GUIDE

Bodily Fluids Exposure

December 2005

2005-0043

The Canadian Association of Petroleum Producers (CAPP) represents 150 companies that explore for, develop and produce natural gas, natural gas liquids, crude oil, oil sands, and elemental sulphur throughout Canada. CAPP member companies produce more than 98 per cent of Canadas natural gas and crude oil. CAPP also has 125 associate members that provide a wide range of services that support the upstream crude oil and natural gas industry. Together, these members and associate members are an important part of a $90-billion-a-year national industry that affects the livelihoods of more than half a million Canadians.

Review by July 2008

Disclaimer This publication was prepared for the Canadian Association of Petroleum Producers (CAPP) by industry representatives and Lost Time Solutions. While it is believed that the information contained herein is reliable under the conditions and subject to the limitations set out, CAPP and the contributors do not guarantee its accuracy. The use of this report or any information contained will be at the users sole risk, regardless of any fault or negligence of the contributors, CAPP or its contributors.

2100, 350 7th Ave. S.W. Calgary, Alberta Canada T2P 3N9 Tel (403) 267-1100 Fax (403) 261-4622

403, 235 Water Street St. Johns, Newfoundland Canada A1C 1B6 Tel (709) 724-4200 Fax (709) 724-4225

Email: communication@capp.ca Website: www.capp.ca

Overview To provide a resource to assist member companies to develop their own code of practice and safe work practices for management of bodily fluids (BF) To limit occupational exposure to BF through the use of Universal Precautions and by appropriate waste management disposal To decrease the risk of occupationally acquired infection from BF This guide is not intended as a safe operating procedure nor does it relieve employers of the responsibility to develop their own site-specific safe operating procedures

Project Scope Applies to all business activities and personnel where first aid and/or life support practices as well as cleanup/disposal of spilled body fluids is an expected role. This may also include the cleanup/disposal of contaminated equipment/supplies that may occur as a result of the above-mentioned activities.

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Contents
Overview ....................................................................................................................................i Project Scope..............................................................................................................................i 1 Program Layout............................................................................................................1 1.1 1.2 2 2.1 2.2 2.3 3 4 Regulatory Requirements................................................................................1 Training Content..............................................................................................1 Employer ..........................................................................................................2 Employee..........................................................................................................2 Contractor.........................................................................................................2

Responsibilities ............................................................................................................2

Record Keeping............................................................................................................2 Risk Management.........................................................................................................3 4.1 4.2 4.3 Identification ....................................................................................................3 Assessment.......................................................................................................3 Control..............................................................................................................3 Work Practices .................................................................................................4 5.1.1 Housekeeping ......................................................................................4 5.1.2 Care and Maintenance of Equipment.................................................4 Personal Protective Equipment.......................................................................4 5.2.1 Gloves ..................................................................................................4 5.2.2 Masks, Eye Protection ........................................................................5 Disposal Practices ............................................................................................5 5.3.1 Sharps Use and Disposal.....................................................................5 5.3.2 Bodily Fluid Waste Disposal..............................................................5 5.3.3 Contaminated Laundry........................................................................5 5.3.4 Incident Management..........................................................................5 Post Exposure Reporting.................................................................................6 Post Exposure Follow-up ................................................................................7

Engineering Controls ...................................................................................................4 5.1

5.2

5.3

6 7 8

Post Exposure Management ........................................................................................6 6.1 7.1 Post Exposure Testing..................................................................................................7 Program Evaluation......................................................................................................7

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Program Layout 1.1 Regulatory Requirements 1.2 Companies should be aware of federal, provincial and territorial regulations/ recommendations pertaining to BF handling in their specific area of operations Refer to Appendix A for examples of regulations

Training Content Training is an integral component of risk management and the following should be considered when implementing a training program. The training content is considered a CAPP recommendation as a due diligence obligation for all employees, students and contractors Training should be provided by a qualified agency that meets local regulatory requirements Contractors will comply with these standards and train employees as part of their contractual obligations Training should include a general explanation of epidemiology and symptoms of blood borne diseases, transmission modes, immunization considerations, appropriate engineering controls, practices and personal protective equipment, waste management and disposal and information on post-exposure protocol and follow-up Employer will maintain records of all training sessions; the contents or summary of training sessions; the name and qualifications of the individual conducting the sessions; and the names and job titles of all persons attending the training session The training record will be maintained according to regulatory and/or specific company requirements

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Responsibilities 2.1 Employer The employer is responsible for: 2.2 Offering all employees the opportunity to participate in the BF Program Identifying employees who are required to be included in the BF Program i.e. (those who have first aid responsibilities as a designated part of their job) Scheduling and delivery of BF Training Program. Ensuring that appropriate protective equipment is supplied, available and maintained commensurate with the potential risks Ensuring that employees are aware of the need and procedures for obtaining immediate first aid/medical attention and for reporting incidents of exposure to blood and body fluids Investigating exposure incidents with follow-up to prevent similar incidents from occurring Providing for the care and maintenance of equipment Program Evaluation Record Keeping

Employee The employee is responsible for: Identifying the risks associated with the potential for exposure to BF Knowing how to access immediate first aid and medical attention Knowing and implementing procedures for reporting exposure incidents Applying appropriate clean-up and disposal procedure as per safe work practices Participating in all training programs Practicing universal precautions, including the use of personal protective equipment

2.3

Contractor The contractor is responsible for: Implementing a guideline that is aligned with applicable regulations.

Record Keeping Employers must comply with federal, provincial or territorial regulations specific to content, retention and confidentiality of personal health care records, training records and equipment maintenance records. As a result, requirements for documentation and record keeping will vary according to operating site location.

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Risk Management 4.1 Identification Identify all procedures where workplace exposure to BF is anticipated. Exposure types include: Contact with mucous membranes such as a splash in the eye, mouth and/or nose Contact with non-intact skin, chapped or abraded skin, open dermatitis or eczema Contact from a needle stick, laceration or puncture Exposure with contaminated material that can occur during procedure administration and / or waste disposal

4.2

Assessment First Aid administration procedures which may include: Suppression and containment of bleeding Artificial Respiration (AR mouth to mouth) Cardiopulmonary Resuscitation (CPR) Automatic External Defibrillators (AED)

4.3

Control Prevention is a key component to any program in order to minimize or eliminate risks to the company or its employees. Universal precautions are designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and other bloodborne pathogens Universal precautions treat all blood and body fluids as potentially infectious Engineering controls should include work practices, personal protective equipment and disposal practices

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Engineering Controls 5.1 Work Practices 5.1.1 Housekeeping All equipment and working surfaces shall be cleaned and decontaminated after contact with blood, body fluids, or other potentially infectious materials Appropriate disinfectants shall be used for cleaning All receptacles which are intended for reuse shall be inspected and decontaminated on a regularly scheduled basis, or as soon as feasible, upon visible contamination Broken glassware shall not be picked up directly with the hands. It shall be cleaned up using mechanical means, such as brush and dustpans, tongs, or forceps. Cleanup materials (brush, forceps, etc.) used for picking up contaminated or potentially contaminated materials shall be properly disinfected or disposed of after use A quality assurance program that includes regular maintenance, inspection, storage and cleaning along with documentation must be in place. Supplies must be inspected and changed on a regular basis. Equipment must be cleaned and maintained according to manufacturer instructions

5.1.2 Care and Maintenance of Equipment

5.2

Personal Protective Equipment Personal protective equipment should be placed in areas where exposure to BF is anticipated (First Aid stations, vehicles etc.) 5.2.1 Gloves Disposable impermeable gloves must be worn for all procedures where it can be reasonably anticipated that there will be contact with blood, other potentially infectious materials, mucous membranes, and non-intact skin, and when touching contaminated items or surfaces Gloves shall be replaced when contaminated, torn, or punctured, or when their ability to function as a barrier is compromised Contaminated, used, or breached gloves shall be disposed of in the specified manner Gloves must be changed after contact with each individual (remove gloves pulling from top and turning inside out) Hands must be washed immediately after gloves are removed

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5.2.2 Masks, Eye Protection Disposable surgical masks, in combination with eye protection, such as goggles or glasses with side shields, should be worn whenever splash, spray, splatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination may be anticipated

5.3

Disposal Practices 5.3.1 Sharps Use and Disposal Containers for contaminated sharps shall be easily accessible to personnel and located as close as possible to the immediate area where sharps are used. The container will be maintained upright throughout use

5.3.2 Bodily Fluid Waste Disposal Using appropriate Personal Protection Equipment (PPE): Place all contaminated products in double garbage bags clearly marked with either a bio-hazard label or in a bio-hazard disposal bag Handle garbage as little as possible Place all sharps in a bio-hazardous labeled, leak-proof sharps container Store, transport and dispose of wastes according to federal, provincial, and local regulations Should be handled as little as possible with a minimum of shaking Should be tagged, bagged or containerized at the location where used and shall not be sorted or rinsed Should be transported in a highly visible labeled bag and cleaned by professional service provider using approved method of disinfection

5.3.3 Contaminated Laundry

5.3.4 Incident Management Incident with loss of blood/body fluid: Close off the area to prevent traffic moving through Put on personal protective equipment (minimum is disposable gloves) Clean area/work surfaces and/or equipment then disinfect with the recommended disinfectant

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Post Exposure Management For workers exposed to blood and body fluids 6.1 Post exposure follow-up will be initiated as soon as possible after the exposure has occurred Refer to http://www.hc-sc.gc.ca/ for post-exposure testing schedule Refer to http://www.phac-aspc.gc.ca//publicat/ccdr-rmtc/95pdf/cdr2119e.pdf for post-exposure guidelines

Post Exposure Reporting Employee Report exposure immediately to Supervisor Complete an incident investigation report form ensuring the following information is captured: Incident description Specific equipment involved i.e. needle Body surface exposed Condition of the skin: Is the skin intact or broken? (i.e. needle prick, cut(s), etc) Eye(s) Nose Mouth Personal protection used (i.e. gloves, gown, disposal surgical mask etc.) Initial treatment Disposition

Supervisor Report exposure immediately to a qualified health professional

Qualified Health Professional Implement follow up protocol which shall have post exposure testing and post exposure follow-up

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Post Exposure Testing To be performed by qualified health professional Review completed incident investigation report Obtain consent from source individual and exposed individual(s) for blood testing Document if no signed consent is received Collect all employees blood as soon as feasible after consent is obtained Provide results of source individuals tests to the exposed individual(s), with the appropriate signed consents Inform the exposed individual about confidentiality laws in order to protect the source individuals privacy rights Laboratory testing should include but not be limited to: Hepatitis B screen HbsAg, Anti-HBC Hepatitis C screen Anti HCV HIV testing Frequency of the above tests will be determined by local, provincial and/or federal requirements Review results and develop subsequent treatment plan, this may include consultation with an infection control specialist File confidential documentation in exposed individuals health record Immediately following a report of an exposure incident, the exposed individual will be given a confidential health evaluation and followup Supportive psychological counseling by a qualified professional may be required Schedule of follow-up blood testing will be dependent upon initial exposure results and shall follow local, provincial and/or federal requirements Keep records for each individual with occupational exposure as per company, local, provincial and federal regulations Assess each exposure to determine prevention strategies

7.1

Post Exposure Follow-up

Program Evaluation Review of overall program content Effectiveness of education and training ensuring all components are covered Data analysis to review frequency trends Safe work practices established

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Appendix A
Canada:

Resources

Canada Labour Code, Canada Occupational Safety and Health Regulations Alberta: Alberta Human Resources and Employment Statutes and Regulations Workplace Health & Safety Bulletins AIDS and the Workplace Universal Precautions for Workers Who May Be Exposed to HIV Alberta First Aid Regulations http://www.gov.ab.ca British Columbia: Workers Compensation Board of British Columbia HIV/AIDS AND HEPATITIS B AND C Preventing Exposure at Work http://www.worksafebc.com Manitoba: Workplace Safety and Health Division Managing Exposure to Human Blood/Body Fluids Work Safe Bulletin http://www.gov.mb.ca/labour/ Ontario: Ontario Occupational Health and Safety Act HIV/AIDS in the Workplace http://www.ipc.on.ca Quebec: Act Respecting Occupational Health and Safety Regulation respecting the Quality of the Work Environment http://www.ccohs.ca Saskatchewan: Saskatchewan Labour Health and Safety Protecting Emergency Response Workers from Infectious Diseases http://www.labour.gov.sk.ca/safety/infectious-diseases/introduction.htm

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The following websites will take you to the provinces government site, some will access the Occupational and Safety Act for that province. Newfoundland: Occupational Health and Safety Act http://www.gov.nf.ca/labour/ New Brunswick: Occupational Health and Safety Act General Regulation http://www.gov.nb.ca/acts/acts/o-00-2.htm Northwest Territories Safety Act, General Safety Regulations http://www.gov.nt.ca/index.html

Nova Scotia: Nova Scotia Offshore Petroleum Occupational Health and Safety Requirements Draft Element 1 Rights, Responsibilities, and Regulatory Mechanisms Part 4 Occupational Health and Safety Policy, Program and Management System http://www.cnsopb.ns.ca/ Nunavut: The Nunavut Act states that all laws of the Northwest Territories will apply in Nunavut. Prince Edward Island: Occupational Health and Safety Act http://www.gov.pe.ca/hss/index.php3 Yukon Occupational Health and Safety Act http://www.gov.yk.ca/

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Appendix B
Bodily Fluid (BF)

Glossary

Includes, but are not limited to, saliva, seminal secretions, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, amniotic fluid and pus. Any bodily fluids visibly contaminated with blood. Includes all bodily fluids in situations where it is difficult or impossible to differentiate between bodily fluids. Means human blood, human blood components, and products made from human blood. Pathogenic microorganisms present in humans. These pathogens include, but are not limited to, Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV). A situation in which mucous membranes or the skin barrier is pierced, through an event such as a needle stick, human bite, cut, and abrasion. Describes the presence or the reasonably anticipated presence of BF on an item or surface. Any contaminated object that can penetrate the skin, including, but not limited to: needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires. Controls (e.g., sharps disposal containers, self sheathing needles), that isolate or remove the blood-borne pathogen hazard from the workplace.

Blood

Bloodborne Pathogens

Broken Skin

Contaminated

Contaminated Sharps

Engineering Controls

Exposed Individual An individual, who in the course of his/her daily duties has been exposed to potentially, infected BF. Exposure Refers to an event which, during the course of an individuals duties, exposes individual to potentially infectious BF. Hepatitis B Virus Hepatitis C Virus Human Immunodeficiency Virus

HBV HCV HIV

Personal Protection Specialized disposable clothing or equipment worn by an Equipment individual for protection against a hazard. General work clothes (e.g., uniforms, pants, shirts, and blouses) not intended to function as protection against a hazard are not considered to be Personal Protective Equipment.

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Source Individual

Any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to other individuals. An approach to infection control. According to the concept of Universal Precautions, all blood and bodily fluids are treated as if known to be infectious for HBV, HCV, HIV, and other blood-borne pathogens. Controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g., prohibiting the recapping of needles).

Universal Precautions

Work Practice Controls

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Appendix C

Bibliography

1. Alberta Workplace Health & Safety Bulletins, Safety Bulletin BH003, AIDS and the Workplace, Universal Precautions for Workers Who May Be Exposed to HIV. 2000 www3.gov.ab.ca/hre/whs/publications/pdf/bh003.pdf 2000 2. Alberta Occupational Health and Safety, First Aid Regulation, 2000 Refer to: www.pao.gov.ab.ca/directives/ohs/first-aid.htm 3. British Columbia Workers Compensation Board, HIV / AIDS and Hepatitis B and C, Preventing Exposure at Work WorkSafe 1998 www.worksafebc.com/publications/health_and_safety_information/by_topic/assets/pdf/hi v_aids.pdf 4. Calgary Regional Health Authority, Blood and Body Fluid Post Exposure Guidelines, Administrative Manual 1998 Refer to: www.calgaryhealthregion.ca/policydb/ShowPolicy?policy_id=1478 www.calgaryhealthregion.ca/policydb/ShowPolicy?policy_id=1465 5. Canadian Center for Occupational Health and Safety, Universal Precautions, 1997 www.ccohs.ca/oshanswers/prevention/ppe/universa.html Last Updated: 2002-04-02 6. Health Canada, An Integrated Protocol to Manage Health Care Workers Exposed to Bloodborne Pathogens, Canadian Communicable Disease Report Supplement Vol. 23S3, May 1997 Last Modified: 2005-09-21 7. Occupational Safety and Health Administration, U.S. Department of Labor, Standards 29 CFR Bloodborne Pathogens 1910 1030, 1996. http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_ id=10051 Last Update: 2001-01-18 8. PanCanadian Petroleum Ltd., Bloodborne Pathogen Exposure Standard, Blood and Body Fluid Post Exposure Management Standard, Draft 2000 9. Workplace Health and Safety, Quality Management Plan for Compliance with First Aid Regulation, (AR48/2000). 2000 Last Update: March 2003

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