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Exposure Control Plan

2005

Prepared by:

____________________________________
Captain James C. Summers
Infection Control and Protection Officer
Safety and Personnel Services Division
Fairfax County Fire and Rescue Department
ACKNOWLEDGEMENTS

The Fairfax County Fire and Rescue Department’s Occupational Health


and Safety Division would like to express its sincere gratitude to all those
who played a role in helping us complete the 2005 Edition of our Exposure
Control Plan. We appreciate your efforts on our behalf.

Special thanks to:

The International Association of Fire Fighters (IAFF)


Local 2068
Fairfax, Virginia

Allan J. Morrison, Jr., MD, MSc, FACP


Infectious Disease Physicians
Annandale, Virginia

Schering Plough
Kenilworth, New Jersey

Merck & Co., Inc.


West Point, Pennsylvania

Photography and Layout:


Scotty W. Boatright & Jackie B. Lewis
Fairfax County Fire and Rescue Department
Fairfax, VA

Editor:

Diane G. Christensen
BioTechnology, Inc.
Falls Church, VA 22046-3126
(703) 534-8200
Table of Contents

Acknowledgements ii

Table of Contents iii

List of Attachments v

Preface vii

Foreword ix

Chapter 1. Introduction 1-1


1.1 Fairfax County Fire and Rescue Department 1-1
1.2 Infectious Disease Control 1-1
1.3 Exposure Control Plan 1-2
1.4 Definitions 1-4

Chapter 2. Exposure Determination/Risk Assessment 2-1


2.1 Job Evaluations and Listings 2-1
2.2 Risk Assessment – Tuberculosis 2-1

Chapter 3. Training and Education 3-1


3.1 Training 3-1

Chapter 4. Compliance 4-1


4.1 Standard (Universal) Precautions 4-1
4.2 Sharps Control 4-7
4.3 Accepting Sharps Containers from Citizens 4-10
4.4 Workplace Contamination 4-10
4.5 Department Facilities 4-11
4.6 Good Samaritan Exposure(s) 4-13
4.7 Commonwealth of Virginia Deemed Consent 4-15
4-8 FRD Member-to-Patient Exposure 4-16

Chapter 5. Personal Protective Equipment (PPE) 5-1


5.1 Qualified Items 5-1
5.2 Cleaning and Disinfecting 5-6

Chapter 6. Communicable Diseases/Immunizations 6-1


6.1 Acquired Immunodeficiency Syndrome (AIDS)/
HIV Infection 6-1
6.2 Chickenpox (Varicella Zoster) 6-2
6.3 Hepatitis A (HAV) 6-2
6.4 Hepatitis B (HBV) 6-3
Table of Contents

Chapter 6. Communicable Diseases/Immunizations (Cont’d.)


6.5 Hepatitis C (HCV) 6-4
6.6 Hepatitis D (HDV) 6-5

6.7 Lice 6-6


6.8 Meningitis (Meningococcus) 6-7
6.9 Methicillin Resistant Staphyloccus
Aureus (MRSA) 6-8
6.10 Severe Acute Respiratory Syndrome (SARS) 6-8
6.11 Scabies 6-10
6.12 Shingles (Herpes Zoster) 6-10
6.13 Smallpox (Variola virus) 6-11
6.14 Tuberculosis (TB) 6-12
6.15 Vancomycin Resistant Entreroccus (VRE) 6-13
6.16 Immunizations 6-13
6.17 Immunizations Available at PSOHC 6-14
6.18 Federal Emergency Management Agency (FEMA)
Virginia Task Force I Participants 6-15
6.19 Tuberculosis (TB) Skin Test 6-16
6.20 Declination of Vaccinations/Immunizations 6-17

Chapter 7. Post-Exposure Management 7-1


7.1 Exposure Incident Management 7-1
7.2 Post Exposure Reporting and Procedures –
On-Duty Reporting 7-3
7.3 Post Exposure Reporting and Procedures –
Off-Duty (Out-of-Metropolitan Area) Reporting 7-8
7.4 Post Exposure Prophylaxis (PEP) – Occupational
Exposure to Agents of Bioterrorism 7-9
7.5 Exposure Incident – Animal Bite 7-10
7.6 Exposure Incident – Ride-Alongs 7-11
7.7 Exposure Incidents – Public Sites Contaminated
with Blood and/or Body Fluids 7-13
7-8 Exposure Incident – Requests from Other Public
Safety Agencies 7-15
7.9 Exposure Incident – In Station Events 7-16
7.10 Medical Surveillance 7-17

Chapter 8. Record Keeping 8-1


8.1 Medical Records 8-1
8.2 Training Records 8-2
List of Attachments

Page

Attachment 2-1
Uniformed and Operational Volunteer Positions
Determined to be “Not at Risk” for Occupational
Exposure on a Reasonable Basis 2-3

Attachment 2-2
Non-Uniformed and Administration Volunteer Positions
Determined to be “Not at Risk” for Occupational
Exposure on a Reasonable Basis 2-4

Attachment 2-3
Exposure Determination/Prevention Guide 2-5

Attachment 2-4
Risk Assessment – Tuberculosis 2-6

Attachment 4-1
Commonwealth of Virginia
Infectious Waste Regulations and Guidelines 4-17

Attachment 4-2
Source Patient Blood Draws in the Event
Of an Occupational Exposure 4-20

Attachment 5-1
Care of Specific Contaminated Equipment
For Stations with Approved Decontamination Rooms 5-11

Attachment 5-2
Cleaning Procedures for Antishock Trousers 5-12

Attachment 5-3
Procedures/Guidelines for use and Cleaning
Resusci-Anne 5-13

Attachment 6-1
Follow-Up for Exposure to Tuberculosis (TB) 6-18

Attachment 6-2
Procedures for Dealing with
Smallpox Vaccine Recipients 6-19
List of Attachments

Page

Attachment 7-1
Immediate Post-Exposure Information Guidelines 7-18

Attachment 7-2
Occupational Exposure Single-Use Diagnostic
System (SUDS) Rapid HIV-Test 7-21

Attachment 7-3
Bloodborne Pathogen Exposures
Counseling Guidelines 7-23

Attachment 7-4
Fairfax County Fire and Rescue Department
Emergency Department Contact Information 7-24

Attachment 7-5
Fairfax County Fire and Rescue Department
Infection Control Designated Officers 7-25

Attachment 7-6
Infection Control Practitioners 7-27

Attachment 7-7
Completing an Infectious Disease Exposure
Injury Report Package 7-29
PREFACE
The Fairfax County Fire and Rescue Department maintains a full and on-going commitment to
the health and well-being of the departmental workforce. The arduous and demanding nature of
fire and rescue operations requires members to be in excellent physical condition and, at all
times, free of disease. The need to maintain peak physical condition is readily apparent; the
need to guard against infectious disease may not be as apparent. Yet, the threat of disease
exposure is always there.

The fire and rescue working environment is anything but orderly. In the performance of their
duties, fire and rescue personnel face life threatening emergency situations, seriously injured
and possibly comatose patients, requiring contact with blood and other body fluids, the risk of an
accidental needlestick during the provision of emergency services, and the likelihood of direct
encounters with hard objects and surfaces capable of puncturing and damaging protective
clothing and equipment. Each of these circumstances provides an opportunity for the
transmission of infectious disease. All of this is complicated by communal living and working
conditions that provide additional opportunities.

The Fairfax County Fire and Rescue Department recognizes the risks imposed by exposure to
infectious diseases during emergency operations and throughout the work environment. This
Exposure Control Plan represents a systematic and proactive effort by the Department to
ensure that fire and rescue personnel are fully protected from infectious diseases both through
use of proper procedures and appropriate equipment. The Plan presented here is
comprehensive and meets or exceeds guidelines and standards of applicable Federal and State
laws and regulations.

The Exposure Control Plan touches on most, if not all, of the daily work activities of Fire and
Rescue Department members. Cleanliness and health practices in fire station facilities are
covered. Proper use of respirators is described. Mandated methods for cleaning and/or
disposal of contaminated items is another topic. And of especial importance is the matter of
reporting and record keeping − an issue that involves every member of the Department.

The above sampling of subject material presented in the Exposure Control Plan illustrates the
breadth of coverage necessary to present a plan for the successful control of infectious
diseases. For the Plan to be indeed successful, many responsibilities must be met.
Department members must be versed in the specifics of the Plan and fully committed to its
prescribed procedures. The Department itself must provide oversight for conduct of the Plan,
must establish appropriate training schedules and materials, must maintain proper quantities of
personal protective equipment (PPE), and must review and update the Plan at least annually.

The Exposure Control Plan of the Fairfax County Fire and Rescue Department presents a
structure for containing infectious diseases in fire and rescue personnel. The Plan is of
fundamental importance in maintaining a healthy and productive workforce. All members of the
Fire and Rescue Department must understand the Plan and work together to ensure its full
success.
____________________________________
Captain James C. Summers
Infection Control and Protection Officer
Safety and Personnel Services Division
Fairfax County Fire and Rescue Department
FOREWORD

This Exposure Control Plan is a notable element in the progressive efforts of Fairfax
County to ensure the safety and health of a most important component of public safety:
the fire and rescue force. First responders of the Fire and Rescue Department are at
risk in many ways. Disease should not be one of them.

The importance of controlling exposure of fire and rescue personnel to infectious


disease is fully appreciated by the Fire and Rescue Department. To ensure a
comprehensive approach to disease protection, the Fairfax County Fire and Rescue
Department and the International Association of Fire Fighters, Local 2068 combined
efforts and resources leading to the development of the Exposure Control Plan. Full
implementation of this Plan will place the Fairfax County Fire and Rescue Department
in the forefront of national efforts toward the protection of those serving the public.

___________________________________
Michael P. Neuhard
Fire Chief
Fairfax County Fire and Rescue Department

____________________________________
R. Michael Mohler
President, Local 2068
International Association of Fire Fighters
EXPOSURE CONTROL PLAN

CHAPTER 1.
INTRODUCTION

1.1 Fairfax County Fire and Rescue Department. The Department is


charged with protecting the lives and property of roughly one million
citizens of the County. The diversity and expanse of the County, its
variety of commerce and industry, and the daily volume of traffic, all place
heavy public safety demands on Fire and Rescue Department personnel.
For these demands to be met, the workforce of the Department must
maintain at full and constant readiness. Nothing should degrade this
readiness. There is an ongoing requirement to “protect the people who
serve the people.”

1.1.1 Those serving in a fire and rescue department must be qualified in


many dimensions. The inherent danger in the profession calls for
high motivation. Members must be trained to a level where proper
responses under high stress become automatic. The physical
challenges of fire fighting require individuals in the best of physical
condition. And, fire fighters must be in good health at all times.
Any health problem, particularly one caused by infectious disease,
can lessen capabilities and proficiency dangerously.

1.1.2 The different environment in which fire and rescue operations take
place presents a variety of hazards. Those found in the heat and
debris of fire suppression are of one kind. The hazards
encountered in extrication of an individual from an overturned
vehicle are another. But throughout, there is the danger of
exposure to an infectious disease and its consequent health risk.
To complicate matters, one may not know whether exposure to a
contaminated item has resulted in infection for weeks or even
months.

1.2 Infectious Disease Control. Exposure to infectious disease represents a


serious problem to fire and rescue personnel. Of particular concern are
the hepatitis infections, all of which affect the liver and can produce
cirrhosis and possibly death. Hepatitis C, caused by the Hepatitis C virus
(HCV), is responsible for thousands of deaths annually. There is no
vaccine against Hepatitis C, making attention to preventive actions
paramount.

1.2.1 Hepatitis C is transmitted principally through direct percutaneous


contact with infected blood. Limited research points to accidental
needle-sticks as the key occupational injury risk.

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1.2.2 Controlling the risk of acquiring Hepatitis C illustrates the approach


used for disease control in the fire and rescue environment.
Emergency Medical Services (EMS) personnel are trained in safe
percutaneous procedures to reduce the number of accidental
needlesticks. The effects of blood splashes are minimized through
immediate washing and disinfecting of contact surfaces. A
respirator is worn to preclude any chance of airborne infection.

1.3 Exposure Control Plan. A program to prevent direct contact of fire and
rescue personnel with infectious disease agents, such as shown for
Hepatitis C, must be comprehensive. There are many routes by which
diseases can be transmitted. There also is a variety of distinct disease
classes, each with its own potency, its own targets, and its own time
course for action. An effective Exposure Control Plan must account for all
of these characteristics.

1.3.1 The number of diseases that can be encountered in fire and rescue
operations is impressive. Fortunately, effective vaccines exist for
certain of these diseases. Also, individual immunity may exist for
others based on earlier exposures. Even so, a number of
potentially infectious diseases remains. A listing of diseases of
concern and disease agents includes, but is not limited to:

♦ Hepatitis A
♦ Hepatitis B
♦ Hepatitis C
♦ Hepatitis D
♦ Human Immunodeficiency Virus (HIV)
♦ Lice
♦ Meningitis
♦ Staphlococcus Aureus
♦ Scabies
♦ Shingles
♦ Tuberculosis (TB)
♦ Enterococcus
♦ Influenza
♦ Measles, mumps, rubella
♦ Lyme Disease
♦ Varicella

1.3.2 A comprehensive exposure control plan must deal with a number of


topics that can affect the success of the plan. These include:

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Awareness. The plan must have a strong training component that


informs and instructs fire and rescue personnel concerning the
nature of the threat, use of protective measures, emergency actions
as required, and necessary reporting procedures.

Cleanliness. An overriding feature must direct daily attention to


cleanliness, both for the individual and for all equipment.

On-scene procedures. No emergency procedure should be


considered so demanding that it takes priority over use of individual
protective equipment. Every person should understand that the first
action item when arriving on-scene is to check that proper
protective equipment is in place.

Medical protection. Vaccines are available for a number of


infectious diseases that can affect fire and rescue personnel.
Procedures for immunization should be described and medical
benefits stressed.

Engineering controls. New devices offering greater protection for


fire and rescue personnel are appearing in the marketplace. For
example, new needle systems reduce the likelihood of
needlesticks. The plan must be updated as required to include
descriptions of such advanced engineering controls as they come
into use.

Work practice controls. Work practice controls reduce the


likelihood of exposure by altering and/or improving the manner in
which a task is performed. Example(s): Prohibit bending or
recapping of needles; minimize splashing, spraying, splattering and
generation of droplets during procedures; do not eat, drink or apply
cosmetics in work areas, etc.

Reporting. The effectiveness of the Fairfax County Fire and


Rescue Department Exposure Control Plan can be improved only if
the Department receives timely reports of the results of each
mission and problems encountered. This is particularly true for an
exposure incident. Data concerning every exposure, including any
difficulties found with protective procedures and equipment, are
vital for a program of ever-improving health support for members of
the Fairfax County Fire and Rescue Department.

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1.4 Definitions

Airborne pathogens: Pathogenic microorganisms that are present in


airborne secretions and can cause diseases in humans. These pathogens
include, but are not limited to, chicken pox, German measles (rubella),
influenza, measles, meningoccocal meningitis, mononucleosis, mumps,
tuberculosis, and whooping cough (pertussis).

Amniotic fluid: Fluid from the uterus.

Blood: Human blood, human blood components, and products made


from human blood.

Bloodborne pathogens (BBPs): Microorganisms that are 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 immunodeficiency virus (HIV).

Body fluids: Fluids that the body produces including, but not limited to,
blood, semen, mucus, feces, urine, vaginal secretions, breast milk,
amniotic fluids, cerebrospinal fluid, synovial fluid, pericardial fluid, and any
other fluids that might contain HIV or HBV viruses.

Body substance isolation: An infection control strategy that considers


all body substances potentially infectious.

Cerebrospinal fluid: Fluid from the spine.

Cleaning: The physical removal of dirt and debris. This generally is


accomplished with soap and water and physical scrubbing.

Contaminated: The presence or the reasonable anticipated presence of


blood or other potentially infectious materials on an item or surface.

Decontamination: Use of physical or chemical means to remove,


inactivate, or destroy bloodborne pathogens on a surface or item to the
point where they are no longer capable of causing disease. Thus, the
surface or item is rendered safe for handling, use or disposal.

Disease transmission: The process that includes a sufficient quantity of


an infectious agent, such as a virus or bacteria; a mode of transmission,
such as blood for HBV and HIV or airborne droplets for tuberculosis; a
portal of entry, such as a needlestick injury, abraded skin, or mucous
membrane contact; and a susceptible host.

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Engineering controls: Equipment that is designed to isolate or remove


the bloodborne pathogen hazard from the workplace (i.e. sharps disposal
containers, self-sheathing needles, blunt needles, plastic capillary tubes).

Exam gloves: Single-use, patient examination gloves that are designed


to provide a barrier against body fluids meeting the requirements of NFPA
1999, Standard on Protective Clothing for Emergency Medical Operations.

Exposure Control Plan: The Department’s formal policy and


implementation of procedures relating to the control of infectious and
communicable disease hazards where employees, patients, or the
general public could be exposed to blood, body fluids, or other potentially
infectious materials in the fire department work environment.

Exposure incident: A specific eye, mouth, other mucous membrane,


non-intact skin (includes skin with dermatitis hangnails, cuts, abrasions,
chafing, acne, etc.), or parenteral contact with blood or other potentially
infectious materials.

Fluid resistant clothing: Clothing worn for the purpose of isolating parts
of the wearer’s body from contact with body fluids.

HBV: Hepatitis B virus; causes inflammation of the liver and may lead to
long-term liver damage, including cirrhosis and cancer.

HCV: Hepatitis C virus; causes inflammation of the liver and can lead to
long-term liver damage, including cirrhosis and cancer.

HIV: Human immunodeficiency virus; attacks critical cells of the immune


system which leads to acquired immunodeficiency syndrome (AIDS), a
life-threatening condition.

Infection Control and Protection Officer (ICPO): The person or


persons within the fire and rescue department responsible for managing
the department infection control program and for coordinating efforts
surrounding the investigation of an exposure.

Infectious Disease Physicians, Inc. (IDP):1 The Department’s


contractual infectious disease physicians.

1
IDP offices currently located at 3289 Woodburn Road, Suite 200, Annandale, VA (as of January
2005).

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Medical gloves: See Exam gloves.

Mucous membrane: A moist layer of tissue that lines the mouth, eyes,
nostrils, vagina, anus, or urethra.

Occupational exposure: Reasonably anticipated (includes the potential


for contact as well as actual contact with blood or OPIM) skin, eye,
mucous membrane, non-intact skin, or parenteral contact with blood or
other potentially infectious materials, or inhalation of airborne pathogens,
that may result from the performance of an employee’s duties.

Other potentially infectious materials (OPIM): Materials in addition to


human blood that may be capable of transmitting bloodborne pathogens.
These include:

1. The following human body fluids: semen, vaginal secretions,


cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid,
peritoneal fluid, amniotic fluid, saliva in dental settings, any body fluid
that is visibly contaminated with blood, and all body fluids in situations
where it is difficult or impossible to differentiate between body fluids.

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

3. HIV-containing cell or tissue cultures, organ cultures, and HIV or HBV-


containing culture media or other solutions as well as human cell
cultures not shown to be free of bloodborne pathogens.

4. Blood, organs, or other tissues from experimental animals infected


with HIV or HBV.

Parenteral exposure: Piercing of the mucous membranes or the skin


barrier due to such events as needlesticks, human bites, animal bites,
cuts, and abrasions.

Percutaneous: Through unbroken skin, as in absorption by inunction.

Personal protective equipment (PPE): Specialized clothing or


equipment worn by a member for protection against an infectious or
communicable disease hazard.

Post-exposure prophylaxis: Administration of a medication to prevent


development of an infectious disease following known or suspected
exposure to that disease.

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Sharps containers: Containers that are puncture-resistant, disposable,


and leakproof on the sides and bottom; red in color or display the
universal biohazard symbol; and designed to store sharp objects after use.
Only those sharps containers approved by the Fairfax County Fire and
Rescue Department are to be utilized by Department personnel.

Source individual: Any individual, living or dead, whose blood, body


fluids, or other potentially infectious materials has been a source of
occupational exposure to a member.

Standard (universal) precautions: An approach to infection control in


which human blood and certain human body fluids are treated as if known
to be infectious for HIV, HBV, HCV, and other bloodborne pathogens.

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CHAPTER 2:
EXPOSURE DETERMINATION/RISK ASSESSMENT

2.1. Job Evaluations and Listing

2.1.1 The Fairfax County Fire and Rescue Department (FRD) has
reviewed all job descriptions and tasks performed by individuals at
risk for potential exposure to blood, other potentially infectious body
fluids, and tuberculosis.

2.1.1.1 This risk assessment was reviewed and determination


made by the Fairfax County Fire and Rescue Department
Safety and Personnel Services Division.

2.1.1.2 Attachment 2-1 identifies uniformed and operational


volunteer members of the FRD determined to be “Not at
Risk” for occupational exposure on a reasonable basis.

2.1.1.3 Attachment 2-2 identifies FRD non-uniformed and


administrative volunteer positions determined to be “Not
at Risk” for occupational exposure on a reasonable basis.

2.1.1.4 Attachment 2-3 addresses two major issues, both of


which are a requirement under 29 CFR 1910.1030,
Bloodborne Pathogens Standard:

1) Tasks that are performed and the body fluids which


may be associated with the task.

2) The personal protective equipment (PPE)


recommended for the specific task(s).

2.2 Risk Assessment − Tuberculosis

2.2.1 Following a review of the Department positions and tasks to be


performed, it was decided that members of the Department
determined to be “At Risk” for bloodborne pathogens would also be
considered “At Risk” for tuberculosis (TB), which is an airborne
pathogen.

2.2.2 Department members determined to be “Not at Risk” for


bloodborne pathogens are also considered “Not at Risk” for TB.
However, should an exposure occur, these members will be

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followed according to the post-exposure protocols outlined in this


Plan.

2.2.3 A complete description of PPD test procedures and


recommendations for Department members determined to be “At
Risk” is provided in Chapter 6 of this Exposure Control Plan.

2.2.4 Attachment 2-4 identifies risk tasks for TB and the personal
protective equipment (PPE) to be utilized.

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ATTACHMENT 2-1

UNIFORMED AND OPERATIONAL VOLUNTEER POSITIONS


DETERMINED TO BE “NOT AT RISK”
FOR OCCUPATIONAL EXPOSURE ON A REASONABLE BASIS

1. Fire Chief
2. Assistant Chief, Administrative
Services
3. Assistant Chief, Operations Positions (1 – 10) determined to be
4. Deputy Chief, Fire Prevention “Not at Risk” for occupational
5. Deputy Chief, Support Services exposure on a reasonable basis.
6. Deputy Chief, Special Operations
7. Deputy Chief, Training
8. Deputy Chief, A Shift
9. Deputy Chief, B Shift
10. Deputy Chief, C Shift
All Battalion Chiefs not assigned to the
11. Battalion Chief Operation’s Division
All Captain II’s not assigned to the
12. Captain II Operation’s Division
All Captain I’s not assigned to the
13. Captain I Operation’s Division
All Lieutenants not assigned to the
14. Lieutenant Operation’s Division
All Master Technicians not assigned
15. Master Technician to the Operation’s Division
All Technicians not assigned to the
16. Technician Operation’s Division
All fire fighters not assigned to the
17. Fire Fighter Operation’s Division
All fire fighters not assigned to the
18. Recruit Fire Fighter Training Division
All volunteer personnel in non-
19. Volunteers (all ranks) operational positions (i.e. Admin
Chief)
All personnel not participating in field
20. Fire Prevention operations.

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ATTACHMENT 2-2

NON-UNIFORMED & ADMINISTRATIVE VOLUNTEER POSITIONS


DETERMINED TO BE “NOT AT RISK”
FOR OCCUPATIONAL EXPOSURE ON A REASONABLE BASIS

1. Account Clerk II & I 19. Life Safety Education Specialist


2. Accounting Technician 20. Limited-Term Personnel
3. Administrative Aide 21. Management Analyst I, II, III, & IV
4. Administrative Assistant 22. Material Requirement Specialist
5. Assistant Motor Equipment 23. Network Analyst I & II
Superintendent
6. Auto Mechanic II 24. Occupational Health and Safety
Manager
7. Business Analyst I 25. Photographic Specialist
8. Clerk I 26. Programmer Analyst II
9. Clerk Typist II 27. Public Information Officer I, II, & III
10. Contractual Consultants (i.e. PSOHC) 28. Publications Assistant
11. Data Entry Operator II 29. Secretary I, II, & III
12. Engineer II & III 30. Senior Building Inspector
13. Engineer Plans Examiner 31. Storekeeper
14. Fire Data Specialist 32. Student Intern
15. Geo Analyst I 33. Vehicle Maintenance Coordinator
16. Information Technician I & II 34. Volunteers – Administrative
Members
17. Instructor III 35. Warehouse Worker – Driver
18. Internal Affairs Investigator 36. Word Processing Operator III

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ATTACHMENT 2-4

RISK ASSESSMENT
TUBERCULOSIS

PERSONAL PROTECTIVE
EQUIPMENT
Care Provider: Patient:
RISK TASKS N95 Respirator Oxygen Mask*
Patient Transport
Respiratory disease X
Patient Transport
Suspected or known TB X X
Suctioning
Suspected or known TB X
Intubation
Suspected or known TB X

*Non-rebreather mask. Minimum 12 liters per minute

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CHAPTER 3.
TRAINING AND EDUCATION

3.1 Training. FRD members in all Fairfax County Fire and Rescue
Department job classifications determined to be “at risk,” as discussed in
Chapter 2 of this Exposure Control Plan, must participate in a training
program on bloodborne pathogens. The training shall be “live” − that is,
presented face-to-face by a qualified individual skilled in the prevention
and control of blood and airborne infectious diseases. This program shall
be provided at no cost to members and conducted during working hours.

The training program instructor shall be knowledgeable in the subject


matter and how it relates specifically to the Department’s operations.

Bloodborne/airborne pathogen training is, in most instances, conducted by


the Department’s Infection Control Officer (ICO). Other instructors
approved by the Department to conduct these training programs shall be
under the direct supervision of the Infection Control Officer.

3.1.1 Training Schedules.

1) Training will be provided:

♦ At the time of initial assignment to tasks where occupational


exposure may occur,

♦ Within 90 days after the revision date of this Exposure


Control Plan,1

♦ At least annually thereafter.

2) Annual training for members will be provided within one year of


their previous training.

3) The Department will provide additional training when changes


such as modification of tasks or procedures, or institution of new
tasks or procedures, affect the member’s occupational
exposure.

3.1.2 Materials/Syllabus. The Bloodborne/Airborne Pathogen Training


Program will include:

1
Every effort will be made by the Department to comply with this mandate.

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1) An explanation of the Exposure Control Plan.

2) The incidence, prevalence, and symptoms of bloodborne and/or


airborne diseases.

3) Modes of transmission of bloodborne and/or airborne


pathogens.

4) Appropriate methods for recognizing tasks and other activities


that may involve exposure to blood and other potentially
infectious materials (OPIM).

5) Use and limitations of methods that will prevent or reduce


exposure, including standard (universal) precautions,
engineering and work practice controls, and personal protective
equipment (PPE).

6) Types, proper use, location, removal, handling,


decontamination, and disposal of personal protective
equipment.

7) The basis for selection of Department-approved personal


protective equipment, and appropriate use of this equipment for
exposure control.

8) Prophylaxis (e.g. hepatitis B vaccine) and treatment of


bloodborne viral diseases.

9) Appropriate actions to take and points of contact in an


emergency involving blood or other potentially infectious
materials.

10) The procedure to follow if an exposure incident occurs, including


the method of reporting the incident.

11) Post-exposure evaluation and medical follow-up that the


Department is required to provide.

12) The labels and/or color coding required to prevent or reduce


exposure to bloodborne viruses.

3.1.3 The training program will also include an interactive question-and-


answer session.

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CHAPTER 4.
COMPLIANCE

4.1 Standard (Universal) Precautions

4.1.1 Use of standard (universal) precautions is justified on the premise


that every work activity of fire, rescue, and emergency service
personnel carries the potential for disease transmission. Even a
relatively routine patient transport in which the patient becomes
agitated presents disease transmission hazards. For this reason,
Fairfax County Fire and Rescue Department (FRD) personnel
should maintain a mindset in which disease hazards are always
present and disease prevention is an on-going challenge.

4.1.2 The Occupational Safety and Health Administration (OSHA) states


that “standard precautions” is an approach to infectious disease
control in which all human blood and certain classes of body fluids
are treated as if known to be infectious for human immuno-
deficiency virus (HIV), hepatitis B (HBV), hepatitis C (HCV) and
other bloodborne pathogens.

Standard precautions should be observed to prevent contact with


blood or other potentially infectious materials (OPIM). If a
distinction of body fluid types is difficult or impossible, all body fluids
should be considered potentially infectious.

Standard precautions include:

4.1.3 Handwashing

4.1.3.1 Handwashing facilities should be easily accessible to


members when possible.

4.1.3.2 Department-provided waterless antimicrobial hand


cleanser should be used when handwashing facilities
are not readily available. Hands should then be
washed with soap and running water as soon as
feasible.

4.1.3.3 Members should wash their hands immediately or as


soon as possible after removal of gloves or other
personal protective equipment (PPE).

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4.1.3.4 Members should wash their hands, and any other


areas of skin, with soap and water, or flush mucous
membranes with water, as soon as possible after
contact between these body areas and blood or
OPIM.

4.1.3.5 FRD personnel should remain cognizant of basic


personal hygiene at all times, including leisure hours.
This includes thorough hand washing before and after
eating, handling food, cooking and using food
utensils; after using bathroom facilities; and whenever
hands become soiled from day-to-day activities.

4.1.4 Eating/Drinking

4.1.4.1 Eating and drinking are prohibited at any location


where there is reasonable risk of exposure. This
includes all FRD vehicles, regardless of the incident
phase (i.e. returning to the station).

4.1.5 Disposal of Infectious and Non-Infectious Waste

4.1.5.1 The Occupational Safety and Health Administration


(OSHA) and the Virginia Waste Management Board
(VWMB) regulate storage and disposal of infectious
material. Some of the restrictions include the type of
storage container, the quantity of material, and the length
of time it can be stored. (Attachment 4-1).

4.1.5.2 Department fire stations and facilities are not approved


for storage of infectious waste. “Red bag” trash cans for
storing infectious waste are not authorized. Station
Captains and EMS Supervisors shall ensure that this
policy is strictly adhered to.

4.1.5.3 Equipment that may become contaminated with blood or


other potentially infectious materials during on-scene
operations shall be handled as follows:

4.1.5.3.1 Infectious Waste Disposal Procedures. For


all infectious material generated on an incident,
FRD personnel shall follow proper waste
disposal protocols prior to leaving the incident
scene. It shall be the responsibility of the

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transporting unit or the last remaining


emergency response vehicle to ensure that
no infectious or non-infectious waste is left
at the incident scene. Sharps and syringes
shall be immediately placed into an approved
biohazard sharps container. Other infectious
materials such as blood saturated trauma pads
are to be placed in specific red trash bags that
are issued with the infection control kits and
available at area emergency departments.
This red bag shall accompany the patient to
the hospital for disposal in a proper receptacle
or “holding” room. In the event that infectious
waste is gathered and bagged after the patient
has been transported (such as a CPR or a
helicopter transport), arrangements shall be
made to immediately have infectious waste
transported to an emergency department for
disposal by one of the other units on the scene.

The following materials are considered


infectious waste:

1) Sharps (used needles, IV stylettes, blood


tubes, blood administration tubing or gauze,
and trauma pads saturated with blood.

4.1.5.3.2 Non-Infectious Waste Disposal Procedures.


Non-infectious waste shall be disposed of in
standard trash cans at the receiving hospital. If
personnel are unable to dispose of non-
infectious waste at the hospital, they shall
dispose of the non-infectious waste directly into
their respective station’s trash dumpster.
Under no circumstances shall personnel
dispose of non-infectious waste that is
generated at an emergency operations scene
into living-area trash cans.

The following items generally are not


considered infectious waste:

1) Gauze or dressings with dried blood


2) Used exam gloves

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3) Used intravenous tubing


4) Airway equipment such as bag-valve-
masks, oxygen masks, or endotracheal
tubes
5) Material, not including sharps, containing
small amounts of blood or body fluids, but
not containing free-flowing or unabsorbed
liquid.

4.1.5.4 Labels/Color Coding. As stated in paragraph 4.1.5.3 of


this Chapter, infectious waste generated during an
incident shall be placed in specific red trash bags that are
issued with the infection control kits and available at area
emergency departments. Infectious waste will be
disposed of at the medical facility, following that facility’s
policies and procedures. Infectious waste will not be
transported to or stored at any FRD facility.

4.1.5.4.1 Contaminated clothing. In instances where


clothing (work uniforms and/or fire fighting
protective gear ensembles) is contaminated
(as defined in Chapter 5 of this Plan), these
articles shall be double bagged in red
biohazard bags. These bags can be ordered
from the warehouse.

Depending on the severity of the


contamination, exposed personnel shall
remove contaminated clothing as soon as
possible to avoid cross-contamination.

4.1.5.5 Contaminated backboards and EMS equipment. The


FRD Safety and Personnel Services Division is working
with Infectious Disease Physicians, Inc. to develop a
comprehensive program to eliminate instances where
contaminated items are placed in local hospital “clean
holding” areas. The Infection Control Plan will be
updated to include this information when it is completed.

Following are “interim procedural guidelines” for all


Department EMS transport units:

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1) It is the hospital’s responsibility to clean


backboards and other EMS equipment before they
are reused.

2) EMS transport units shall not accept


contaminated backboards or other contaminated
EMS equipment from hospitals. In the event
transport unit personnel discover uncleaned
backboards or other contaminated EMS
equipment in the hospital’s clean holding area,
they shall immediately notify their EMS supervisor
or the duty Safety Officer.

3) The EMS Supervisor or the duty Safety Officer


shall inspect the hospital clean holding area and, if
needed, photograph the contaminated equipment.
Photographs shall be sent to the Department’s
Infection Control Officer.

4) When there are no clean backboards or other


EMS equipment at a hospital, the EMS supervisor
will assist the transport unit in obtaining
replacement equipment.

5) EMS transport units shall not use contaminated


equipment to remain in-service. This poses a
secondary health risk to firefighters, paramedics,
and the people who call for assistance.

4.1.6 Incident-Related Blood and Body Fluid Spill Management

4.1.6.1 The management of on-scene blood and body fluids is an


area where the Fire and Rescue Department may assist
by providing roadway/area wash down services. Wash
down services may begin only after the collection of
remnant soft tissue and bone fragments has been
completed by other agencies or vendors.

4.1.6.1.1 Upon receipt of a request for wash down


services, the Public Safety Communications
Center (PSCC) shall dispatch the nearest
available engine company in a Priority 2
fashion. A rescue company equipped with a

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pump and booster tank may be substituted for


a more distant engine company.

4.1.6.1.2 The ranking on-scene Fire and Rescue


Department officer shall consult with the
ranking law enforcement official prior to
beginning wash down services.

4.1.6.1.3 Precautions shall be taken to limit and/or


control the potential for cross-contamination of
emergency response apparatus, equipment,
private vehicles, and/or other property.

4.1.6.1.4 If indicated, a 10:1 water/bleach solution may


be used prior to beginning wash down
services. Whenever possible, the effects of the
wash down service should be directed into the
nearest sanitary sewer.

4.1.6.1.5 Questions arising on an incident scene


concerning proper procedures for providing
wash down services should be directed to the
Department’s Safety Officer or the
Department’s Infection Control and Protection
Officer.

4.1.6.2 The management of remnant soft tissue and bone


fragments shall, at all times, remain a law enforcement
and/or medical examiner responsibility. Fire and Rescue
personnel shall not engage in the collection, removal, or
transportation of remnant soft tissue and bone fragments.

4.1.7 Transport of Deceased Bodies.

4.1.7.1 The removal of deceased bodies from an incident scene


is a law enforcement and/or medical examiner
responsibility. However, under certain circumstances,
the Fire and Rescue Department may be asked by law
enforcement to assist in such transport. Such requests
will be managed in accordance with the Fire and Rescue
Department EMS Manual, Administrative Protocol 3.1.8,
“Transportation of Deceased Bodies, (Code Four).”

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4.1.8 Removal of Infectious/Biohazardous Waste from Fire and


Rescue Department Vehicles.

4.1.8.1 All Fire and Rescue Department vehicles (County and


volunteer-owned) shall be free of contaminated and/or
infectious waste before the vehicle is sent to the
Apparatus Shop for necessary repairs or inspections.
Examples of such waste include, but are not limited to:

• Used sharps containers


• Waste (“trash”) cans containing infectious materials

Failure to remove contaminated and/or infectious waste


from vehicles prior to sending them in for service poses a
secondary health risk to Apparatus Shop personnel and
others.

The Officer in Charge (OIC) of the vehicle being


forwarded to the Apparatus Shop shall ensure
compliance with this policy.

4.1.9 Other Important Standard (Universal) Precautions

4.1.9.1 The use of any tobacco products (i.e., smoking, dipping,


chewing, etc.), applying cosmetics or lip balm, and
handling contact lenses are prohibited in work areas
where there is a reasonable risk of exposure. (See
S.O.P. 02.03.12 for FRD regulations regarding Tobacco
Use).

4.1.9.2 All procedures involving blood or other potentially


infectious materials should be performed in a manner
that minimizes splashing, spraying, splattering, and
generating droplets of these substances.

4.2 Sharps Control

4.2.1 First responders routinely deal with sharp tools and objects capable
of penetrating the skin. When the skin is penetrated by one of the
many “sharps,” rescue personnel can be exposed to a number of
bloodborne pathogens.

The most prominent event causing a skin penetration is a needle


stick. By virtue of their unique work environment, fire and rescue

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personnel are particularly at risk for occupational injuries caused by


needle sticks or through use of other sharps. The practice of
standard precautions requires that any such event be considered
an exposure to an infectious agent.

4.2.2 Fire and Rescue Department personnel shall utilize only


Department-approved safety device needles/syringes while
rendering patient care in accordance with federal, state, and
industry standards.

4.2.2.1 Fire and Rescue Advanced Life Support (ALS) personnel


shall not draw blood from a patient while rendering care
unless (1) authorized (e.g. Medical Control, Operational
Medical Director), or (2) in instances of an occupational
exposure/risk to blood or infectious body fluids (e.g.,
contaminated needle-stick injury, mucous membrane
splash, etc.).

In the event of an exposure risk, ALS personnel are


authorized to draw source patient blood if the patient
refuses transportation to a medical facility but consents to
having blood drawn. If the source patient refuses
consent to have blood drawn, the Safety Officer or ICO is
to be notified immediately. (See Attachment 4-2.)

4.2.2.1.1 The Safety Officer and each EMS supervisor


shall carry a blood-drawing kit supplied by the
Safety and Personnel Services Division in the
event source patient blood drawing is
warranted1.

4.2.2.2 In an effort to further reduce occupational exposure to


percutaneous injuries, the FRD encourages IVs initiated
in the transporting unit be administered while the unit is
not in motion. The practice of initiating IVs in transporting
units in motion shall be limited to life-threatening
emergencies.

4.2.3 Full and continuing precautions must be taken by fire and rescue
members when using needles or other sharp instruments or

1
The drawing of source patient blood is in accordance with the Code of Virginia Statutes, 32.1-
45.2.

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devices. Following each use, each instrument will be considered


contaminated.

4.2.4 Contaminated needles or other contaminated sharps shall not be


bent, recapped, or removed unless no other alternative is feasible.

4.2.5 If absolutely necessary and no other alternative is feasible,


bending, recapping or needle removal must be accomplished
through use of a mechanical device or a one-handed technique.

4.2.6 Contaminated sharps shall be placed in appropriate containers for


disposal or proper reprocessing elsewhere. Guidelines outlined in
this Plan shall be followed by all FRD personnel. A summary of
FRD-approved disposal policy and procedures follows:

1) The one-quart sharp container will no longer be stocked or used


for sharps disposal. During a CPR or other incident(s) away
from a unit where use of pre-filled syringes is indicated, an
eight-quart container shall be brought to the scene.

2) The eight-quart sharp containers in use shall be secured in the


unit. The white rotational lid shall be kept closed on all
containers when not in use.

3) The P2 Sharp-Shuttle is to be used when personnel are away


from the unit and are starting an IV(s) or using 1cc. or 3 cc.
syringe. The use of the Sharp-Shuttle shall be a single-hand
operation (i.e., Sharp-Shuttle laid flat). Once the sharp(s) has
been placed in the Shuttle, it will be taped shut. It shall be the
responsibility of each ALS provider to dispose of his/her own
sharp(s).

4) The Shuttle shall be disposed of at the hospital − not in the


eight-quart container. The only exception shall be when a
patient is not transported to a hospital.

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Fairfax County Fire and Rescue Department


Sharps Container Inventory for Department Units
Medic Minimum of three 8-qt sharps
containers
Minimum of ten P2 Sharp Shuttles
allocated as follows:
9 2 in the main drug box
9 2 in the trauma bag
9 6 in reserve on the unit
Paramedic Engine Minimum of three P2 Sharp Shuttles
allocated as follows:
9 2 in the ALS bag
9 1 in the trauma bag
Ambulance Minimum of two 8-qt sharps containers
Minimum of one P2 Sharp Shuttle in
BLS bag
Truck and Squad Minimum of one P2 Sharp Shuttle in
BLS bag
EMS supervisor Minimum one 8-qt sharps container
Minimum six P2 Sharp Shuttles
allocated as follows:
9 2 in ALS bag
9 4 for restocking of units
9 12 in EMS Captain’s supply
cabinet
Restocking of items will be done through Order Express

4.3 Accepting Sharps Containers from Citizens

4.3.1 Under no circumstances shall FRD career, volunteer, or civilian


members accept infectious, contaminated waste or sharps
containers – regardless of amount or size – from citizens
requesting the disposal of such items. Citizens who need to
dispose of such items shall be referred to their personal physician
for direction and disposal information.

4.4 Workplace Contamination

4.4.1 The Department supports continuous efforts to reduce potential


contamination and secondary contamination in the workplace.
Toward this end, Fire and Rescue personnel will not check any
portable EMS, suppression, and/or rescue equipment anywhere

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within the living quarters. Equipment checks are to be confined to


designated areas (i.e., apparatus bay, shop areas). Station and
shift commanders shall ensure compliance with this policy.

4.4.2 Personnel are strictly prohibited from wearing any PPE in any living
space or office area(s) within any fire and rescue station.

4.5 Department Facilities

4.5.1 All FRD and volunteer station facilities shall comply with applicable
and appropriate health and infection control laws, regulations, and
standards for public-use facilities.

FRD members will maintain all facility areas in accordance with


their station’s written policies and procedures for housekeeping/
maintenance. Following are general guidelines for station
maintenance. In the event these guidelines conflict with individual
station’s policies and procedures, the Safety and Personnel
Division should be contacted for direction.

4.5.2 Kitchen areas. When feasible, food preparation areas should be


of a non-porous material. All personnel should follow general
“good housekeeping” rules when working in and around food
preparation areas. Basic cleanliness/sanitation precautions
include:

4.5.2.1 All food preparation surfaces shall be cleaned after each


use with an absorbent cloth (disposable paper towel) and
disinfectant cleanser, using manufacturer’s directions.
Cleaning materials will be provided by the FRD or
volunteer companies.

4.5.2.2 Members shall wash their hands with antimicrobial liquid


soap before and after handling any food items,
particularly raw meats. Liquid soap will be provided by
the FRD or volunteer. Bar soap is not to be stocked or
used in FRD facilities.

4.5.2.3 Food preparation and storage areas shall meet local


health standards.

4.5.2.4 Disinfectants/cleaning materials shall be used in


accordance with manufacturer’s instructions.

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4.5.3 Sleeping Areas. Sleeping areas are provided at each station.


Sleeping areas are to be maintained by all members using general
“good housekeeping” guidelines for personal and facility
cleanliness. Basic cleanliness/sanitation guidelines include:

4.5.3.1 Members shall provide their own personal bed linens.


Members are also encouraged to provide their own
pillow(s). Linens may be washed at the station, following
manufacturer’s instructions. Bed linens shall be washed
and dried at least once a week.

4.5.3.2 Other bedding necessities, i.e., mattress cover and


blankets, are provided by the FRD. This bedding shall be
washed, dried, and returned to the appropriate sleeping
area on the second and fourth Sunday of each month.
Washing and drying of blankets shall be done according
to manufacturer’s instructions. White cotton mattress
covers shall be washed using the “hot” water option and
with one-quarter cup of bleach added to the
recommended amount of detergent. Clothes washing
detergent and bleach will be provided by the FRD or
volunteer companies.

4.5.4 Bathrooms shall meet all local standards and are to be maintained
by all members using general “good housekeeping” guidelines for
personal and facility cleanliness. Basic cleanliness/sanitation
guidelines include:

4.5.4.1 Disposable (paper towels) will be used in station


bathrooms for hand drying. Paper towels will be provided
by the Department or volunteer companies.

4.5.4.2 Personnel will provide their own personal bath items


(towels, wash cloths, etc.). Personnel should store these
items in their assigned lockers. They should not be left in
bathrooms after use. Bath linens shall be washed and
dried according to manufacturer’s instructions at least
once a week.

4.5.4.3 Personal hygiene items (bar soaps, lotions, bath gels,


etc.) should be stored in assigned lockers when not in
use. These items should not be shared or “borrowed.”

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4.5.4.4 Sinks and toilets shall be wiped clean using an


appropriate disinfectant cleaner and an absorbent
disposable cloth (paper towel) on a daily basis.

4.5.4.5 Bath tubs/shower stalls shall be rinsed clean of


soap/shampoo residue after each use.

4.5.4.6 Bathroom cleaning materials shall be provided by the


FRD or volunteer companies.

4.5.4.7 All bathrooms shall have a clearly visible sign reminding


members to wash their hands.

4.5.4.8 Disinfectants/cleaning materials shall be used in


accordance with manufacturer’s instructions.

4.5.5 Dayrooms. Dayrooms (Recreation/Television Room) are provided


for the enjoyment of all station personnel and are to be maintained
in accordance with each station’s written policies and procedures.

4.5.6 Control Room. Control Rooms are utilized by personnel to


conduct FRD business. This area shall be maintained in
accordance with each station’s written policies and procedures. .

4.5.7 Laundry Areas. Laundry areas shall be maintained in accordance


with each station’s written policies and procedures. This area
should be kept clean and orderly. For information regarding
cleaning/laundering of Personal Protective Equipment (PPE), see
Chapter 5.

4.5.8 Storage Areas. Storage areas will be utilized and maintained in


accordance with each station’s written policies and procedures.

4.5.9 High Bay Areas. Bay areas will be utilized and maintained in
accordance with each station’s written policies and procedures.

4.6 Good Samaritan Exposure(s)

4.6.1 Virginia Code 32.1-45.1 (subsections A, C, and D) states: “When a


person who renders emergency care or assistance without
compensation and in good faith is directly exposed to body fluids of
a patient in a manner that, according to current guidelines of the
Centers for Disease Control and Prevention (CDC), might transmit
the human immunodeficiency virus (HIV) or hepatitis B or C

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viruses, the person whose body fluids were involved in the


exposure shall be deemed to have consented to testing for infection
with the HIV or hepatitis B or C viruses. Such a person also shall
be deemed to have consented to the release of such test results to
the patient who was exposed.”

4.6.2 Fairfax County Fire and Rescue Department personnel shall use
Form FRD-399 to document communicable disease exposure or
potential exposure to a citizen who stops to render emergency aid
to others. All work stations maintain a supply of these forms.
Forms are printed in English and Spanish.

4.6.3 The following procedures shall be observed by all FRD personnel


during incidents involving Good Samaritans.

4.6.3.1 Responsibility of Emergency Medical Service (EMS)


Personnel

1) Presentation of and assistance with information to a


Good Samaritan shall be at the conclusion of an
incident.

2) Personnel shall offer saline, soap, disinfectant


solution, etc. to a Good Samaritan to clean the
exposed site(s).

3) The EMS Captain or unit Officer-in-Charge (OIC) shall


be responsible for completing Form FRD-399.
Information required includes:

a) Date
b) Incident number
c) Unit number
d) OIC’s name and contact numbers
e) Good Samaritan’s names and contact numbers
f) Type of sustained/possibly sustained exposure

4) At the conclusion of the incident, and after all


information is received from the Good Samaritan, the
EMS Captain or the unit OIC shall immediately notify
a Designated Officer (DO) or the Department ICPO
about the exposure. A hard copy of the FRD-399
shall be forwarded to the DO.

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4.6.3.2 Responsibility of the Designated Officer (DO)

1) The DO shall notify the Infection Control Practitioner


(ICP) and/or an emergency room charge nurse at the
medical facility where the source patient was
transported that a Good Samaritan sustained an
exposure (bloodborne or airborne).

2) The DO shall forward a hard copy of the FRD-399


and other pertinent information related to the
exposure to the FRD Infection Control and Protection
Officer.

4.6.3.3 Responsibility of the Infection Control and Protection


Officer (ICPO)

1) The ICPO shall notify the Fairfax County Health


Department’s epidemiologist when an exposure or
possible exposure to a communicable disease is
sustained by a Good Samaritan.

2) The Health Department shall offer counseling and


diagnostic testing to Good Samaritans and advise
them of the source patient’s serology results and/or
infectivity.

4.7 Commonwealth of Virginia Deemed Consent.

4.7.1 The Fairfax County Fire and Rescue Department Exposure Control
Plan meets and exceeds all Commonwealth of Virginia laws
regarding “Deemed Consent” for testing and informing in exposure
incidents for both patient-to-health care worker exposures and
health care worker-to-patient exposures.

The FRD Exposure Control Plan shall be used by all FRD


personnel when dealing with issues of exposure control and
reporting.

4.7.2 Paragraph B of Virginia law 32.1-45.1 (Deemed Consent) states:


“Whenever any patient is directly exposed to body fluids of a health
care provider, or of any person employed by or under the direction
and control of a health care provider, in a manner which may,
according to the current guidelines of the Centers for Disease
Control and Prevention (CDC), transmit human immunodeficiency

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virus or hepatitis B or C viruses, the person whose body fluids were


involved in the exposure shall be deemed to have consented to
testing for infection with human immunodeficiency virus or hepatitis
B or C viruses. Such person shall also be deemed to have
consented to the release of such test results to the patient who was
exposed.”

4.7.3.1 Paragraph B of Virginia law 32.1-45.1 is applicable to


FRD personnel and shall be observed.

4.8 FRD Member-to-Patient Exposure

4.8.1 In the unlikely event an FRD member learns that he or she has
contracted an infectious disease and is still providing patient
service, the FRD member shall immediately inform the Infection
Control Officer (ICO). The member shall receive direction
regarding any further action(s) required from the ICO or his
designee.

4.8.2 Reporting and documentation procedures shall be in accordance


with Chapter 7 of this Plan (reference SOP 02.03.02).

4.8.3 When an FRD member learns that he/she has contracted an


infectious disease and is still providing patient care, the FRD
member shall immediately notify the Public Safety Occupational
Health Center (PSOHC) Medical Director to ensure appropriate
follow-up or referral to the Contractual Infectious Disease Physician
(CIDP). The member’s work status shall be determined by the
PSOHC Medical Director.

In accordance with CDC, no current recommendations exist to


restrict professional activities of health care works (fire fighters and
paramedics) with HCV infection.

4.8.4 The PSOHC shall ensure the FRD member’s notification is


documented and placed in his or her medical file. All information
will be treated as confidential.

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Attachment 4-1

Commonwealth of Virginia
Department of Health
Division of Health Hazards Control

INFECTIOUS WASTE REGULATIONS AND GUIDELINES

NOTE: The following is a summary of the FRD-relevant content of a


memorandum dated January 5, 1990 titled “Infectious Waste Regulations and
Guidelines,” published by the Virginia Department of Health, Division of Health
Hazards.

Infectious Waste Definition

Infectious waste is defined in the regulations as:

1) Cultures and stock of microorganisms and biologicals. Discarded


cultures of patient specimens are infectious waste if they are likely to
contain organisms pathogenic to healthy humans.

2) Blood and blood products. This includes serum, plasma, and blood, as
well as items contaminated by free-flowing blood. This would include a
patient’s blood sample tube with residual blood, but it would not include
most blood-contaminated dressings and medical gloves (unless the blood
were free-flowing).

3) Pathological wastes. This includes human tissues, organs, and body


parts.

4) Sharps. This includes used hypodermic needles, syringes, scalpel


blades, pasteur pipettes, and broken glass likely to be contaminated with
organisms that are pathogenic to healthy humans, as well as all sharps
used in patient care.

5) Certain animal carcasses and related wastes. This includes body parts
and bedding materials. This category only applies to animals that were
intentionally infected with organisms likely to be pathogenic to healthy
humans.
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6) Other wastes identified by a health professional. The health care


professional in charge may identify a solid waste as being infectious waste
if the waste is known or suspected to be capable of causing an infectious
disease in humans (after considering factors such as pathogenicity,
virulence, and quantity).

Storing Your Waste

FRD facilities will not store infectious waste.

Packaging

Solid waste meeting the definition for infectious waste must be contained in two
leak-poof plastic bags each capable of passing the ASTM 125 pound drop weight
test and each sealed separately, or one leak-proof plastic bag inside a double-
walled corrugated fiberboard box. Bags must be red in color except for waste
which is to be autoclaved, which must be in an orange bag and marked with
autoclave tape.

Liquid wastes should be contained in sturdy leakpoof containers. Sharps must


be collected at the point of use in puncture-resistant and leakpoof containers
which should be red in color if they are to be incinerated. If they are to be
autoclaved, they must have a large orange label or be orange in color.

Labeling

A label must be securely attached to each package of waste. The label should
be marked with the biological hazard symbol and the words “INFECTIOUS
WASTE” in large print, and should include the name, address, and telephone
number of both the generator and the hauler or person to whom the waste is
transferred.

Transportation

Waste must be transported to a permitted treatment facility (includes hospitals)


either directly by the practitioner, or an employee, or by a transporter registered
as such with the Department of Waste Management.

Treatment and Disposal

Blood, body fluids and pathological waste (with or without grinding) may be
disposed of in a sanitary sewer system without prior treatment. All other
infectious waste must be either incinerated or autoclaved (pathological waste

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which is not disposed of in a sanitary sewer, however, may only be incinerated)


prior to disposal as solid (noninfectious) waste in a landfill or other waste
management facility.

If You Need Assistance

Questions about the interpretation of these regulations should be addressed to


Mr. Robert Wickline at the Department of Waste Management by writing to the
address given above, or by calling (804) 225-2667. Technical questions of a
medical or epidemiologic nature may be addressed to Carl Armstrong, M.D. at
the Virginia Department of Health, Room 700, 109 Governor St., Richmond, VA
23219, or by calling (804) 786-6029.

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Attachment 4-2

SOURCE PATIENT BLOOD DRAWS


IN THE EVENT OF AN OCCUPATIONAL EXPOSURE

DEPARTMENT PROCEDURES:

Occupational exposure(s) to FRD personnel that result in the need to draw


source patient blood in the field are rare. However, when and/or if they do occur,
it is of the utmost importance that Departmental procedures be followed.

PROCEDURES WHEN SOURCE PATIENT REFUSES


TRANSPORTATION TO A MEDICAL FACILITY

1) Immediately notify the duty safety officer (SAFO) and/or Infection Control
and Prevention Officer (ICPO) of the exposure event and the assistance
needed to draw the source patient’s blood. Notification of the event shall
be done from the incident scene.

2) Exposed personnel shall comply with Chapter 7: Post-Exposure


Management of this Exposure Control Plan

3) Exposed personnel on the incident scene shall inform the source patient
refusing transportation that an occupational exposure has occurred from
his/her blood and transportation to a medical facility is strongly
encouraged.

a) If the source patient continues to refuse transportation after several


attempts have been made, the unit officer-in-charge (OIC) shall
notify the Public Safety Communication Center (PSCC) to have the
SAFO or the ICPO dispatched to the incident scene with the blood
drawing kit.

4) If the SAFO and/or the ICPO are unavailable to respond to the incident
scene, PSCC shall notify the respective EMS supervisor within the
battalion to be dispatched to the incident with the blood drawing kit.

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a) Only those ALS personnel trained to draw blood are authorized2.


As with any invasive procedure, aseptic technique is required (as
outlined in this Exposure Control Plan).

b) Two blood tubes shall be drawn and filled from the source patient –
lavender top and a “tiger-top-SST.” Ensure documentation
accompanies the blood tubes such as (1) source patient’s name;
(2) name of the medic drawing the blood, and (3) date and time
blood was drawn.

c) Dispose of sharps and contaminated materials in accordance with


this Exposure Control Plan.

5) The unit OIC shall ensure (1) the venipuncture of the source patient is
noted on FRD-207 and (2) the on-line fire report reflects the venipuncture
of the source patient under Actions Taken.

6) The SAFO and/or the ICPO shall notify the contractual infectious disease
physician of the situation and request assistance from the on-call
physician in notifying INOVA Fairfax Hospital’s Laboratory to conduct the
necessary serologic testing3.

7) Follow-up of source patient serology results will be handled in accordance


with this Exposure Control Plan. The ICPO and/or the contractual
infectious disease physician shall notify exposed personnel.

2
Questions relating to the drawing of source patient blood shall be directed to Captain James C.
Summers, Safety and Personnel Services Division at (571) 722-8670 or via email at
james.summers@fairfaxcounty.gov.
3
Source patient serologic testing includes SUDS-rapid HIV, hepatitis B surface antigen, and
hepatitis C antibody.

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CHAPTER 5.
PERSONAL PROTECTIVE EQUIPMENT (PPE)

5.1 Qualified Items

5.1.1 Fairfax County Fire and Rescue Department personnel shall


use/wear, store and stock only Department-issued Personal
Protective Equipment (PPE).

The Safety and Personnel Services Division (SPSD), in cooperation


with the Emergency Medical Services Section (EMS) has issued
Personal Infection Control (PIC) Kits to all uniformed personnel and
operational volunteers. The purpose of the PIC Kit is to increase
the level of personal protection and to minimize the risk of exposure
to bloodborne pathogens to emergency field personnel.1

5.1.1.1 In an effort to maintain continuity, the following


donning/use procedures shall be used by all FRD
employees.

♦ All items used or worn, with the exception of the


safety eyeglasses, are designed for a single “one
time use.” Contents shall be discarded in compliance
with this Exposure Control Plan.
♦ Personnel shall restock their PIC Kit from the station’s
EMS supply or order from the Department’s on-line
ordering service.
♦ Personnel shall maintain the minimum level of the
personal protective ensemble carried in the PIC Kit
while on duty.
♦ During shift safety inspections, the PIC Kits will be
inspected by the duty Safety Officer for proper
contents and maintenance.

1
Issues and questions should be reported to Captain James C. Summers, Infection Control
Officer. Reporting may be done via telephone (571) 722-8670 or email
(james.summers@fairfaxcounty.gov).

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Fairfax County Fire and Rescue Department


Individual Issue Personal Infection Control (PIC) Kits
CONTENTS
• Fanny bag
• Latex/nitrile exam gloves (minimum of two pair)
• Disposable sleeves (minimum of two pair)
• Eye protection/glasses
• N95 TB respirator (ensure proper fit-test size)
• Waterless hand rinse (4 fluid oz.)
• Pocket mask/protective barrier
• Pen light/scissors
• Other items approved by the EMS Section and SPSD
PROCEDURES
• FRD personnel shall be accountable for their personal issue PIC
Kit and contents
• Personnel arriving on the scene of an EMS incident shall don the
PIC Kit.
• Exam gloves shall be donned prior to patient contact. If the event
warrants donning other contents such as eyeglasses, sleeves,
etc. due to the presence or potential presence of blood or body
fluids, FRD personnel shall don the applicable contents to
reduce/eliminate personal risk of sustaining an occupational
exposure.
• Suppression/rescue personnel (e.g. Rescue 439) assisting on
motor vehicle accidents or EMS incidents shall don the PIC Kit
over the protective suppression ensemble or place the PIC Kit in a
pocket of the coat or pants so that it is readily accessible.
CONTAMINATION
• In the event a PIC Kit becomes contaminated with blood or body
fluids, it shall be put out of service immediately.
• Under no circumstances shall personnel decontaminate the PIC
Kit in the station’s washing machine. The contaminated Kit shall
be bagged, tagged and sent to the Personal Protective Equipment
Center (PPEC) for cleaning.
• Affected personnel shall contact their respective EMS supervisors
for a PIC Kit replacement. EMS supervisors shall carry a
minimum of six replacement PIC Kits.
HELP
Questions concerning the PIC Kits can be answered by:
• Captain John Niemiec, Health Programs, SPSD at (703) 246-4681
• Captain James C. Summers, SPSD at (571) 722-8670

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5.1.2 Personal protective equipment (PPE) refers to any item of


equipment, including clothing used or worn by fire and rescue
personnel as protection against infectious agents. Personal
protective equipment is designed to prevent blood or other
potentially infectious materials from passing through or reaching a
firefighter’s and/or EMS-only volunteer’s work clothes, street
clothes, under garments, skin, eyes, mouth, or other mucous
membranes under normal conditions of use.

5.1.3 Personal protective equipment (PPE) must be used in all


circumstances where infectious material(s) might be encountered
unless, in the member’s professional judgment, such use would
prevent the efficient and successful completion of fire fighting or
emergency medical services or pose an increased hazard to the
safety of the individual or coworker.

5.1.4 All items of personal protective equipment are provided by the


Fairfax County Fire and Rescue Department and include, but are
not limited to:

1) NFPA 1999 compliant latex and nitrile non-latex exam gloves2.


♦ NFPA 1999 compliant non-latex gloves are also available for
personnel to glove patients with a latex allergy.
2) Splash-resistant eyewear
3) Respirators, including pocket masks
4) Fluid-resistant clothing/gowns
5) Disposable blood pressure covers
6) Disposable protective sleeves
7) EMS-only turn-out gear

5.1.5 Exam gloves shall be donned by Emergency Medical Service


(EMS) personnel prior to providing any emergency medical service.
This includes circumstances where provision of care to other FRD
members is required. Such gloves will be removed at the
completion of the incident, taking care to avoid contact with the
exterior surface of the gloves. Used exam gloves should be
disposed of in accordance with procedures outlined in Chapter 4 of
this Plan.

2
Recommended reading: Preventing Allergic Reactions to Natural Rubber Latex in the
Workplace (DHHS {NIOSH} Publication No. 97-135). Telephone: 1-800-356-4674; email:
pubstaft@cdc.gov.

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1) Personnel who have no allergies to latex shall continue using


latex exam gloves for emergency medical incidents.

2) Personnel with known allergies to latex shall order and use


nitrile (non-latex) exam gloves for emergency medical incidents.

3) Double gloving is strongly encouraged when dealing with


incidents where copious amounts of body fluid are present.

5.1.6 An adequate supply of exam gloves shall be stored on all


Department vehicles and in all kits (first aid and trauma).
Additionally, all personnel shall keep a minimum of two (2) pairs of
gloves stored in their PIC Kit which shall be worn while on duty.

5.1.7 Exam gloves that become torn, damaged, or contaminated during


an incident shall be removed and disposed of immediately and
replaced with a new pair.

5.1.8 FRD personnel shall not accept or use replacement exam gloves
(latex and/or nitrile exam gloves) from area medical facilities unless
the exam gloves are clearly labeled as NFPA 1999 compliant.

5.1.9 Respirators, splash-resistant eyewear, and fluid-resistant


clothing/gowns shall be used in any situation where gross
contamination might be anticipated. This includes events such as
serious trauma, child birth, or any situation where emergency
medical personnel could encounter spurting blood.

5.1.10 During any procedure involving airway management, such as


cardiopulmonary resuscitation (CPR), rescue personnel shall use
bag-valve masks (BVM). These masks shall be available on all
Department emergency response vehicles. In the event a BVM is
not available, mouth-to-mouth resuscitation shall not be performed.

5.1.11 If a patient’s physical condition or medical history suggests that an


airborne infectious disease might exist, an N95 respirator shall be
worn by the FRD member. The Department-approved respirators,
available in all Department emergency response vehicles and
individually issued PIC Kits, shall be the appropriate size, as
determined in required fit testing.

5.1.12 An appropriately fit tested N95 respirator shall be donned by FRD


members prior to providing aid in any of the following situations:

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1) Confirmation or suspicion of the existence of tuberculosis,


meningitis, chicken pox, and various other respiratory illnesses;
this includes patient transport to or from a medical facility.

2) Intubation and/or suctioning of the airway (accompanied with


eye protection).

3) Copious amounts of body fluids are present (accompanied with


eye protection).

4) During patient care at major trauma incidents (accompanied


with eye protection).

5.1.13 N95 respirators are disposable items of personal protective


equipment. These respirators shall be properly disposed of after
one use. They shall not be cleaned or reused.

5.1.14 Gloves shall not be worn under structural firefighting gloves. Such
use is contraindicated due to adverse reaction of medical gloves to
high heat conditions.

5.1.15 Gloves used for cleaning of equipment or surfaces with possible


contamination shall be disposable, heavy-duty, and designed to
provide limited protection from abrasions and punctures. Cleaning
gloves provide a barrier against body fluids, cleaning fluids, and
disinfectants. Approved cleaning gloves will be provided by the
Department.

5.1.16 Latex-Free EMS Aid Bags. All medic units shall be issued latex-
free EMS aid bags. These bags will assist personnel when
rendering medical care to patients who have known allergies and
reactions to latex. The aid bag contains: a bag valve mask (BVM),
nitrile exam gloves, oxygen masks and cannulas, and other medical
supplies.

5.1.16.1 The aid bags are to be used only for patients with a
known sensitivity to latex.

5.1.16.2 Should an incident arise where a latex-free EMS aid bag


is needed but not available, a request shall be made
through the PSCC that a unit with a latex-free EMS aid
bag be dispatched to the scene.

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5.1.16.3 Replacement supplies for the aid bags may be ordered


from the Department’s “On-Line Services.” Questions
regarding ordering supplies for the bag should be
directed to the Resource Management Section.

SUMMARY FOR PERSONAL PROTECTIVE EQUIPMENT USE


TO MINIMIZE POTENTIAL EXPOSURE

If it’s wet, it’s infectious. Use exam gloves.

If it could splash onto your face, use eye shields and mask or full
face shield.

If it’s airborne, mask the patient and/or yourself.

If it could splash on your clothes, use a gown or structural


firefighting gear.

If it could splash on your head or feet, use appropriate barrier


protection.

5.2 Cleaning and Disinfecting

5.2.1 As outlined in Chapter 4 of this Plan, it is the hospital’s


responsibility to clean backboards and other EMS equipment
before they are reused. EMS transport units shall not use
contaminated equipment to remain in-service, nor shall they
transport contaminated equipment back to stations.

5.2.2 All EMS equipment transport and storage areas of all Department
vehicles shall be cleaned and sanitized on a daily basis and after
an exposure (engine cab, ambulance transport “box” and cab, etc.).
This cleaning shall include surfaces such as stretcher handles and
steering wheels. A notation shall be made in the station log book
upon completion.

5.2.3 Cleaning and disinfecting areas:

5.2.3.1 Only those stations with a designated/approved


decontamination room may be used for the purpose of
decontamination of equipment. Personnel shall carry out
decontamination tasks at these stations in accordance

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with each station’s written procedures and policies


(Attachment 5-1).

Fairfax County Fire and Rescue Department


Fire Stations with
Approved Decontamination Rooms
Station 22 Station 38
Station 37 Station 39

5.2.3.2 Exposed portions of the vehicle shall be thoroughly


cleaned following a specific exposure case. This may
require the unit to be placed out-of-service until the
cleaning is complete. Equipment that does not
accompany the patient should be bagged and
transported to a safe, designated cleaning site within the
work location. Contaminated equipment: will be cleaned
only at stations approved for decontamination efforts.

a) This area should not be used for the cleaning of Self-


Contained Breathing Apparatus (SCBA) face pieces.
b) This area should be away from living areas.
c) This area must be conspicuously marked with limited
access to prevent accidental exposures.

5.2.3.3 Personnel shall refer to the Department’s Respiratory


Protection Program Manual for guidelines regarding
required/appropriate respiratory protection for cleaning
SCBA face pieces.

5.2.3.4 If SCBA ensemble is contaminated, personnel shall


contact the Safety Officer or the Infection Control Officer
(ICO) for further directions/instructions. SCBA
ensembles will be cleaned/decontaminated by the Air
Shop.

5.2.3.5 Material Safety Data Sheets (MSDS) for each


disinfectant will be posted in a prominent location in all
station’s designated cleaning area (29 CFR 1910.1200,
Hazardous Communication Standard). Refer to the
MSDS for each disinfectant solution to decide what PPE
may be needed.

5.2.3.6 Disinfectants can be toxic or caustic. Disinfection


solutions should have an Environmental Protection

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Agency (EPA) registry number and show that they are


effective against mycobacterium tuberculosis.

5.2.3.7 Routine disposal of the germicidal cleaning water into the


drainage system is acceptable.

5.2.3.8 Each work site will be maintained in a clean, sanitary


condition, following the direction of a work location
cleaning schedule.

5.2.3.9 Any equipment shipped for repair, return, etc. must be


completely cleaned prior to shipping. If this is not
possible, the company sales representative must be
notified that cleaning was not possible and the packaging
must be labeled as “Not Cleaned.”

5.2.4 Laundry:

5.2.4.1 All fire stations are supplied with a clothes washer and
dryer. These facilities may be used to wash slightly
contaminated uniforms. “Slightly contaminated” uniforms
are those uniforms soiled with small drops of blood or
body fluid. These uniforms shall be washed and double
rinsed, in accordance with Department policy.
Contaminated uniforms shall not be taken from work
locations for laundering.

5.2.4.2 The Department will furnish necessary laundry products


(detergent, bleach, etc.)

5.2.4.3 “Grossly contaminated” uniforms are those soiled with


copious amounts of blood or fluid and are not to be
washed in the station. Procedures for handling grossly
contaminated uniforms are:

1) Notify the Safety Officer re grossly contaminated


uniform(s) and ask for instructions.
2) Carefully remove grossly contaminated uniform to
minimize having any contaminated portions touch
your body. Do not remove grossly contaminated
uniforms in any station living area(s).
3) Double bag uniform.

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4) Place a tag on bagged uniform clearly noting your


name, location, and the contents of the bag. Affix a
biohazard label on outer bag.
5) Place bag in a safe area away from personal/living
areas.
6) Ensure personal cleanliness/hygiene after handling
the contaminated uniform.

5.2.5 Linens:

5.2.5.1 All soiled linens will be laundered by the receiving


medical facility, according to their exposure control
guidelines.

5.2.5.2 Linens that have been in contact with any patient – even
if the patient is not subsequently transported − will be
exchanged for fresh/laundered linens before the unit is
put back in service. Used linens will be stored on the unit
and dropped off at a medical facility for laundering as
soon as feasible.

5.2.6 Infectious waste disposal. The Fairfax County Fire and Rescue
Department will:

5.2.6.1 Assure all infectious waste requiring disposal is handled


in accordance with Chapter 4 of this Plan.

5.2.6.2 Require that all Department vehicles be equipped with


Department-approved containers to dispose of needles,
disposable syringes, and other sharp surface instruments
(See Chapter 4).

1) During a CPR or other incident(s) away from a unit


where use of pre-filled syringes is indicated, an eight-
quart sharps container shall be brought to the scene.
The eight-quart sharps containers in use shall be
secured in the unit. The white rotational lid shall be
kept closed on all containers when not in use.

2) The P2 Sharp Shuttle© is to be used when personnel


are away from the unit and are starting an IV(s) or
using 1cc. or 3cc. syringe. The use of the sharp
shuttle shall be a single-hand operation, i.e., sharp
shuttle laid flat. Once the sharp has been placed in

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the shuttle, it will be closed and sealed with a


minimum of two pieces of one-inch tape.

5.2.6.3 Require all sharps be placed in the appropriate container


immediately following use. These containers will be
disposed of per Department guidelines.

1) The P2 Sharp Shuttle© shall be disposed of at the


hospital, not in the eight-quart container. The only
exception shall be when a patient is not transported to
a hospital.

5.2.6.4 Assure that bins, pails, cans, and receptacles be


inspected and decontaminated daily, and after potential
contamination. All such equipment used for trash
collection shall be lined with a closable, leak-proof bag
that is marked or labeled, as required by law.

5.2.6.5 Assure that broken glassware that has been potentially


contaminated is cleaned up by mechanical means − not
by hand. Personnel performing this task shall use
universal precautions while performing the task, and
assure that the material is placed in an appropriate
container for disposal.

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ATTACHMENT 5-1
CARE OF SPECIFIC CONTAMINATED EQUIPMENT
FOR STATIONS WITH APPROVED DECONTAMINATION ROOMS
CLEANING KEY:
(1) Dispose (4) Cleaning (Golden Glo)
(2) Disinfection (1:100 bleach/water solution) (5) Launder
(3) High-level disinfectant (CIDEX)

ARTICLE CLEANING KEY


02 Cannulas, Masks 1
Airways (Including ET tubes, OP, NP) 1
B/P Cuffs 1
Bite Sticks 1
Bulb Syringe 1
Cervical Collars 1 or 2
Dressings and Paper Products 1
Drug Boxes 3
Electronic Equipment Mfgr’s instructions
Emesis Basins 1
Humidifiers, Regulators, Tanks 2
KED 3
Laryngoscope/blades 4
MAST Suit 3
N95 Respirators 1*
Needles/Syringes 1
Penlights 1 or 2
Pocket Masks 1
Restraints 2
Resuscitators (BVM) 1
Scissors 3
Splints 2
Stethoscope 2
Stretcher 3
Stylets 1 or 4
Suction Catheters 1
Suction Unit (collection jars) 3
Uniforms* 5

*Only “slightly contaminated” uniforms may be laundered in stations. Procedures for


grossly contaminated suits are outlined in section 5.4 of this Chapter.

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ATTACHMENT 5-2

CLEANING PROCEDURES FOR


ANTISHOCK TROUSERS

Policy:

Soiled antishock trousers should be cleaned to remove blood and secretions.

Procedure:

The procedure for cleaning this equipment depends on whether the trouser
bladders are removable or non-removable. Always check the manufacturer’s
recommendations.

1) Removable bladders. Remove air chambers and close them. Wipe with
a cloth dampened with antiseptic soap or detergent. Rinse with warm
water and allow to air dry. DO NOT MACHINE WASH OR MACHINE
DRY.

2) Outer garment. Hand or machine wash at a medium temperature setting


with a detergent soap. DO NOT WASH WITH OTHER ITEMS. Air dry or
machine dry at a low setting.

3) To sterilize outer garments or those without removable bladders, gas


sterilize them or use a cold liquid sterilization solution.

Antishock trousers should never be stored wet or even damp. Never use dry
cleaning solutions, chemical solvents, or bleach on them.

Do not boil, steam sterilize, iron or press antishock trousers unless specified by
the manufacturer.

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ATTACHMENT 5-3

PROCEDURES/GUIDLEINE FOR USE AND CLEANING


RESUSCI-ANNE
Basic Considerations:

1) Personnel and/or students should be told in advance that the training


sessions will involve “close physical contact” with their fellow students.

2) Students who have dermatological lesions on their hands or in oral areas


should not actively participate in training sessions.

Students known to be seropositive of hepatitis B surface antigen or


hepatitis C may participate if appropriate/effective surface barrier
protection is available and provided.

Students with upper-respiratory tract infections or who have been exposed


to or are in the active stage of any potentially infectious process should
not actively participate in training sessions.

3) If possible, each student should have his/her own manikin “face.”

4) All persons responsible for CPR training should be thoroughly familiar with
handwashing procedures and the cleaning and maintenance of manikins.

5) Manikins should be inspected routinely for cracks or tears in plastic


surfaces that make thorough cleaning difficult.

Cleaning After Each Participant:

1) After each participant, the manikin’s mouth and lips should be wiped with
a 2 x 2 gauze pad wetted with a solution of 1:100 bleach and water or 70
percent isopropyl alcohol. The surface of the manikin should remain wet
for at least 30 seconds before it is wiped dry.

2) If a protective face or face shield is used, it should be changed for each


student.

3) Airway/lung shall be replaced after each class.

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For Two-Rescuer CPR:

1) During two-rescuer CPR, there is no opportunity to disinfect the manikin


between students when the “switching procedure” is practiced. To limit
the potential for disease transmission during this exercise, the second
student taking over ventilation on the manikin should simulate ventilation.
This recommendation is consistent with current training recommendations
of the American Red Cross and the American Heart Association.

2) Training in the “obstructed airway procedure” involves the student using


his or her finger to sweep foreign matter out of the manikin’s mouth. This
action could contaminate the student’s finger with saliva from previous
students and/or contaminate the manikin with material from the student’s
finger. The finger sweep should either be simulated or done on a manikin
whose airway was decontaminated before the procedure and will be
decontaminated after the procedure.

3) Rinse all surfaces with fresh water.

4) Wet all surfaces with a sodium hypochlorite solution (1:100 bleach/water)


for 10 minutes. This solution must be made fresh at each class and
discarded after each use.

5) Rinse with fresh water and dry all surfaces. Rinsing with alcohol will aid
drying of internal surfaces and will prevent the survival and growth of
bacterial or fungal pathogens.

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CHAPTER 6.
COMMUNICABLE DISEASES/IMMUNIZATIONS

COMMUNICABLE DISEASES

6.1 Acquired Immunodeficiency Syndrome (AIDS)/HIV Infection

6.1.1 AIDS is a severe, life-threatening, clinical condition. This syndrome


represents the late clinical stage of infection with human
immunodeficiency virus that most often results in progressive
damage to the immune and other organ systems, including the
central nervous system.

6.1.2 Symptoms:

Persistent fever Night sweats


Chronic fatigue Significant weight loss
Diarrhea Thrush (fungal infections of
Swollen lymph nodes the mouth and throat)

6.1.3 Mode of transmission. Routes of transmission of HIV are through


sexual exposure, sharing of HIV-contaminated needles and
syringes, and transfusion of infected blood or its components. The
virus has on occasion been found in saliva, tears, urine and
bronchial secretions. Transmission after contact with these
secretions has not been reported.

6.1.4 Incubation period. The time from infection to the development of


detectable antibodies is generally one to three months. The time
from HIV infection to diagnosis of AIDS has been observed to be
less than one year to ten years or longer.

6.1.5 Preventive measures. Care should be taken in handling, using,


and disposing of needles and syringes. Utilize standard
precautions to avoid contact with blood or fluids that are visibly
bloody. Any patient’s blood on workers’ skin should be cleaned
with soap and water or germicidal solution without delay. Disinfect
contaminated equipment using a bleach solution (1:10 dilution).

6.1.6 Relative risk to providers:

Low: Risk among health care workers in general is very low.

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6.2 Chickenpox (Varicella Zoster)

6.2.1 Chickenpox is an acute, generalized viral disease with sudden


onset of slight fever, mild flu-like symptoms and skin lesions.
Lesions may appear on the scalp, high in the axilla, on mucous
membranes of the mouth and upper respiratory tract, and on the
conjunctivae.

6.2.2 Symptoms: Itching, tingling, or burning sensation at the site where


lesions appear. Small, usually painful, blisters on the skin.

6.2.3 Mode of transmission. By direct person-to-person contact;


droplet or airborne spread of vesicle fluid; or secretions of the
respiratory tract. Chickenpox is one of the most readily
communicable of disease, especially in its early stages.

6.2.4 Incubation period. May be from two to three weeks, but most
commonly 13 to 17 days. May be prolonged after passive
immunization.

6.2.5 Preventive measures. Utilize standard precautions. Isolation;


protect respiratory tract with non-rebreather mask on patient. EMS
provider(s) should don N95 respirator. Any patient’s body fluids on
worker’s skin should be cleaned with soap and water or waterless
antimicrobial solution without delay. Disinfect contaminated
equipment using a bleach solution.

FRD members with inadequate titer or no previous history of


chickenpox contraction should consider having the varicella
vaccination. The vaccination is offered by FRD at no cost to
members.

6.2.6 Relative risk to providers:

None: If immune
Significant: If not immune

6.3 Hepatitis A (HAV)

6.3.1 Hepatitis is an inflammation of the liver, with accompanying liver


cell damage or death. Hepatitis is most often caused by a viral
infection, but alcohol consumption, drugs, chemicals, or poisons
may also be a cause of chemical hepatitis. Hepatitis A was

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formerly known as “infectious hepatitis” and is a specific form of


hepatitis.

6.3.2 Symptoms:

Mild fever Diarrhea (light colored)


Headache Dark urine
Fatigue Jaundice
Loss of appetite Muscle and joint aches
Nausea Abdominal discomfort
Vomiting

Symptoms are the same for all types of hepatitis.

6.3.3 Mode of transmission. Person-to-person by the fecal-oral route.


The infectious agent is found in feces, contaminated water, food
contaminated by infected food handlers and contaminated
uncooked food products. Contact with contaminated water may
also cause infection, e.g. water rescue efforts.

6.3.4 Incubation period. Fifteen to 50 days, depending on dose.


Average incubation period = 28 days.

6.3.5 Preventive measures. Utilize standard precautions. Any patient’s


blood or body fluids on worker’s skin should be cleaned without
delay using soap and water or germicidal solution. Disinfect
contaminated equipment using a bleach solution.

Receive Hepatitis A vaccine (2-step vaccination). This vaccination


series is offered by FRD at no cost to members.

6.3.6 Relative risk to providers:

None: If immune

6.4 Hepatitis B (HBV)

6.4.1 Hepatitis B is also referred to as “serum hepatitis.” It is caused by


the hepatitis B virus which attacks and replicates in liver cells. HBV
is a bloodborne and body fluid borne disease that is highly
concentrated in the blood and serous fluids.

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6.4.2 Symptoms:

Mild feverq Diarrhea


Headache Dark urine
Fatigue Jaundice
Loss of appetite Muscle and joint aches
Nausea Abdominal discomfort
Vomiting

Symptoms are the same for all types of hepatitis.

6.4.3 Mode of transmission. HBV transmissions occur through skin or


mucous membranes, infected blood or body fluids, sexual contact,
or through contaminated needles.

6.4.4 Incubation period. Forty-five to 160 days. Average incubation


period = 120 days.

6.4.5 Preventive measures. Utilize standard precautions. Use caution


while handling contaminated needles. Any patient’s blood or body
fluids on worker’s skin should be cleaned without delay using soap
and water or germicidal solution. Disinfect contaminated
equipment using a bleach solution.

Receive Recombinant Hepatitis B vaccine (3-step vaccination).


Receive booster if antibody falls below protective level. This
vaccination series (and booster when required) is offered by FRD at
no cost to members.

6.4.6 Relative risk to providers:

None: If immune with Hepatitis B Vaccine.

6.5 Hepatitis C (HCV)

6.5.1 Hepatitis C was formerly known as “parenterally transmitted non-


A/non-B hepatitis.” Intravenous drug users and individuals
receiving blood transfusions or hemodialysis have an increased risk
of acquiring hepatitis C. Individuals who get tattoos and/or body
piercing(s) also have an increased risk of acquiring hepatitis C.

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6.5.2 Symptoms:

Mild fever Diarrhea


Headache Dark urine
Fatigue Jaundice
Loss of appetite Muscle and joint aches
Nausea Abdominal discomfort
Vomiting

Symptoms are the same for all types of hepatitis.

6.5.3 Mode of transmission. Contact with the blood or body fluids of an


infected patient.

6.5.4 Incubation period. Fifteen to 64 days.

6.5.5 Preventive measures. Utilize standard precautions. Use caution


while handling contaminated needles. Any patient’s blood or body
fluids on worker’s skin should be cleaned without delay using soap
and water or germicidal solution. Disinfect contaminated
equipment using a bleach solution.

6.5.6 Relative risk to providers:

None: Provided there is no contact with infected blood (i.e.


percutaneous exposure incident).

6.6 Hepatitis D (HDV)

6.6.1 Hepatitis D is also known as the “delta virus.” It is a virus that


causes infection only when an active HBV infection is present.
Approximately four percent (4%) of strains of hepatitis B contain
hepatitis D virus.

6.6.2 Symptoms:

Mild fever Diarrhea


Headache Dark urine
Fatigue Jaundice
Loss of appetite Muscle and joint aches
Nausea Abdominal discomfort
Vomiting

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Symptoms are the same for all types of hepatitis.

6.6.3 Mode of transmission. Exposure to the blood or body fluids of a


patient infected with hepatitis D when the exposed person already
has hepatitis B.

6.6.4 Incubation period. Two to ten weeks.

6.6.5 Preventive measures. Utilize standard precautions. Use caution


while handling contaminated needles. Any patient’s blood or body
fluids on worker’s skin should be cleaned without delay using soap
and water or germicidal solution. Disinfect contaminated
equipment using a bleach solution.

6.6.6 Relative risk to providers:

High: If provider is negative for hepatitis B antibody

None: If provider is positive for hepatitis B antibody (immune for


hepatitis B).

6.7 Lice

6.7.1 Lice are small, wingless insects that feed on blood. There are three
species: (1) head, (2) body, and (3) crab or pubic louse. All lice
have flattened bodies and measure up to one-eighth inch (1/8”)
across.

6.7.2 Symptoms:

1) Scratching
2) Dermatitis
3) Impetigo

6.7.3 Mode of transmission: Close contact. Head-to-head or body.

6.7.4 Incubation period: Twenty-four to 48 hours.

6.7.5 Preventive measures. Employee’s hands should be washed


thoroughly with an antimicrobial liquid soap. Hair should be
shampooed using Kwell shampoo or as directed by Infectious
Disease Physicians, Inc. (IDP). Avoid contact. The Infection
Control Officer (ICO) may provide further guidance/direction.

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6.7.6 Relative risk to providers:

High

6.8 Meningitis (Meningococcus)

6.8.1 Meningitis is an inflammation of the membranes lining the central


nervous system. This inflammation can be from either infectious or
noninfectious causes. Infectious agents include bacteria, viruses,
and fungi. Noninfectious agents include chemicals or a
“sympathetic” reaction to other diseases. Meningitis occurs most
often in children, but may also be present in adults.

6.8.2 Symptoms:

Fever Irritability
Headache (children over
2 years of age) Tachycardia
Lethargy Tachypenia
Nausea Hypotension
Vomiting Stiff neck (children over
2 years of age)

6.8.3 Mode of transmission. Meningitis is transmitted through airborne


or direct contact with infected respiratory secretions. Other
transmission can occur from contact with cerebrospinal fluid as a
result of trauma, sputum from suctioning, unprotected mouth-to-
mouth resuscitation, or coughing.

6.8.4 Incubation period. Two to four days.

6.8.5 Preventive measures. Utilize standard precautions, including:

1) Minimize the number of personnel in close proximity to the


patient.
2) Have all personnel within close proximity immediately don
Department-issued N-95 respirators.
3) Place non-rebreather mask on the patient.

Any patient’s body fluids on worker’s skin should be cleaned


without delay using soap and water or germicidal solution.
Disinfect contaminated equipment using a bleach solution.

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Receive post-exposure prophylaxis dose of Ciprofloxacin if


Neisseria Meningitidis form of meningitis is documented or highly
suspected. This treatment is provided by FRD at no cost to
members.

6.8.6 Relative risk to providers:

Low: (One in several thousand) for Neisseria Meningitidis, but


prophylaxis is warranted due to the nature of infection if
transmission occurs.

6.9 Methicillin Resistant Staphyloccus Aureus (MRSA)

6.9.1 MRSA is a bacterial organism commonly seen in nursing homes


and other long-term care facilities.

6.9.2 Symptoms: Depends upon body site.

6.9.3 Mode of transmission. Spreads upon contact.

6.9.4 Incubation period. Varies depending upon body site.

6.9.5 Preventive measures. Utilization of exam gloves. Hand washing


immediately after contact.

6.9.6 Relative risk to providers:

None: If provider is healthy and has an intact immune


system.

6.10 Severe Acute Respiratory Syndrome (SARS)

6.10.1 SARS is a viral respiratory illness caused by a coronavirus (SARS-


CoV).

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6.10.2 Symptoms:

High fever (≥100.4o F) Body aches


Chills Diarrhea
Headache Dry, nonproductive cough1
General discomfort

6.10.3 Mode of transmission. Close/direct person-to person contact;


droplet or airborne spread via infected patient coughing or
sneezing. May also be transmitted via touching a surface or object
contaminated with infectious droplets and then touching your
mouth, nose, or eye(s). It is possible that SARS-CoV might be
spread more broadly through the air (airborne spread) or by other
ways that are not now known.

6.10.4 Incubation period. Typically 2 to 7 days, although in some cases


it may be as long as 10 days. In a very small proportion of cases,
incubation periods of up to 14 days have been reported.

6.10.5 Preventive measures.

1) Minimize the number of personnel in close proximity to the


patient.
2) Have all personnel within close proximity immediately don
Department-issued N-95 respirators and eye protection.
3) Utilize exam gloves.
4) Place non-rebreather mask on the patient.

Any patient’s body fluids on worker’s skin should be cleaned


without delay using soap and water or germicidal solution. Wash
hands thoroughly. Disinfect contaminated equipment using a
bleach solution.

6.10.6 Relative risk to providers:

Low2: If provider observes recommended precautions.

1
After 2 to 7 days, SARS patients may develop a dry, nonproductive cough that might be
accompanied by or progress to hypoxia. In 10 to 20 percent of cases, patients require
mechanical ventilation. Most patients develop pneumonia (CDC, 2004).
2
There are still “unknowns” regarding the transmission of SARS and the risk to providers. It is
imperative that all providers use recommended precautions to minimize their risk.

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High: If provider is unprotected (mask, eye protection, etc.) and


comes in direct contact with aerosol spray from patient coughing or
sneezing.

6.11 Scabies

6.11.1Scabies is a highly contagious skin disease caused by mites that


burrow underneath the skin, especially in skin folds.

6.11.2 Symptoms: Scratching, resulting in the formation of scabs and


sores.

6.11.3 Mode of transmission. Scabies are transmitted through sexual


contact and indirect contact by shared towels, bedding, and
clothing.

6.11.4 Incubation period. Twenty-four to 48 hours.

6.11.5 Preventive measures. Utilize standard precautions. Worker’s


skin should be cleaned without delay using soap and water or
germicidal solution. Change clothing if necessary. The Infection
Control Officer may require additional preventive measures as
appropriate.

6.11.6 Relative risk to providers:

Likely if direct contact with infected person.

6.12 Shingle (Herpes Zoster)

6.12.1 Shingles is a viral infection of the nerves that supply certain areas
of the skin. It is caused by the herpes zoster virus, the same virus that
causes chickenpox.

6.12.2 Symptoms:

1) Sensitive skin lesions


2) Rash
3) Blisters

6.12.3 Mode of transmission. Direct contact with open lesions or


airborne transmission if provider is not immune.

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6.12.4 Incubation period. Two to three weeks.

6.12.5 Preventive measures. Avoid contact to a provider who has not


had chickenpox. Worker’s skin should be cleaned with soap and
water or germicidal solution.

FRD members with inadequate titer or no previous history of


chickenpox contraction should consider having the varicella
vaccination. The vaccination is offered by FRD at no cost to
members.

6.12.6 Relative risk to providers:

Low: If provider has had chickenpox

High: If provider who has not had chickenpox comes in


contact with open lesions.

6.13 Smallpox (Variola virus)

6.13.1 Smallpox is an acute viral disease caused by the variola virus.

6.13.2 Symptoms:

High fever Swollen lymph nodes


Fatigue/malaise Coughing blood
Weakness A cough that might be pro-
ductive or non-productive

6.13.3 Mode of transmission. Person-to-person through direct contact


with respiratory droplets, aerosols, secretions, and skin lesions of
an infected person. May also be spread through direct contact with
infected body fluids or contaminated objects such as bedding or
clothing. In rare instances, smallpox has been spread by a virus
carried in the air in enclosed settings such as buildings, buses, and
trains.

6.13.4 Incubation period. Initial symptoms usually occur 12-14 days


after exposure (range 7 – 17 days). The rash appears shortly
thereafter and progresses to vesicles within 1 – 2 days.

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6.13.5 Preventive measures. Smallpox vaccination is effective in


preventing infection before and shortly after exposure3.

Personal protective measures include:

1) Minimize the number of personnel in close proximity to the


patient.
2) Have all personnel within close proximity immediately don
Department-issued N-95 respirators and eye protection.
3) Utilize Department-issued exam gloves.
4) Place non-rebreather mask on the patient.

6.13.6 Relative risk to providers4:

Low: If provider observes recommended precautions (including


being vaccinated before or shortly after exposure).

High5: If provider is unprotected (mask, gloves, eye protection, etc.)


and comes in direct contact with aerosol spray from patient
coughing or sneezing. Also considered "potentially high" if provider
is not vaccinated before or shortly after exposure.

6.14 Tuberculosis (TB)

6.14.1 Tuberculosis (TB) is an airborne disease that commonly attacks the


respiratory system.

6.14.2 Symptoms:

Fever with night sweats Swollen lymph nodes


Unexplained weight loss Coughing blood
Weakness A cough that might be pro-
ductive or non-productive

6.14.3 Mode of transmission. Tuberculosis is transmitted by inhaling


aerosolized droplets from an infected person who is coughing or
sneezing. The TB organism is sensitive to light and air and

3
Please see the Department's "Smallpox Policy" for additional information.
4
Please see Attachment 6-2 for "Procedures for Dealing with Smallpox Vaccine Recipients"
5
The last outbreak of smallpox in the US occurred in 1949. Most Americans born before 1980
were vaccinated, but the level of protection still in effect for these individuals is debatable. In the
unlikely event of an outbreak of smallpox in our area, the Department has a comprehensive Plan
of Action for infection control and protection that is clearly delineated in the Smallpox Policy.

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therefore dies quickly when exposed to either. Thus, this disease is


rarely spread by indirect contact.

6.14.4 Incubation period. Two to ten weeks. The organism can be


reactivated after a period of several years.

6.14.5 Preventive measures. Utilize standard precautions, including


respiratory protection. (NIOSH approved fit-tested N-95 mask)
Place non-rebreather mask on patient. Worker’s skin should be
cleaned with soap and water or waterless antimicrobial solution
without delay. Decontaminate any equipment if necessary.

A routine PPD skin testing program has been successfully


implemented by the Fairfax County Fire and Rescue Department.
Member participation in this program is strongly recommended.
Attachment 6-1 provides information regarding “Follow-Up for
Exposure to Tuberculosis (TB)” for FRD members.

6.14.6 Relative risk to providers:

Likely, depending on level of direct contact with infected person,


length of exposure, and ventilation present.

6.15 Vancomycin Resistant Entreroccus (VRE)

6.15.1 Vancomycin resistant entreroccus (VRE) is a bacterial organism


increasingly seen in nursing homes and other long-term care facilities or in
patients who have received multiple rounds of antibiotic therapy.
Symptoms. Depends upon body site.

6.15.2 Mode of transmission. Spreads on contact.

6.15.3 Incubation period. Depends on body site.

6.15.4 Preventive measures. Utilization of exam gloves. Hand washing


immediately after contact.

6.15.5 Relative risk to providers: None if provider is healthy and has an


intact immune system.

IMMUNIZATIONS

6.16 The Fairfax County Public Safety Occupational Health Center (PSOHC).
One facet of this full-service Occupational Health Center provides all

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recommended vaccinations/immunizations to members determined to be


“at risk” for certain potential exposures. Additionally, “preventive”
vaccinations for communicable diseases such as influenza are available to
all members (“at risk” and “not at risk”). All services are provided at no
cost to the member.

6.17 The following immunizations/vaccinations are available and administered


via the PSOHC:

6.17.1 Hepatitis A. Members designated “at risk” will be offered the


Hepatitis A vaccine series upon employment/entry into the FRD.

Administration Protocol: Initial 2-shot series. First shot in series


administered during initial visit. Second shot administered not less
than 6 months and not more than 12 months after first shot.

6.17.2 Hepatitis B. Members designated “at risk” are offered and strongly
encouraged to have the hepatitis B vaccine series if there is no
documentation of prior infection or vaccination.

The World Health Organization (WHO) defines adequate immunity


(titer) as 10IU/ml or greater. This level of immunity will protect
members from the hepatitis B virus.

Administration Protocol: Initial 3-shot series. Series is


administered with first shot during initial visit; 2nd shot one month
later; 3rd and final shot six months after date of 2nd shot.

Upon completion of the initial 3-shot series, blood will be drawn


after 30 days to check adequate immunity. Personnel may receive
another complete series of HBV (x3) for a total of six HBV vaccine
administrations if serologic results of HBV titer warrant. Personnel
who do not convert to an immunity HBV titer of 10IU/ml or greater
after administration of 6 vaccine administrations shall be referred to
the Contractual Infectious Disease Physician (CIDP) for
consultation and/or alternative immunity against HBV.

6.17.3 Influenza. All members are offered the opportunity to receive the
influenza immunization annually. FRD members, particularly those
designated “at risk,” are strongly encouraged to participate in the
influenza vaccination program once a year.

Administration Protocol: One shot administered annually.

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6.17.4 Lyme Disease. Members designated “at risk” may be offered the
Lyme Disease vaccination series upon employment/entry into the
FRD at the discretion of the PSOHC or the CIDP.

Administration Protocol: Initial 3-shot series. Series is


administered with first shot during initial visit; 2nd shot one month
later; 3rd and final shot 12 months after date of 2nd shot.

Frequent Lyme Disease boosters may be necessary.

6.17.5 Measles, Mumps, Rubella (MMR). Members designated “at risk”


will be offered the MMR shot upon employment/entry into the FRD.

Administration Protocol: One shot administered during initial


visit.

6.17.6 Pneumococcal. This vaccine is available through the PSOHC.


Determination of requirement for this vaccination will be made by
the PSOHC physician.

6.17.7 Tetanus. Members designated “at risk” will be offered the initial
tetanus shot upon employment/entry into the FRD.

Tetanus boosters are recommended at ten year intervals.

6.17.8 Varicella. It is estimated that over 90 percent of the adult


population in this country have immunity to varicella. Determination
of the requirement for this vaccination series will be made by the
PSOHC physician.

Administration Protocol: Initial 2-shot series. Series is


administered with 1st shot upon initial visit. Second shot
administered 1 − 2 months later with only a negative liter.

6.18 Federal Emergency Management Agency (FEMA)/Virginia Task Force


I Participants. In addition to the vaccines listed above, FEMA (Virginia
Task Force I) participants shall have the following vaccines in order to be
considered eligible for deployment/activation:

6.18.1 Yellow Fever

Administration Protocol: One shot administered every 10 years

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6.18.2 Polio

Administration Protocol: One vaccination

6.18.3 Meningococcal

Administration Protocol: One shot administered every three


years

6.18.4 Others as required by deployment location and recommendations


of the Centers for Disease Control and Prevention (CDC).

6.19 Tuberculosis (TB) Skin Test. At this time, there is no vaccine to prevent
an individual from contracting tuberculosis, nor is there a vaccine to cure
the disease. There is, however, a safe and reliable means to test
employees for the disease.

All members designated “at risk” shall be offered a purified protein


derivative (PPD) skin test to check for tuberculosis (TB). The purpose
of the PPD skin-test is to safeguard the health and welfare of
employees and to enhance the Department’s compliance with all
applicable regulations mandated by OSHA in accordance with the
Safety and Health Codes Board of the Commonwealth of Virginia.

PPD testing is offered by the FRD upon initial employment/entry and at


least annually thereafter. Under special circumstances (exposure
incident), testing may be performed more frequently. (Attachment 6-1).

Please note: Any member with a history of a positive PPD should not
have the PPD skin-testing performed. The PSOHC physician should
be notified of the positive history immediately.

Administration Protocol: If a member does not have a history of a


positive PPD, the initial PPD skin test will usually be performed using
the “two step” method of screening (i.e. a second PPD will be placed
two to three weeks after the first if the initial reading is negative). The
“two-step” method of screening is done to eliminate the possibility of a
false negative reading.

If a member has documentation of a negative PPD within the previous


twelve months, only a single test will be done during the initial applicant
medical examination.

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In the skin-test process, an intradermal injection of 0.1 cc of the PPD


tuberculin is administered to the employee’s left forearm. The
interpretation of the skin test is read 48 to 72 hours after the tuberculin
is injected. Readings of the skin tests shall be confidential and shall be
done only by PSOHC medical staff or their designee(s).

6.20 Declination of Vaccinations/Immunizations

6.20.1 All vaccinations/immunizations mentioned in the previous section


are provided at no cost to employees. FRD members designated
to be “at risk” for potential exposure to bloodborne and airborne
pathogens are particularly encouraged to receive all
vaccinations/immunizations offered and/or recommended.

6.20.2 FRD members have the right to refuse any and all vaccinations/
immunizations. Should a member, for any reason, wish to decline
certain immunizations, he/she must sign a Declination Form which
will be placed in his/her permanent medical record. This
Declination Form will be provided at the time of refusal by the
Public Safety Occupational Health Center. Vaccination/
immunization refusals for which a signed Declination Form are
required are:

1) Hepatitis B
2) Tuberculosis (TB) PPD Skin-Test

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ATTACHMENT 6-1

FOLLOW-UP FOR EXPOSURE TO TUBERCULOSIS (TB)

PROCEDURE ACTION/NOTES
If an unprotected exposure occurs and the Persons who have tested positive in
employee has no documented negative the past should not be tested again.
test in the last 3 months and was not
previously testing positive, a Mantoux skin
test (PPD) should be administered as soon
as possible.
If this skin test is negative, the employee
should be retested in 12 weeks.
If the employee tests positive (>5mm Persons with previous positive tests
reaction) or shows symptoms of TB, a who are exposed to an infectious
chest x-ray should be taken. patient DO NOT require a skin test
or an x-ray unless they show signs
or symptoms of TB.
Members testing positive following an
exposure should be evaluated for
preventive therapy in accordance with the
current published guidelines.
Healthy members who are receiving
preventive treatment for TB should be
allowed to continue normal work activities.

Work Restrictions − Tuberculosis

1) It should be noted that individuals with a positive Mantoux (PPD) skin test, but
no symptoms of disease, need not be placed on work restrictions.

2) Individuals with a positive Mantoux skin test, a positive chest x-ray, or


symptoms of tuberculosis will be placed on work restrictions until there is
medical clearance for return to work. This determination will be made by
Infectious Disease Physicians, Inc. (IDP).

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ATTACHMENT 6-2

PROCEDURES FOR DEALING WITH


SMALLPOX VACCINE RECIPIENTS

Introduction
In December 2002, the President of the United States initiated a "National
Smallpox Vaccination Plan" to immunize frontline troops who serve in high-threat
areas and domestic emergency responders. This voluntary plan was brought
about in the aftermath of 9/11, which brought to light the nation's vulnerability to a
terrorist attack.

At that time, it was emphasized that there was no imminent threat of a smallpox
threat against the United States, but "the possibilities are real."

This program has since stalled in its implementation for non active duty military
personnel (i.e. civilian health care workers, first responders, etc.) due to a
number of issues regarding "risk vs. benefit" questions, publicized adverse
reactions to the vaccine, and other concerns.

At this time, it is unlikely that Fairfax County Fire and Rescue Department first
responders would be called to a medical emergency involving a recently
vaccinated patient who may pose an "exposure risk" for personnel. "Unlikely,"
but not impossible. Although the program to vaccinate certain members of the
health care community has, for the time being, been halted, active duty military
personnel scheduled for deployment to areas considered "high risk" are required
to receive the vaccination. Given the fact that many active duty military
personnel live and work in our area, it is not unrealistic to envision a scenario
where a recently vaccinated member of the Armed Forces would require
emergency medical assistance from the Fairfax County Fire and Rescue
Department.

This being the case, the Department feels it is prudent to provide the following
procedures for dealing with smallpox vaccine recipients.

Procedures for FRD Personnel


1) It is very reasonable to inquire about vaccination status of any and all
patients for whom FRD personnel respond for care. This shall become
part of the routine screening questions at first interface with the patient.

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2) Typically, the smallpox vaccine is administered in the deltoid (upper arm)


region. However, there has been discussion of using the inner thigh and
the buttocks as alternatives. Vaccinia virus from this live virus vaccine can
be shed from the site for 19-2` days. Shedding ceases when the scab at
the vaccination site sloughs (falls off).

3) The care of a vaccine site includes the application of gauze with a semi-
occlusive dressing (e.g., 2x2 inch gauze and tape, or TegaDerm) and the
use of long-sleeved upper body clothing until the scab sloughs.

4) If the patient has received the vaccine, assessing the site of the
vaccination is recommended. If a semi-occlusive dressing is present, it
shall not be removed, but might be reinforced (e.g., 3-4 inch tape or
TegaDerm) during evaluation, care, and/or transport. If the patient has not
been vaccinated, normal standard precautions shall be followed.

5) If the patient has received the vaccine and no occlusive dressing is


present over the vaccination site, FRD personnel rendering care shall
ensure the donning of exam gloves prior to applying 2x2 inch gauze and
tape, or TegaDerm to the site. Items such as exam gloves and other
ancillary supplies that come in contact with the vaccination site shall be
placed in a z plastic bag and discarded at the emergency room's
biohazard receptacle. Exam gloves should be removed and bagged
immediately after applying the bandage and a new pair donned before
proceeding with any additional care.

6) FRD personnel shall make every effort to avoid or limit using diagnostic
instruments (e.g., BP cuff) to the vaccinated arm or leg. Should diagnostic
instruments (e.g., BP cuff, EKG cables, etc.) come in contact with an
unprotected (not covered) vaccination site, FRD personnel shall
immediately place the contaminated item out of service and in a biohazard
bag. FRD personnel shall then contact the Safety Officer for further
direction.

7) Patient might present with disseminated Vaccinia which could include


diffuse skin lesions. Thus, the use of exam gloves, disposable sleeves,
and a gown is required.

8) As time progresses, it is entirely possible that patients who have received


the vaccine have already completed their 19-21 day post vaccination
timeframe with sloughing of their vaccine scab site. Such patients would
pose absolutely no risk whatsoever and shall be dealt with as any other
patient.

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9) Advance notification of the receiving facility is recommended to alert them


to the patient's vaccination status.

10) Should the unprotected vaccination site of a patient contaminate the


sheets/blankets on the stretcher, FRD personnel shall request assistance
from the emergency room staff as to the "dirty linen" receptacle to place
contaminated items.

11) If any part of your work uniform comes in contact with the unprotected
vaccination site, personnel shall place themselves out of service, check for
potential skin contact, wash the site if necessary, and immediately launder
the contaminated work uniform (times two) on hot water at the fire station.

12) In complying with acceptable infection control procedures, immediate


hand washing shall be the normal practice when rendering patient care to
Vaccinia virus recipients.

13) Should FRD personnel on the scene require additional guidance relating
to the handling of the Vaccinia vaccination site, notification of the Infection
Control and Prevention Officer is strongly encouraged.

14) FRD personnel rendering care to a vaccine recipient shall complete the
applicable exposure reports and forward the reports to the Infection
Control and Prevention Officer in a timely fashion6.

6
Questions concerning guidance on handling smallpox vaccine recipients shall be directed to:
Captain James C. Summers, Safety & Personnel Services Division at 703-246-3965 or via emal
at james.summers@fairfaxcounty.gov.

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CHAPTER 7.
POST-EXPOSURE MANAGEMENT

7.1 Employees1 who sustain an occupational exposure to an infectious


disease shall receive prompt response and follow-up investigation in
compliance with federal and state regulations. Trained infectious disease
designated officers shall administer this program under the direction of the
Infectious Disease Physician (IDP).

Employees who sustain an exposure to an infectious disease shall receive


post-exposure counseling, post-exposure evaluation, diagnostic testing,
and treatment when medically indicated.

Exposure Incident − Bloodborne Pathogen:

7.1.1 An occupational risk-event exposure to a bloodborne pathogen is a


specific eye, mouth, other mucous membrane, nonintact skin, or
parenteral contact with blood or other potentially infectious material
that results from the performance of a member’s duties. Examples
include:

1) Contaminated needlestick injury


2) A cut or laceration from objects covered with blood or body
fluids
3) Injury sustained while cleaning contaminated equipment

7.1.2 A non-risk-event exposure to a bloodborne pathogen is defined as


blood or body fluids to intact skin, work uniform, or personal
protective equipment (PPE).

7.1.3 After an exposure incident, members should treat the exposure


site.

7.1.3.1 Initial treatment of the exposure site:

1) Wash wounds and skin sites that have been in


contact with blood or body fluids with soap and water.

2) Flush mucous membranes (eyes, mouth, etc.) with


water.

1
The term “employee” as used in this chapter applies to both employees of the Fire and Rescue
Department and to members of volunteer companies.

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3) Antiseptics may be used for wound care.

4) Do not apply caustic agents such as bleach or inject


antiseptics or disinfectants into the wound.

5) If garment is penetrated by blood or other potentially


infectious materials, the garment(s) must be removed
immediately or as soon as possible. Garments
should be removed in such a way as to avoid contact
with the outer surface (e.g. roll garment up as it is
pulled toward head for removal). See Chapter 5 for
procedures regarding handling, cleaning, and
decontamination of work uniforms.

Exposure Incident − Airborne Pathogen:

7.1.4 An occupational exposure to an airborne pathogen is defined as


unprotected contact with a patient confirmed or suspected of having
active tuberculosis (TB), meningitis, or varicella zoster virus
(chicken pox).

7.1.4.1 Airborne risk-event exposure: Positive purified protein


derivative (PPD) skin test and acid fast bacilli (AFB)
smears from the source patient are determined to be
infectious by the infection control practitioner, the
Infectious Disease Physician (IDP), or the Fairfax County
Department of Health. A source patient may also be
considered to be infectious if the infectious disease
physician investigates and determines the patient is
positive for bacterial meningitis.

7.1.4.2 Airborne non-risk event exposure: Positive PPD skin


test for the source patient is identified as not infectious by
the infection control practitioner, the Infectious Disease
Physician, or the Fairfax County Department of Health.
When meningitis is suspected, the IDP will further
investigate to determine that the source patient is not
infectious with meningitis.

7.1.5 Reporting/procedural guidelines for exposure to airborne pathogens


(risk and non-risk events) are the same as those for exposure to
bloodborne pathogens.

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7.2 Post Exposure Reporting and Procedures – On-Duty Reporting

7.2.1 The primary designated officer contact for reporting occupational


exposures to Fire and Rescue Department (FRD) personnel shall
be the duty safety officer. If the duty safety officer is unavailable,
employees shall refer to the station’s Exposure Control Plan for
other designated officers.2

7.2.2 All occupational and Good Samaritan exposures (risk and non-risk
events) to an infectious disease shall be immediately reported to
the duty safety officer or another designated officer (DO) via phone
or pager.3 The exposed employee shall make contact with the
designated officer prior to leaving the receiving facility or upon the
completion of the emergency incident. Contact with the designated
officer shall be done after patient care is completed.

7.2.3 Employees sustaining an exposure from a patient who


subsequently refuses transportation to a medical facility shall
contact a designated officer prior to leaving the incident scene.
Employees may contact the Public Safety Communications Center
(PSCC) for assistance in notifying a designated officer.

7.2.4 If the exposed employee is not assigned to the transporting unit, he


or she shall contact a designated officer immediately upon returning
to the station.

7.2.5 The investigating designated officer shall ensure the exposed


employee’s and patient’s confidentiality.

7.2.6 An exposed employee shall ensure that the site or area exposed is
properly cleaned with a disinfecting solution and/or hand soap.

7.2.7 An exposed employee shall inform the unit officer-in-charge (OIC)


that an occupational exposure or potential exposure has occurred.
The supervisor of an exposed employee shall not solicit any
specific information regarding the exposure. The only information
that needs to be given to a supervisor is that the employee
sustained an occupational exposure.

2
For the purposes of this chapter, the term “designated officer” shall refer to the individual
responsible for reporting requirements, investigation, and actions necessary to assist exposed
employees.
3
See Attachment 7-1, “Designated Officer’s Resource Material: Immediate Post-Exposure
Information Guidelines.”

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NOTE: An exposed employee is discouraged from sharing


information about the exposure with coworkers who were not
involved in the emergency incident.

7.2.8 A current listing of designated officers is included in this Exposure


Control Plan (Attachment 7-5). In addition, the exposed employee
can notify PSCC and ask the Uniformed Fire Officer (UFO) for a
designated officer. Specific information about the exposure shall
not be discussed with the UFO or other PSCC workers.

7.2.9 If known, the exposed employee shall provide the designated


officer with the following information:

1) Source patient’s name, age, receiving hospital, and hospital ID


number
2) The type, nature, and duration of exposure
3) Suspected or known disease and infectious organism
4) Actions taken to reduce the exposure
5) Name of charge nurse and/or attending physician notified

7.2.10 The following documentation is required for all occupational


exposures (risk and non-risk events) to infectious diseases4.

♦ Completed Infectious Disease Exposure Report (FRD-314)


♦ Copy of Fire Event History (FEH)
♦ Copy of the Incident Reporting System report of the unit the
employee was assigned to when the exposure occurred.

7.2.10.1 The unit OIC shall ensure that the exposure to the
employee is stated in the narrative portion of the incident
report. Specific information concerning the exposure
shall not be mentioned.

• Correct Example: Firefighter Jane Jones sustained


an occupational exposure while rendering aid to the
patient on incident #973255050.
• Incorrect Example: Firefighter Jane Jones sustained
a needle stick injury to her left thumb while rendering
aid to an HIV infected patient on incident
#973255050.

4
Reference attachments 7-7 and 7-8, “Completing an Infectious Disease Exposure Injury Report
Package,” and “Occupational Exposure to Infectious Diseases: Forms Required,” respectively.

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7.2.11 Exposed personnel shall not make an entry into the fire station’s
logbook that an occupational exposure has occurred.

7.2.12 The completed Infectious Disease Exposure Report (FRD-314),


FEH, and Incident Reporting System reports shall be faxed to the
Safety Officer.

7.2.13 Exposed volunteer personnel shall be responsible for ensuring that


the Attending Physician’s Statement (VFIS) is completed by the
infectious disease physician.

7.2.14 Exposed volunteer personnel shall forward the volunteer insurance


carrier’s documents, Accident/Sickness Claim Report and the
Attending Physician’s Statement directly to the Infection Control
Officer in the SPSD. Contact with the Volunteer Liaison is not
required.

Designated Officer

7.2.15 The designated officer shall evaluate the information received from
the exposed employee to determine if the exposure is a risk or non-
risk event. Additionally, the designated officer shall provide post-
exposure counseling (if necessary) to the exposed employee to
include, but not limited to:

♦ Information and education regarding the infectious disease


exposure
♦ Modes and rates of transmission
♦ Safe-sex counseling

7.2.16 The designated officer shall contact the receiving facility’s infection
control practitioner and fax notification that an employee from the
FRD sustained an occupational exposure. If the exposure occurs
outside of normal business hours, the designated officer shall notify
the receiving facility’s charge nurse or attending physician that an
occupational exposure occurred. If necessary, the designated
officer shall contact the infectious disease physician to assist with
coordinating and confirming an occupational risk-event exposure.

7.2.17 When directed by the infectious disease physician, the designated


officer shall ensure a blood sample is drawn from the source patient
and tested for Hepatitis B (HBV), Hepatitis C (HCV), and single-use
diagnostic testing (SUDS) for rapid HIV testing.

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7.2.18 The designated officer shall maintain a written summary to include:

♦ Contact dates and times


♦ All information gathered from the exposed employee
♦ All information gathered from any persons contacted during the
exposure investigation.

This information shall be retained in the employee’s case history file


maintained by the FRD Infection Control Officer.

Infection Control Officer

7.2.19 The FRD Infection Control Officer or his/her designee shall notify
the exposed employee of the source patient’s blood results and
infectivity status as soon as the information becomes available.

7.2.20 If medically indicated, the exposed employee shall be referred to


the infectious disease physician (IDP) for post-exposure evaluation,
counseling, diagnostic testing, and treatment.

7.2.21 All required evaluations and procedures shall be done by or under


the supervision of the IDP.

7.2.21.1 All required evaluations and procedures will be provided


at no cost to the employee.

The IDP will complete a Medical Status Report for each visit clearly
indicating return to work (RTW) status such as:

♦ Full Duty – no restrictions are cited


♦ Modified Duty – restrictions are cited
♦ Injury Leave – totally disabled for work is cited

The IDP will ensure that the employee and the OHSD are apprised
of the RTW status decision.

7.2.22 All completed exposure reports and case history files shall be
reviewed by the Infection Control Officer and the infectious disease
physician. A letter verifying the event shall be mailed to the
exposed employee’s home address. A copy of this letter will be
placed in the employee’s Public Safety Occupational Health Center
(PSOHC) medical file and in the Infection Control Officer’s

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exposure file(s). A separate written opinion by the infectious


disease physician will be provided to the exposed employee.

7.2.23 With consent, blood may be drawn from the employee5 and the
source individual. The member may consent to have his or her
blood tested for HBV, HCV, and HIV. The employee may elect to
have blood drawn, but not tested for HIV baseline. The blood will
be held at the testing facility’s lab for 90 days. The employee may
elect to have their blood tested any time within this 90-day period.

7.2.23.1 Under the Code of Virginia, patients consenting to


hospital treatment are deemed to have given consent for
blood testing and may be tested for infectious diseases,
including HBV, HCV, and HIV if an employee
experiences a bloodborne exposure while offering,
treating, or assisting with treatment. Conversely, if a
patient is exposed to an employee’s blood, consent to
test the blood for HBV, HCV, and HIV must be given by
the employee and the results sent to the exposed patient.

7.2.24The Ryan White Comprehensive AIDS Resources Emergency Act


(1990) requires that a receiving facility Infection Control Practitioner
(ICP) notify the Department’s Infection Control Officer within 48
hours of a communicable disease diagnosis for a patient treated by
pre-hospital providers. Under this act:

7.2.24.1 Hospital responsibilities are to:

1) Notify Department Infection Control Officer within 48


hours when an employee may have been
unknowingly exposed.

2) Provide the name of the disease involved and the


date of the exposure.

7.2.24.2 The Fairfax County Fire and Rescue Department


responsibilities are to:

1) Notify employee(s) involved of possible exposure.

2) Provide the name of the disease involved.

5
NOTE: The only two approved sites for employees to have blood drawn are (1) the PSOHC
and (2) the office of the infectious disease physician (ICP).

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3) Schedule employee for medical evaluation with


Infectious Disease Physician, Inc. (IDP).

7.2.25 The Infection Control Officer shall contact the exposed employee to
ensure that the necessary documentation and forms are completed
and retained within the employee’s case history file.

7.3 Post Exposure Reporting and Procedures – Off-Duty (Out-of-


Metropolitan Area) Reporting

7.3.1 All occupational exposures (risk and non-risk events) to an


infectious disease occurring while off-duty and out of the
metropolitan reporting area shall be reported to a designated officer
or the Department’s Infection Control Officer immediately upon
completion of the emergency incident.

7.3.2 If the exposed off-duty employee sustains an exposure within


Fairfax County or the Baltimore-Washington metropolitan area, he
or she shall be responsible for notifying a designated officer
immediately upon conclusion of the incident. The off-duty
employee shall not wait until returning to duty to report the
exposure.

7.3.3 The exposed off-duty, out-of-area employee shall contact the UFO
at PSCC. The employee shall:

♦ Identify him or herself


♦ Inform the UFO that he or she sustained an infectious disease
exposure
♦ Provide a telephone number where a designated officer and/or
the Infection Control Officer can contact the employee.

The UFO shall immediately notify the duty designated officer that
an off-duty, out-of area employee has sustained an infectious
disease exposure and give the DO the employee-provided contact
telephone number.

The DO shall contact the off-duty exposed employee as soon as


possible.

7.3.4 The DO shall assist the employee by attempting to notify the


hospital where the source patient was transported and informing

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the infection control practitioner that an exposure has occurred to


an off-duty, out-of-area emergency responder.

7.3.5 The DO shall evaluate the information received from the exposed
member to determine if the exposure is a risk or non-risk event.
Additionally, the DO shall provide post-exposure counseling (if
necessary) to the exposed member to include, but not limited to,
information and education regarding the infectious disease
exposure, modes and rates of transmission, and safe-sex
counseling.

7.3.6 The exposed off-duty employee shall be responsible for following


the steps outlined in paragraphs 7.2.1 through 7.2.14 of this Plan
and for ensuring that all appropriate documentation is completed,
as outlined in 7.2.10.

7.3.7 If possible, the exposed off-duty employee shall obtain the following
information regarding the source patient:

♦ Source patient’s name, age, receiving hospital, and hospital ID


number.
♦ Type, nature, and duration of exposure.
♦ Suspected or known disease(s).
♦ Name of employees treating and transporting source patient.
♦ Transporting unit number.
♦ Phone numbers (receiving hospital, fire station, etc.).

7.3.8 If necessary, the Infection Control Officer shall notify the infectious
disease physician to assist with the procurement of source patient
infectivity information.

7.4 Post Exposure Prophylaxis (PEP) – Occupational Exposure to


Agents of Bioterrorism

7.4.1 The Safety and Personnel Services Division, in cooperation with


the Public Safety Occupational Health Center and the
Operational Medical Director, has a plan for the administration
of prophylactic medications in the event of an occupational
exposure to agents of bioterrorism (i.e. anthrax and/or a
radiation incident).

Specifically, several hundred doses of ciprofloxacin,


doxycycline, and potassium iodide tablets are available for
administration as post-exposure prophylaxis (PEP). These
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tablets will significantly reduce or eliminate the transmission of


toxins from exposure to anthrax and/or a radiation incident.

7.4.2 Distribution of the tablets – should an event occur – will be


coordinated with the Operational Medical Director, the PSOHC,
the Department’s Infectious Disease Physician, and the on-duty
Safety Officer. Response is available on a 24/7 basis to
personnel who have a confirmed occupational exposure to
anthrax and/or radiation event.

7.5 Exposure Incident − Animal Bite

7.5.1 Personnel arriving on a scene that may potentially place them at


risk for animal bites shall first ensure no immediate potential life
hazard exists.

7.5.2 Personnel should then exit the area, using caution, thus placing a
physical barrier between the animal and FRD personnel. Once all
personnel have safely exited, the following procedures shall be
observed:

1) Notify the Public Safety Communications Center (PSCC) to


assist with contacting Fairfax County Animal Control.

2) Await the arrival of Animal Control prior to entering area/areas


that may place them at risk for animal bites.

7.5.3 In the event an animal bite is sustained, the following procedures


shall be observed:

1) Thoroughly clean any wound sustained using soap and water.


In the event soap and water are not immediately available, a
waterless antimicrobial solution shall be used to cleanse the
wound. The wound should then be washed with soap and water
as soon as facilities are available.

2) Notify the Safety Officer and/or the Infection Control Officer


(ICO) of the incident prior to leaving the scene. PSCC can
assist with the appropriate notification.

a) The Safety Officer and/or Infection Control Officer will


contact the Fairfax County Health Department for additional
assistance and consultation.

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3) Provide Animal Control with the animal’s identity and location, if


known.

4) If the animal cannot be located and/or identified, the Safety


Officer and/or ICO shall immediately contact the Department’s
Contractual Infectious Disease Physician (CIDP).

7.5.4 If medically indicated, the CIDP will schedule the affected employee
for post-exposure evaluation, diagnostic testing, and post exposure
vaccine(s).

7.5.5 Employees who have sustained an animal bite shall complete an


“Infectious Disease Exposure Injury Report Package” (see
Attachment 7-7) and follow post-exposure management guidelines
outlined earlier in this chapter.

7.6 Exposure Incident − Ride-Alongs

7.6.1 A “ride-along” is defined as any individual(s) who is not a certified


FRD member (career or volunteer) and who wishes to participate in
emergency responses of fire and/or EMS apparatus. Ride-alongs
may be college students, personnel from other fire and rescue
departments, nurses, administrators, or any other individual
authorized to participate by the Department.

7.6.2 Applicants for the Ride-Along Program shall submit a written


request, including a brief explanation of the reason for the
requested ride-along and the benefits to be derived from the
experience. Requests for the Ride-Along Program must be
submitted at least five working days prior to the start date of the
ride-along (Reference S.O.P. 01.04.06).

7.6.3 Official approval of ride-along requests may be made by the Fire


Chief, the Assistant Chief of Operations, or a deputy chief. Upon
approval of the ride-along request, the participant shall receive a
copy of the Department-approved ride-along agreement. Unless
otherwise specified, ride-alongs shall be assigned to ride with a
Battalion Chief or an EMS supervisor as an observer only.

7.6.4 The Fire and Rescue Department’s Operations Division, EMS


Administration, shall ensure the ride-along(s) is current with
required Department-adopted immunizations and medical
screening (e.g. PPD test) prior to actively participating in
emergency medical services (EMS) responses.

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7.6.5 To receive approval for active participation, the ride-along shall


provide the EMS Administration the following
immunization/vaccination records:

1) Verification of current tuberculosis skin testing


2) A copy of his/her immunization record, signed by a physician, of
the following vaccinations:
a) Hepatitis B (HBV) three-dose series or evidence of an
adequate HBV titer (10IU/ml or greater)
b) If the ride-along refused the HBV series, he/she shall provide
a declination document
c) Tetanus
d) MMR (measles, mumps, and rubella)
e) Polio

7.6.6 In the event EMS Administration has concerns regarding the ride-
along’s immunization record(s) and/or PPD test, the Public Safety
Occupational Health Center medical staff should be consulted.

7.6.7 EMS Administration shall maintain strict confidentiality regarding


the ride-along’s medical information, in accordance with
Department policy.

7.6.8 Infectious Disease Exposure to Ride-Alongs:

7.6.8.1 The Unit Officer of the apparatus to which the ride-along


is assigned shall treat any ride-along exposure incident in
the same manner as FRD personnel exposures. Policies
and procedures outlined earlier in this chapter shall be
followed.

7.6.8.2 The Department’s Infection Control and Prevention


Officer (ICPO) shall establish contact with the ride-
along’s designated contact at his/her institution (college,
fire department, hospital, etc.). The ICPO shall ensure
the contact person receives all pertinent information and
copies of applicable exposure documents.

7.6.8.3 Confidentiality shall be maintained according to


Department policy.

7.6.8.4 The FRD shall assist the exposed ride-along in post-


exposure management requirements. Financial

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responsibility for serologic testing, diagnostic testing,


evaluation, and/or treatment of the source patient and/or
exposed ride-along shall be in accordance with the ride-
along’s sponsoring institution’s exposure policy.

7.7 Exposure Incidents − Public Sites Contaminated with Blood and/or


Body Fluids

7.7.1 FRD personnel frequently encounter blood and/or body fluids


contaminating or potentially contaminating public access due to
traumatic incidents such as motor vehicle accidents, shootings,
serious falls, etc.

7.7.2 Public access is defined as any area, including private areas,


where the general public may drive or move through (walk, run,
bicycle, etc.).

7.7.3 FRD personnel shall not leave a general public access incident
scene contaminated with blood and/or body fluids. FRD personnel
shall immediately notify the Safety Officer and/or the Infection
Control and Prevention Officer (ICPO) for consultation and
assistance prior to leaving the incident scene. PSCC can assist
with the appropriate notification.

7.7.4 FRD personnel on the scene shall ensure no immediate potential


life hazard exists. FRD personnel shall ensure personal safety
is not compromised.

7.7.5 FRD personnel shall take immediate actions to isolate


contaminated areas from further cross-contamination to other
personnel and to the general public. Isolation shall include:

1) Use of fire-line tape


2) Use of Department vehicles, physical barriers, and/or FRD
personnel to prohibit entry into the contaminated area(s).

7.7.6 FRD personnel shall attempt, if procedures can be done without


compromising personal safety, to control “run-off” of blood/body
fluids from contaminating other public areas.

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7.7.7 Follow-up procedures for public site(s) contamination:

7.7.7.1 Exposed or potentially exposed citizens shall be cared for


in accordance with “Good Samaritan” guidelines and
policies, as described in Chapter 4 of this Plan.

7.7.7.2 Minimal contamination clean-Up. For public access


streets, walkways, stairways, etc. minimally contaminated
with blood and/or body fluids, FRD personnel shall –
ensuring personal safety – attempt to clean the site(s)
with the appropriate absorbent. (Reference Chapter 4 of
this Plan for appropriate use and disposal guidelines.)

7.7.7.3 Public site decontamination and infectious waste disposal


shall be coordinated between the Incident Commander
(Unit Officer), Safety Officer, and Infection Control and
Prevention Officer.

7.7.7.4 FRD personnel conducting public site decontamination


shall ensure appropriate personal protective equipment
(PPE) is donned in accordance with Chapter 5 of this
Plan.

7.7.7.5 Gross contamination. If after consultation with the


Safety Officer and/or Infection Control and Prevention
Officer, the Incident Commander determines the site
poses a risk to personal safety, attempts shall be made
to hose down the contaminated site with water to dilute
the blood and/or body fluids. Washing blood and/or body
fluids down the public sewer system is allowed and
preferred.

7.7.7.6 Appropriate PPE shall be donned prior to beginning any


clean-up efforts.

7.7.7.7 FRD personnel shall ensure actions are taken to prevent


cross-contamination with FRD apparatus, equipment,
private vehicles, other public and private property, etc.

7.7.7.8 If necessary, the Incident Commander (Unit Officer),


Safety Officer, or Infection Control and Prevention Officer
shall, via the PSCC, dispatch the Hazardous Materials
Unit to assist with provision of additional personal

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protective equipment, decontamination, and/or disposal


of infectious waste.

7.7.7.9 Exposed or potentially exposed FRD personnel shall


ensure the appropriate exposure reports are completed
and forwarded in accordance with procedures detailed
earlier in this chapter (see Attachment 7-7).

7.8 Exposure Incident – Requests from Other Public Safety Agencies

7.8.1 The FRD occasionally receives requests to assist other public


safety agencies with (1) clean-up/disposal of blood and/or
remnant tissues and (2) transport of deceased persons.

7.8.1.1 The management of remnant soft tissue and bone


fragments remains – at all times – a law enforcement
and/or medical examiner responsibility. FRD personnel
shall not engage in the collection, removal, or
transportation of remnant soft tissue and bone fragments.

7.8.1.2 The management of body fluids, while a law enforcement


and/or medical examiner responsibility, is an area where
the Fire and Rescue Department will assist by providing
roadway/area wash down services following the
collection of remnant soft tissue and bone fragments by
other agencies or vendors.

7.8.1.3 Upon receiving a request for wash down services, the


Public Safety Communications Center (PSCC) shall
dispatch the nearest available engine company in a
Priority 2 fashion. A rescue company, equipped with a
pump and booster tank, may be substituted for a more
distant engine company.

7.8.1.4 The ranking FRD officer shall consult with the ranking law
enforcement official prior to beginning wash down
services.

7.8.2 Transport of deceased persons. The removal of deceased


bodies is a law enforcement and/or medical examiner responsibility.
This activity is typically managed through the use of a private
vendor. Occasionally, the FRD may be requested by law
enforcement to assist in the transportation of deceased persons.
Such requests shall be managed in accordance with the FRD EMS

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Manual Administrative Protocol 3.1.8, "Transportation of Deceased


Bodies (Code Four)."

7.9 Exposure Incident − In Station Events

7.9.1 Fire stations serve as “home base” for on-duty personnel and, as
such, are subject to the same “in home” accidents as personal
residences. Slips, trips, and falls that occur may result in open
(bleeding) wounds. Illness may produce nausea (vomiting) events.
Such incidents should be viewed as “potentially infectious” and
handled accordingly.

7.9.2 In the event of a blood spill, the following procedures should be


observed:

1) Immediately notify the shift supervisor or Safety Officer.

2) Cordon off the contaminated area and minimize the number of


personnel in this area.

3) Don appropriate personal protective equipment (gloves, apron,


eye protection, etc.).

4) If blood is on a porous (tile/linoleum) surface, wipe excess blood


off surface using absorbent paper towels. Clean surface
thoroughly using a water/bleach solution. Ensure that all traces
of blood have been cleared. Dry area using absorbent paper
towels.

5) If blood is on a non-porous surface (rug, carpet), blot as much of


the excess blood as possible using absorbent paper towels.
Scrub soiled areas using an appropriate disinfectant cleanser.
Blot excess moisture using absorbent paper towels.

6) Limit or deny access to area until the shift supervisor, Safety


Officer, or Infection Control Officer has determined it is safe for
use.

7) Dispose of waste using guidelines presented in this Chapter.

8) If necessary, ensure the appropriate exposure reports are


completed and forwarded in accordance with procedures
detailed earlier in this chapter (see Attachment 7-7).

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7.9.3 In the event of vomit spills, the same procedures and precautions
shall be observed.

7.10 Medical Surveillance

7.10.1 All post-exposure evaluations, procedures, vaccinations, and


management shall be provided according to the recommendations
established by the Centers for Disease Control and Prevention
(CDC) and the Occupational Safety and Health Administration
(OSHA).

7.10.2 Employees shall receive annual medical examinations and


evaluations at the Public Safety Occupational Health Center
(PSOHC).

In addition, the infectious disease physician (IDP) shall provide


post-exposure evaluations, when medically indicated.

7.10.3 An employee diagnosed with a communicable disease shall consult


with the IDP and the PSOHC physician for the determination of his
or her work status.

7.10.4 All personal medical information pertaining to a communicable


disease is confidential.

7.10.4.1 All reports, records, and the physician’s written opinion


pertaining to the employee’s evaluation and diagnosis
shall be maintained in the employee’s medical health file
located in the PSOHC.

7.10.4.2 In accordance with federal and state regulations, the


Department shall maintain health and exposure records
for all Department personnel for the term of employment
plus thirty (30) year.

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ATTACHMENT 7-1
FAIRFAX COUNTY FIRE AND RESCUE DEPARTMENT
DESIGNATED OFFICER’S RESOURCE MATERIAL

IMMEDIATE POST-EXPOSURE INFORMATION GUIDELINES

BLOOD OR BODY FLUID EXPOSURE ISSUES

There are three (3) main viral pathogens that create concern in the event
of a bloodborne and/or body fluid exposure. These are human
immunodecificiency virus (HIV), Hepatitis B (HBV), and Hepatitis C (HCV).

The following information on these three viral pathogens may be used as


guidelines:

Human Immunodeficiency Virus (HIV)6

1) The HIV prevalence in the population is approximately 0.5 percent, or


1 in 200.
2) The prevailing risk of penetrating needlestick injury resulting in
transmission from a known source-positive individual is less than 0.4
percent or 1 in 300.
3) Risk of infection from mucous membrane contact from bloody fluids is
estimated to be below 1 in 1000.
4) Prevention strategies in the form of vaccine are not available
5) Treatment strategies in the form of post-exposure prophylaxis (PEP)
can include two or three-drug therapy and should be instituted within
hours of the exposure if at all possible.
6) Data indicate PEP will reduce the transmissible risk of HIV in high risk
events by a significant margin.

Exposure to non-bloody body fluids does not constitute a significant risk to


HIV, but should be evaluated on a case-by-case basis.

Hepatitis B (HBV)

1) The prevalence of hepatitis B in the community is greater than HIV and


has been documented to be several per thousand population.

6
See Attachment 7-2 for information regarding Single Use Diagnostic Systems (SUDS)

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2) The likelihood of transmission of hepatitis B from blood or body fluids is


exceedingly high unless the exposed Fire and Rescue member is
immune by virtue of prior natural infection or (more likely) prior
vaccination.
3) The risk of a penetrating needlestick injury is essentially equivalent to a
mucous membrane exposure and is in the range of 20 to 40 percent
for the non-immune employee.
4) Prevention is available in the form of hepatitis B vaccine/booster
dosing and active treatment is present in the form of hepatitis B
immunoglobulin, which can be given in the post-exposure setting.

Hepatitis C (HCV)

1) Hepatitis C is the most prevalent of the three primary transmissible


pathogens in the occupational setting.
2) Approximately one percent of the U.S. population is HCV infected.
3) The needlestick risk is in the range of several percent, placing it at a
lower level of risk than hepatitis B, but a higher level of risk than HIV.
4) There is no preventive vaccine available and no effective post-
exposure prophylaxis (PEP) that can be instituted.
5) Specific issues regarding counseling are on a case-by-case basis.

AIRBORNE EXPOSURE(S)

There are three (3) main pathogens of concern with regard to airborne
transmissible agents in the occupational setting. These are chickenpox
(varicella zoster), Neisseria meningitides, and myobacterium tuberculosis.

Chickenpox (varicella zoster)

The varicella zoster virus (VZV) is virtually 100 percent transmissible for
the non-immune individual. Thus, a history of chickenpox in the past is
strong evidence that the individual is immune/protected. There are,
however, exceptions to this, which should be discussed on a case-by-case
basis.

Neisseria Meningitides

While the risk of secondary transmission of Neisseria meningitides is


documented to be a low-frequency event (one in several thousand), the
rapid and severe/potentially life-threatening nature of this infection
warrants prompt post-exposure prophylaxis in the event of exposure
contact. Specifically, being within one meter of an infected individual

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and/or frank contact with infected secretions constitute the highest risk
possibility.

Post-exposure prophylaxis is available in the form of a single dose of


antibiotic therapy in most instances. Decisions regarding the
implementation of PEP will be done on a case-by-case basis.

Mycobacterium Tuberculosis

The risk of acquiring tuberculosis (TB) when exposed to a patient with


active pulmonary TB is based upon several factors. First, if the source
individual is actively on therapy, this may decrease the risk by a significant
margin. However, caution must be added since the duration of treatment
plays a large role in the likelihood of infectivity of a given person.
Moreover, the level of infection present in the source patient at the
initiation of treatment and/or present in the person without active
antituberculous treatment will predict infection in general terms. Thus, the
more severe the case of pulmonary tuberculosis in the source patient
(cavitary lesions, frank abscess), the more likely a transmission to fire and
rescue personnel who are administering to the patient during evaluation
and transport.

The use of protective (N95) respirators is highly desirable. However,


exposures do occur and warrant strict adherence to a routine PPD skin
testing program. The PPD skin testing program has been successfully
implemented by the Fairfax County Fire and Rescue Department.

NOTE

The information provided in this attachment is to be used as a guide to


assist the Designated Officer(s) in providing useful information to
exposed or potentially exposed emergency responder employees and/or
Good Samaritans in the immediate post-exposure setting.

More detailed information will be provided to the individual at the time of


the confidential exposure evaluation with Infectious Disease Physicians,
Inc. (IDP)

Please call IDP, Inc. at (703) 560-7900 if you have medical questions.
Non-medical (procedural, etc.) questions should be directed to the
Infection Control Officer (ICO).

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ATTACHMENT 7-2

OCCUPATIONAL EXPOSURE
SINGLE-USE DIAGNOSTIC SYSTEM (SUDS)
RAPID HIV-TEST

The SUDS Test is a rapid result test that can be conducted on the source
patient’s blood from whom Department personnel sustained a known
bloodborne risk event such as:

1) Contaminated needlestick or percutaneous injuries involving


blood/body fluids,

2) Mucous membrane exposure to the eyes(s), nose, or mouth,

3) Exposure to non-intact (broken) or open skin.

The turn-around time for SUDS testing is normally one hour after an
individual receives a source patient’s blood. The accuracy of SUDS
testing is 99.9 − 100 percent for sensitivity, and 98.4 − 100 percent for
specificity when compared to the Western Blot for HIV testing.

Negative SUDS Test results are final and further testing is not required.

Positive SUDS Test results require confirmation by the Western Blot and
may require that the exposed member take antiviral chemoprophylaxis
(medication) as recommended by the Centers for Disease Control and
Prevention (CDC).

SUDS is used only to test the source patient’s blood for HIV-1 results and
to test exposed employees’ blood if medically indicated by the contractual
infectious disease physician (CIDP). The SUDS Test cannot be used for
hepatitis-B or hepatitis-C testing.

When FRD personnel sustain a risk event to a bloodborne pathogen, the


following procedures shall be performed:

Responsibility of Exposed Personnel

1) Immediately cleanse and irrigate the exposed site(s).

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2) Notify a Designated Officer (DO) and provide the following information


to avoid delay of the SUDS Test:

a) Type of bloodborne exposure (e.g. contaminated needlestick to the


left index finger; blood/body fluid splashed in both eyes; etc.)
b) Name, age, and gender of source patient involved
c) The hospital to which the source patient was transported

3) Wait for further direction from the DO regarding when and where to
report.

Exposed personnel shall be relieved of duty after consulting with the CIDP.
Exposed personnel shall notify the unit Officer in Charge (OIC) that an
occupational exposure has occurred. The OIC shall not solicit any specific
information regarding the exposure.

Responsibility of the Designated Officer (DO)

1) Immediately notify the Contractual Infectious Disease Physician (CIDP)


and/or emergency room attending physician at the medical facility where the
source patient was transported that an occupational risk event exposure to a
bloodborne pathogen has been sustained by Department personnel. The
source patient’s blood should be drawn and tested, and the SUDS Test
performed immediately.

2) If requested, pick up the source patient’s blood at a medical facility that does
not perform the SUDS Test and transport it to one that does. The
responsibility and guidance of transporting source patient’s blood from one
facility to another shall be coordinated only with the CIDP.

3) Request information form the CIDP regarding when and where exposed
personnel should go, if medically indicated, for post-exposure follow-up,
counseling, diagnostic testing, and chemoprophylaxis. Exposed personnel
should be contacted with this information and transportation provided if
necessary.

4) Assist with the purchase of the medications (if prescribed by the CIDP) for
exposed personnel by authorizing the use of the Department credit card.

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ATTACHMENT 7-3
FAIRFAX COUNTY FIRE AND RESCUE DEPARTMENT
DESIGNATED OFFICER’S RESOURCE MATERIAL

BLOODBORNE PATHOGEN EXPOSURES


COUNSELING GUIDELINES

1. Emergency response employees (ERE’s) who have been exposed or


potentially exposed to bloodborne pathogens will be advised by the
Designated Officer (DO) to refrain from any “unprotected” body fluid
exchange with family members, coworkers, or other individuals until
source patient blood results are known.

2. The DO will advise the exposed or potentially exposed ERE to use


protection (i.e. condom) when engaging in acts of sexual intimacy until
source patient results are known.

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ATTACHMENT 7-4

FAIRFAX COUNTY FIRE AND RESCUE DEPARTMENT


EMERGENCY DEPARTMENT CONTACT INFORMATION
(As of December 2004)

FACILITY TELEPHONE

ACCESS of Fairfax (703) 591-9329

ACCESS of Reston (703) 668-8327

Alexandria Hospital (703) 751-7878

Arlington Hospital (703) 522-4679

Dewitt Army Hospital (703) 805-0414

(703) 876-0522 or
Fairfax Hospital (703) 776-2925

Fair Oaks Hospital (703) 391-0767

Loudoun Health Care (703) 858-6040

Mount Vernon (703) 360-9199


Hospital
(703) 670-1363 or
Potomac Hospital (703) 670-3009

Prince William
Hospital (703) 369-7511

Reston Hospital (703) 796-6812


(703) 671-7666 or
Vencor Hospital (703) 578-2080

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ATTACHMENT 7-5

FAIRFAX COUNTY FIRE AND RESCUE DEPARTMENT


INFECTION CONTROL DESIGNATED OFFICERS

(As of December 2004)

DO LOCATION OFFICE = O/CELL = C


PAGER = P

(703) 246-3965 (O)


(571) 722-8670 (C)
Infection Control (703) 705-6512 (P)
Captain Craig Summers and Protection (703) 246-2339 (Fax)
Officer
Captain John Niemiec Safety/Personnel (571) 221-1069 (C)
Services (703) 246-3851 (O)
(703) 365-5078 (C)

BFC Danny Gray EMS (703) 246-3995 (O)


Administrative (703) 378-5936 FS15
Services (703) 366-4301 (P)
(571) 238-8293 (C)

The on Duty Safety Officer (SAFO) is always the first


point of contact for infectious disease exposures. The
SAFO can be contacted through the PSCC. If the SAFO
is unavailable, the department Infection Control Officer
is the next point of contact.

ACHMENT 7-6

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INFECTION CONTROL PRACTITIONERS

(As of December 2004)


T=TELEPHONE;
FACILITY POINT OF F=FAX
CONTACT
Inova Emergency Care of (703) 934-5076 (F)
Fairfax Chris Russe (703) 591-9322 (T)

Inova Emergency Care of (703) 668-8333 (T)


Reston Mitzi Minehart (703) 478-2778 (F)
Martha Harris (703) 504-3297 (T)
Alexandria Hospital Kathleen Bury (703) 504-7826 (F)
(703) 558-6353 (T)
Arlington Hospital Karen Torres (703) 558-5717 (F)
Commonwealth Care (703) 934-5038 (T)
Center Sarah Stuart (703) 934-5083 (F)
(703) 391-3397 (T)
Fair Oaks Hospital Jane Lane (703) 391-3699 (F)
Judy Hathaway (703) 776-3071 (T)
Anne Patullo (703) 776-4126 (F)
Fairfax Hospital Fran Vasaly
(703) 273-7705 (T)
Fairfax Nursing Center Bridgette O’Neill (703) 273-0366 (F)
Infectious Disease (703) 560-7900 (T)
Physician, Inc. Dr. Allan Morrison, Jr. (703) 560-8408 (F)
Loudoun Hospital Linda Belmonte (703) 858-6630 (T)
Cecile Allen (703) 858-6000 (T)
(703) 664-7199 (T)
Mt. Vernon Hospital Linda Brown (703) 664-7183 (F)
Northern Virginia (703) 578-2104 (T)
Community Center Denise Skaggs (703) 578-2134 (F)
HealthPlex Jo-Lynn Aponte (703) 797-6861 (T)
Melonie Brescia (703) 797-6814 (T)
(703) 580-8535 (F)

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Potomac Hospital Suzanne Davis (703) 670-1247 (T)


T=TELEPHONE;
FACILITY POINT OF F=FAX; P=PAGER
CONTACT
(703) 369-8349 (T)
Prince William Hospital Susan Arbogast (703) 369-8071 (F)
(703) 331-7361 (P)
(703) 689-9077 (T)
Reston Hospital Center Pat Nelson (703) 689-9182 (F)
(202) 537-4265 (T)
Sibley Hospital Bernie Freedman (202) 364-7654 (F)

Washington Hospital Nancy Donegan (202) 877-7636 (T)


Center Karen Myeson (202) 877-6781 (T)

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ATTACHMENT 7-7

COMPLETING AN INFECTIOUS DISEASE EXPOSURE


INJURY REPORT PACKAGE

1. The designated officer (DO) or Infection Control Officer (ICO) shall


direct career or civilian personnel who sustained a risk-event
exposure to complete a Personal Injury Report Package that includes:

¾ Employer’s First Report of Accident (employee completes).


¾ Employee Notice of Job-Related Injury/Illness (employee
completes).
¾ Medical Status Report (physician completes).
¾ Secondary Employment Data Sheet (employee completes).
¾ Request for a Second Opinion or a Change of Physician (employee
completes).

2. The DO or the ICO shall direct the volunteer employee who has
sustained a risk-event exposure to complete:

¾ Accident/Sickness Claim Report (volunteer employee completes).


¾ Attending Physician’s Statement (physician completes).

3. The exposed employee is responsible for submitting the Personal


Injury Report Package to the DO or to the ICO.

4. Employees shall be responsible for forwarding any exposure-related


medical bills or statements to the ICO in the Occupational Health and
Safety Division (OHSD).

5. Exposed employees shall be responsible for ensuring that the treating


physician completes a Medical Status Report or an Attending
Physician’s Statement for each visit. This document shall be either
faxed or submitted to the OHSD immediately following each visit with
the infectious disease physician.

6. The OHSD shall be responsible for submitting the injury claim to the
Risk Management Division (RMD).

7. The ICO shall be responsible for submitting the completed Attending


Physician’s Statement and Accident/Sickness Claim Report to the
current volunteer insurance carrier.

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ATTACHMENT 7-8

OCCUPATIONAL EXPOSURE TO INFECTIOUS DISEASE(S)


PERSONAL INJURY REPORT PACKAGE
FORMS REQUIRED7

♦ Personnel Injury Report Package:

• Employer’s First Report of Accident


ƒ Tan colored original

• Employee Notice of Job-Related Injury/Illness Risk (Risk 01)

• Medical Status Report

• Supervisor’s Personnel Injury Investigative Report (SUP-INV.FRM)

• Narrative Statement (FRD-317)

• Secondary Employment Data Sheet (Risk 06)

• Authorization for Medical Information (MEDINFO.FRM)

• Fairfax County Government Therapy Report


ƒ If applicable

• Request for a Second Opinion or a Change of Physician (Risk 02)

♦ Infectious Disease Exposure Report (FRD-314)

♦ Medical Expense Reimbursement

♦ Accident/Sickness Claim Report (VFIS)

♦ Attending Physician’s Statement (VFIS)

7
Current forms are located on the Department’s Intranet and Risk Management’s Infoweb.

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CHAPTER 8.
RECORD KEEPING

8.1 Medical Records.

8.1.1 The Fairfax County Fire and Rescue Department will:

8.1.1.1 Maintain all exposure and medical records for each member for
the duration of employment plus thirty (30) years. These
records will be maintained by the Public Safety Occupational
Health Center (PSOHC) and shall include:

1) Member’s name and social security number.

2) A copy of the member’s hepatitis B vaccination status


including the dates of all the hepatitis B vaccinations, lab
results related to hepatitis B testing performed to verify
antibody status, and any medical records relative to the
member’s ability to receive vaccination. If the member
declines vaccination, a copy of the signed declination
statement will be included.

8.1.1.2 Assure that all members’ medical records are kept confidential
and are not disclosed or reported to any person within or
outside the Department without the member’s express written
consent, except as required by law.

8.1.1.3 Assign the Public Safety Occupational Health Center as the


responsible office for all health and safety-related records.

8.1.1.4 Follow standard medical practice when transferring any medical


record outside the PSOHC.

8.1.1.5 Review all records annually to monitor compliance.

8.1.1.6 Provide members with a copy of their medical records within


fifteen (15) days of a written request. Such requests shall be
made to the Public Safety Occupational Health Center.

8.1.2 A summary of all reported exposure incidents (“risk“ and “non-risk events”)
is maintained in the member’s Department medical record housed at the
PSOHC and the Contractual Infectious Disease Physician (CIDP)
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exposure file, housed at his/her facility. As required by law, the CIDP shall
maintain copies of the physician’s written opinion of exposed FRD
personnel.

8.1.3 A complete exposure incident report file is maintained separately by the


Department’s Infection Control Officer (ICO). Member’s wishing to review
these files must submit their request in writing to the Infection Control
Officer, and may expect a reply within 15 days of receipt of the request.

8.1.4 All files are confidential and are maintained in compliance with Federal,
State and Department regulations.

8.2 Training Records.

8.2.1 Training records shall be maintained by the Fairfax County Fire and
Rescue Department (FRD) for all members (career and volunteer) for a
period of three (3) years from the date on which the training occurred.

8.2.2 Training records shall include:

1) The dates and duration of the training sessions.

2) A contents list or content summary of the training sessions.

3) The name, rank, and qualifications of person(s) conducting the


training.

4) The names and social security numbers of all persons (career,


volunteer, and/or civilian) attending the training sessions.

8.2.3 Training records are confidential and are housed at the FRD Academy.
Personnel wishing to obtain a copy of his/her training record shall submit
this request in writing to the Academy. The Academy will respond to such
requests within fifteen (15) days.

8.3 If the Fairfax County Fire and Rescue Department (FRD) should cease to do
business, it shall notify the Director of the Virginia Occupational Safety and
Health Administration (VOSHA) office at least three (3) months prior to the end of
business. The Director may require that all records be transferred to him/her
before the end of the three-month period.

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