection control. Human blood and certain body fluids are treated as if known to be infectious with HIV, HBV, and other blood-borne pathogens. They're also known as standard precautions.