Effective Date: 01-Feb Table of Contents

Transcription

1 Versin: 13 Page: 1 f 25 Table f Cntents 1.0 Intrductin Purpse Scpe Definitins Respnsibilities... 5 Management... 5 Principle Investigatrs (PIs)/Supervisrs... 6 Persnnel... 6 Emry University Envirnmental, Health and Safety Office (EHSO)... 7 Bisafety Officer (BSO), Directr f EHSO and Research Health and Safety Cmmittee (RHSC)... 7 Emplyee Health Services (EHS)/Occupatinal Injury Management (OIM) Training Requirements Recrdkeeping Requirements Prgram Evaluatin Expsure Determinatin Expsure Categry A Expsure Categry B Tasks and Prcedures Standard Wrk Practices OPIM General Guidance Engineering Cntrls and Wrk Practices Hand Washing Facilities Sharps Needles and Syringes Sharps Cntainers Reusable Cntainers Cntainers fr Specimens f Bld r OPIM Autclaves Bilgical Safety Cabinets Ducted Exhaust Air Ventilatin System Administrative Cntrls and Wrk Practices Signs and Labels Cmmunicatin f Hazards t Persnnel Husekeeping Persnal Prtective Equipment (PPE) Glves Prtective Clthing Masks, Eye Prtectin, Face Shields and Respiratrs Decntaminatin Vacuum Lines Regulated Medical Waste Dispsal Including Sharps Cntainer Dispsal... 19

2 Versin: 13 Page: 2 f Laundry Human Cell Cultures Emergency and Medical Prcedures Emergency Prcedures Spills Reprting f Expsures, Injuries and Illnesses Health Surveillance HBV Vaccine Sharps Injury Lg Pst-Expsure Examinatin and Fllw-Up References... 25

3 Versin: 13 Page: 3 f Intrductin 1.1 Purpse This dcument serves as a brad-based expsure cntrl plan fr all Emry University persnnel, whse ccupatinal tasks r respnsibilities include reasnable anticipated risk f expsure t human bld r ther ptentially infectius materials (OPIM) f human rigin, including ccupatins with nn-rutine expsure. This dcument will hereafter be referred t as the Bldbrne Pathgen Expsure Cntrl Plan (ECP) and cmplies with the Occupatinal Safety and Health Administratin (OSHA) Occupatinal Expsure t Bldbrne Pathgens Standard (29 CFR ), which was first published in 1991 because f significant health risks assciated with expsure t viruses and ther micrrganisms that cause bldbrne diseases. Per the OSHA Bldbrne Pathgen Standard, the rganisms f primary cncern are the human immundeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). The intent f these rules is t reduce r eliminate ccupatinal expsure t ptentially infectius bldbrne pathgens. Fundamental t the cntrl f ccupatinal expsure is a set f rules and practices cllectively defined as Universal Precautins. Under the Universal Precautins cncept, all human bld, bld prducts and OPIM are cnsidered t be cntaminated with bldbrne pathgens. In additin t Universal Precautins, the regulatin mandates specific emplyer actins that must be taken t minimize ccupatinal expsure t bldbrne pathgens. These actins include: Written ECP (presented as this dcument) Emplyee expsure determinatin Guidance and infrmatin regarding safer sharps technlgy HBV vaccinatin prgram Medical plicies Training prgram 1.2 Scpe This BBP-ECP applies t Emry University emplyees, including faculty, staff, student emplyees, cntractrs, and ther peple wh have a ptential fr ccupatinal expsure t bld r OPIM as defined in Sectin 1.3 Definitins. 1.3 Definitins Bilgically hazardus cnditins. Equipment, cntainers, rms, materials, experimental animals infected with HBV r HIV r cmbinatins theref that cntain, r are cntaminated with bld r ther ptentially infectius material. Bld. Human bld, human bld cmpnents, and prducts made frm human bld. Bldbrne pathgens. Human bld, human bld cmpnents, and prducts made frm human bld. Cntaminated. The presence, r the reasnably anticipated presence, f bld r

4 Versin: 13 Page: 4 f 25 OPIM n an item r surface. Cntaminated laundry. Laundry that has been siled with bld r OPIM (may cntain sharps). Cntaminated sharps. Any cntaminated bject that can penetrate the skin, including needles, scalpels, brken glass, brken capillary tubes and Pasteur pipettes, expsed ends f dental wires. Decntaminatin. The use f physical r chemical means t remve, inactivate, r destry bldbrne pathgens n a surface r item t the pint where they are n lnger capable f transmitting infectius particles and the surface r item is rendered safe fr handling, use r dispsal. Disinfect. T inactivate virtually all recgnized pathgenic micrrganisms, but nt necessarily all micrbial frms n inanimate bjects. Engineering cntrls. Cntrls (e.g. sharps dispsal cntainers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury prtectins and needle less systems) that islate r remve the bldbrne pathgens hazard frm the wrkplace. Expsure incident. A specific eye, muth, ther mucus membrane, nn-intact skin, r parenteral cntact with bld r ther ptentially infectius material that results frm the perfrmance f a persnnel's duties. Handwashing facilities. Facilities that prvide an adequate supply f running, ptable water, sap and single-use twels r a ht air drying machine. Needleless systems. A device that des nt use needles fr the cllectin f bdily fluids r withdrawal f bdy fluids after initial venus r arterial access is established; the administratin f medicatin r fluids; r any ther prcedure invlving the ptential fr ccupatinal expsure t bldbrne pathgens due t percutaneus injuries frm cntaminated sharps. Occupatinal expsure. Reasnably anticipated skin, eye, mucus membrane, r parenteral cntact with bld r ther ptentially infectius materials that may result frm the perfrmance f persnnel s duties. This definitin excludes incidental expsures that may take place n the jb, and that are neither reasnably nr rutinely expected and that the wrker is nt expected t incur in the nrmal curse f emplyment. Other ptentially infectius materials (OPIM). Any f the fllwing: semen, vaginal secretins, amnitic fluid, cerebrspinal fluid, peritneal fluid, pleural fluid, pericardial fluid, synvial fluid, and saliva in dental prcedures; any bdy fluid that is visibly cntaminated with bld; all bdy fluids in situatins where it is difficult r impssible t differentiate between bdy fluids; any unfixed tissue r rgan, ther than intact skin, frm a living r dead human; cell r tissue cultures that cntain HIV, rgan cultures, and culture medium r ther slutins that cntain HIV, HBV, r HCV; bld, rgans r

5 Versin: 13 Page: 5 f 25 ther tissues frm experimental animals infected with HIV, HBV, HCV r ther bldbrne pathgen. Parenteral. Expsure ccurring as a result f piercing mucus membrane r the skin barrier, such as expsure thrugh subcutaneus, intramuscular, intravenus, r arterial rutes resulting frm needle sticks, human bites, cuts and abrasins. Persnal prtective equipment (PPE). Specialized clthing r equipment that is wrn by persnnel t prtect him r her frm a hazard. General wrk clthes, such as unifrms, pants, shirts, r bluses are nt intended t functin as prtectin against a hazard and are nt cnsidered t be PPE. Regulated waste. Any f the fllwing: liquid r semi-liquid bld r OPIM; cntaminated items that wuld release bld r ther ptentially infectius material in a liquid r semi-liquid state if cmpressed; Items which are caked with dried bld r ther ptentially infectius material and which are capable f releasing these materials during handling; cntaminated sharps; pathlgical and micrbilgical waste that cntains bld r OPIM. Research labratry. A labratry that prduces r uses research labratry-scale amunts f HIV, HCV r HBV. A research labratry may prduce high cncentratins f HIV, HCV r HBV, but nt in the vlume fund in a prductin facility. Standard micrbial practices. Prcedures cmparable t thse utlined in the current editin f the Bisafety in Micrbilgical and Bimedical Labratries. Standard perating prcedures (SOPs). Any f the fllwing, which address the perfrmance f wrk activities s as t reduce the risk f expsure t bld and OPIM: written plicies, written prcedures, written directives, written standards f practice, written prtcls, written systems f practice, elements f an infectin cntrl prgram. Sterilize. The use f a physical r chemical prcedure t destry all micrbial life, including highly resistant bacteria spres and mld spres, and the inactivatin f viruses. Universal precautins. A methd f infectin cntrl that treats all human bld and OPIM as capable f transmitting HIV, HBV, HCV and ther bldbrne pathgens. Wrk practices. Cntrls that reduce the likelihd f expsure t bldbrne pathgens by altering the manner in which a task is perfrmed. 1.4 Respnsibilities Emry University and all persnnel have a jint respnsibility t be well infrmed regarding the hazards assciated with bldbrne pathgens. Delineatin f these respnsibilities is described belw. Management Senir management supprts this ECP as well as all safety prgrams by prviding facilities, prper equipment, persnal prtective equipment (PPE) and versight.

6 Versin: 13 Page: 6 f 25 Principle Investigatrs (PIs)/Supervisrs PIs/supervisrs are respnsible fr their labratry s cmpliance with the ECP and are respnsible fr: Establishing and maintaining an accurate recrd fr each emplyee with ccupatinal expsure Ensuring that all persnnel are infrmed f the hazards assciated with the wrk perfrmed. Identifying and infrming persnnel n prper cntrl measures, including available vaccinatins/immunizatins, safe wrk practices, standard perating prcedures specific t the labratry and use f engineering cntrls and PPE. NOTE: Where the scpe f hazards is nt adequately addressed by this dcument, hazard specific SOPs will be develped. Limiting access t wrk areas where ptential bihazards are present until training and entry requirements are met Ensuring that persnnel under their directin are prperly trained and have a means t determine when an emplyee demnstrates prficiency. Enfrcing all safety rules and plicies. The ECP will be readily available t all persnnel thrugh their Supervisr r the Envirnmental Health and Safety Office (EHSO) website. Persnnel All persnnel wrking with bldbrne pathgens must accept a shared respnsibility fr perating in a safe manner. Persnnel shall nt engage in wrk fr which they are nt trained. Persnnel shall reprt t their supervisr, management, r EHSO, ptentially unsafe wrk cnditins r practices. Persnnel are als respnsible fr: Knwing which tasks have a ptential ccupatinal expsure t bldbrne pathgens. Fllwing guidance prvided in the ECP. Fllwing Universal Precautins and standard micrbial practices; Planning and cnducting all peratins in accrdance with expsure cntrl prcedures and specific unit (departmental r labratry) safety prcedures. Cmpleting the apprpriate Bldbrne Pathgens Training mdule (initial and annual retraining) depending n jb functins (ex: researchers r nnresearchers). Reprting hazardus cnditins t the PI/supervisr/EHSO. Reprting jb-related injuries r illnesses t the PI, supervisr, and EHSO and seeking medical treatment immediately. See instructins n hw t reprt accidents and injuries at Requesting infrmatin and training when unsure hw t wrk with bldbrne pathgens. Wearing and prperly maintaining the PPE necessary t perfrm each task t which he/she is assigned. Using engineering cntrls, including safe sharps technlgy and safety equipment prperly.

7 Versin: 13 Page: 7 f 25 Emry University Envirnmental, Health and Safety Office (EHSO) EHSO is respnsible fr verseeing cmpliance with the OSHA Bldbrne Pathgens Standard and the ECP required therein and will develp the prvisins f the ECP. Bisafety Officer (BSO), Directr f EHSO and Research Health and Safety Cmmittee (RHSC) The BSO, the Directr f EHSO and the RHSC will wrk with management t assign areas f respnsibility t departments, principal investigatrs, labratry supervisrs and ther individuals as necessary, t implement and carry ut the prvisins f the ECP. Emplyee Health Services (EHS)/Occupatinal Injury Management (OIM) EHS shall be respnsible fr managing the HBV Vaccinatin Prgram. OIM will be respnsible fr prviding apprpriate treatment and cunsel if persnnel is expsed t bldbrne pathgens and will maintain the sharps injury lg. 1.5 Training Requirements All persnnel in Categry A wh have the ptential fr expsure t bldbrne pathgens shall participate in the Bldbrne Pathgen Training Prgram (this includes HIV and HBV training as referenced in 29 CFR (g) (2) (ix)). Training will be prvided at the time f initial assignment and at least annually thereafter. Annual training fr all emplyees must be cmpleted within ne year f their previus training The PI must assure that emplyees have prir experience wrking with human pathgens r tissue cultures befre wrking with HIV r HBV. Additinally, PI specific training is required fr persnnel in HIV and HBV research labratries. This training must prvide assurance that persnnel are prficient in lab practices and peratins befre being allwed t wrk with HIV r HBV. The emplyee must nt participate in wrk invlving infectius agents until prficiency is demnstrated. A training prgram must be prvided t emplyees wh have n prir experience in handling human pathgens. Initial wrk activities must nt include the handling f infectius agents. A prgressin f wrk activities must be assigned as techniques are learned and prficiency is develped. The emplyer must assure that emplyees participate in wrk activities invlving infectius agents nly after prficiency has been demnstrated. Additinal training is prvided when changes such as the mdificatin f tasks r prcedures affect the persnnel's ccupatinal expsure. The additinal training may be limited t addressing nly the new expsures created. Training cntent will be presented t all persnnel in Categry A as t accmmdate all levels f educatin and literacy. Training Tpics Tpics cvered in the training prgram include: The OSHA Bldbrne Pathgens Standard. The epidemilgy and symptms f bldbrne diseases. The mdes f transmissin f bldbrne pathgens. The ECP. Apprpriate methds fr recgnizing tasks and ther activities that may invlve expsure t bld and OPIM.

8 Versin: 13 Page: 8 f 25 A review f the use and limitatins f methds that will prevent r reduce expsure, including: engineering cntrls, administrative cntrls, safe sharps technlgy wrk practice cntrls, PPE, and universal precautins. Selectin and use f PPE, including: types available, prper use, lcatin, remval, handling, decntaminatin, dispsal. Visual warning f bihazards including: labels, signs, and clr-cded cntainers. The prper prcedures and materials invlved in the cleanup f spills f ptentially infectius materials. Infrmatin n the HBV vaccine, including: its efficacy, its safety, methd f administratin, benefits f vaccinatin, and Emry s Vaccinatin Prgram. Actins t take and persns t cntact in an emergency invlving bld r OPIM. The prcedures t fllw if an expsure incident ccurs, including incident reprting. Infrmatin n the pst-expsure evaluatin and fllw-up, including medical cnsultatin. Recmmendatins specific t a particular department and unique threats psed by ptentially infectius materials in that department. Training Methds - One r mre methds may be used t deliver training cntent and include: Persnal instructin. Cmputer aided interactive training. Training manuals. EHSO mnthly newsletter, the Lab Rat. The pprtunity fr persnnel t ask questins. 1.6 Recrdkeeping Requirements Trainers will be familiar with the OSHA Bldbrne Pathgen Standard, the ECP and required elements f the bldbrne pathgen training. Training cmpletin recrds are entered int the Emry Learning Management System by the EHSO Administrative Assistant. Persnnel maintain a hard cpy f the recrd f their mst current training. Training recrds shall include all f the fllwing infrmatin: Dates f the training sessins. Cntents r a summary f the training sessins. Names and qualificatins f persns wh cnduct the training. Names and jb titles f all persns wh attend the training sessins. Training recrds shall be maintained fr a perid f three years frm the date n which training ccurred. All training recrds shall be made available upn request t OSHA fr examinatin and cpying. Emplyees, emplyee representatives, and OSHA shall be prvided with training recrds upn request fr the purpse f examinatin and cpying. All recrds that are required by law t be maintained will be made available upn request. Emry shall establish and maintain medical recrds fr each Categry A

9 Versin: 13 Page: 9 f 25 emplyee in accrdance with this ECP. Medical recrds shall cntain, at a minimum, all f the fllwing infrmatin: Name and emplyee ID number f the persnnel. Cpy f the emplyee s hepatitis B vaccinatin status, including the dates administered, and medical recrds relating t the emplyee s ability t receive a vaccinatin. In additin, Emry will maintain a cpy f the medical histry and all results f physical examinatins, medical testing and fllw-up prcedures as they relate t either f the fllwing: Persnnel s ability t wear prtective clthing and equipment and receive vaccinatin. Pst expsure evaluatin after an ccupatinal expsure incident. Emplyer s cpy f the physician's written pinin. Cpy f the infrmatin prvided t the physician. All medical recrds that are required by this ECP are kept cnfidential and are nt disclsed r reprted withut the persnnel's express written cnsent t any persn within r utside Emry, except as may be required r permitted by law. Emry shall maintain persnnel medical recrds accrding t OSHA standards fr the duratin f emplyment plus 30 years. OIM will maintain a Sharps Injury Lg fr five years fllwing the end f the calendar year that the recrds cver. The sharps injury lg cntains, at a minimum: The type and brand f device invlved in the incident The department r wrk area where the expsure incident ccurred An explanatin f hw the incident ccurred 1.7 Prgram Evaluatin The ECP shall be reviewed and updated at least annually r whenever necessary t reflect new r mdified tasks and prcedures, which affect ccupatinal expsure, and t reflect new r revised persnnel psitins with ccupatinal expsure. The review and update f such plans shall: Reflect changes in technlgy that eliminate r reduce expsure t bldbrne pathgens. Dcument annual cnsideratin and implementatin f apprpriate cmmercially available and effective safer medical devices designed t eliminate r minimize ccupatinal expsure. Dcument the emplyer s slicitatin frm nn-managerial persnnel respnsible fr direct patient care wh are ptentially expsed t injuries frm cntaminated sharps in the identificatin, evaluatin and selectin f effective engineering cntrls and wrk practices. 2.0 Expsure Determinatin Persnnel are placed in ne f tw categries regarding their ptential ccupatinal expsure. The expsure determinatin must be made withut regard t the use f PPE. 2.1 Expsure Categry A

10 Versin: 13 Page: 10 f 25 Includes all emplyees whse ccupatinal tasks r respnsibilities include expsure r reasnable anticipated risk f expsure t human bld r OPIM. The fllwing persnnel have risk f ccupatinal expsure (Categry A): EHSO emplyees. Labratry researchers including PIs, pst dctral fellws, research assciates, technicians and students. Building Services staff wh prvide services t the restrms, University husing, and labratry areas (Main Campus, Oxfrd Campus, and Yerkes). Members f the Emry Emergency Medical Service (EEMS). Plice department staff. Divisin f Animal Resurces. University Athletics. Rads and Grunds. Engineering and Infrmatin Technlgy persnnel wh prvide services t labratry r research areas (Main Campus, Oxfrd Campus, and Yerkes) Operatins, Maintenance, r Facilities persnnel wh prvide services t labratry r research areas (Main Campus, Oxfrd Campus, and Yerkes) 2.2 Expsure Categry B Includes all emplyees whse ccupatin des nt rutinely invlve expsure r reasnable anticipated risk f expsure t human bld r OPIM n a rutine r nn-rutine basis. Emplyees in Categry B are nt included in the bldbrne pathgen prgram. Individual departments shall review and update their persnnel expsure ptentials annually r with any significant changes in wrk prcedures. Significant changes shall be reprted immediately t the BSO with the fllwing infrmatin: The names f department persnnel wh have ptential ccupatinal expsures. Jb titles/classificatins and an estimate f expsure frequency. 2.3 Tasks and Prcedures The BBP Occupatinal Expsure Determinatin Frm is used t assist Principal Investigatrs, supervisrs, managers, and EHSO in determining the persnnel within departments that are at risk fr ccupatinal expsure t bldbrne pathgens. If persnnel perfrm prcedures r tasks indicated n the questinnaire, then thse persns must fllw all safety precautins t minimize expsure and cmplete training /immunizatins required by the Bldbrne Pathgen Standard and Emry s Bldbrne Pathgen Expsure Cntrl Plan. Refer t figure 1.0. Fr specific departments, EHSO may request a cmpleted Occupatinal Expsure Questinnaire frm department representatives n an annual basis. The fllwing are examples f tasks perfrmed by persnnel that present a ptential fr expsure t human bld r OPIM: Handling r Treating Bihazard Waste Perfrming Emergency Healthcare Prcedures Administratin f First Aid Phlebtmy Sanitizing Restrms Cleaning Labratry r Research Spaces

11 Versin: 13 Page: 11 f 25 Cleaning Bihazard r Bdy Fluid Spills Administering Injectins t Study Participants r Patients Handling Cntaminated Sharps Perfrming Animal Necrpsy Handling Animals Infected with Bldbrne Pathgens Pefrming repairs n pipes r drains in labratries, perating rms, r mrgues FIGURE 1.0 Example f BBP Occupatinal Expsure Questinnaire 3.0 Standard Wrk Practices 3.1 OPIM Where the scpe f hazards is nt adequately addressed by this general dcument, specific SOPs must be develped by department and labratry supervisrs. Persnnel shuld cnsult their department perating prcedures, jb aids, and safety manuals fr additinal detailed infrmatin. Specific questins relating t the bisafety f a given peratin r prcedure shuld be reviewed with the department supervisr and the BSO. The Emry University Bisafety Manual is a guidance dcument t infrm and advise persnnel f ptential hazards when handling r using OPIM and prvides instructins n practices and prcedures used t minimize the ptential fr an ccupatinal expsure. 3.2 General Guidance General safety principles shall be fllwed when wrking with bldbrne pathgens. These include, but are nt limited t: The risk f expsure t bldbrne pathgens shuld nt be underestimated. Persnnel shall bserve Universal Precautins. Accrding t the cncept f Universal Precautins, all human bld and OPIM are treated as if they are

12 Versin: 13 Page: 12 f 25 knwn t be infectius fr bldbrne pathgens (e.g., HIV, HBV, HCV and thers), regardless f the perceived status f the surce. As a cnsequence, administrative cntrls (t include immunizatins), prper engineering cntrls, wrk practices and PPE shuld be used t eliminate r minimize ptential expsure t human bld and OPIM. Universal Precautins apply t human bld and bdy fluids cntaining visible amunts f bld. Universal Precautins currently d nt apply t feces, nasal secretins, sputum, sweat, tears, urine, vmit r saliva unless they cntain visible bld. In circumstances where it is difficult r impssible t differentiate between bdy fluid types, these fluids are assumed t be ptentially infectius and Universal Precautins apply. Preferentially, use engineering cntrls, fllwed by wrk-practice prcedures, t eliminate r minimize persnnel expsure. All prcessing r analysis f human bld r OPIM shuld be cnducted in labratries at Bisafety Level 2 (BSL2), as defined by the U.S. Centers fr Disease Cntrl and Preventin (CDC) and Natinal Institutes f Health (NIH) publicatin: Bisafety in the Micrbilgical and Bimedical Labratries. Prcedures invlving bld r OPIM need t be perfrmed in such a manner as t minimize splashing, spraying, r aerslizatin f these substances. Standard micrbilgical wrk practices will be utilized. Mst prcedures will require the use f engineering cntrls like bilgical safety cabinets (BSC). Persnnel shuld wear PPE apprpriate fr the ptential expsure. Minimum PPE required fr wrking with human bld and OPIM include a lab cat, eye prtectin and glves. Use f needles and ther sharps shall be avided whenever pssible. Muth pipetting is prhibited. Persnnel shall nt eat, drink, apply csmetics r lip balm, smke r handle cntact lenses in wrk areas where there is a reasnable likelihd f expsure t bld r OPIM. In additin, fd and drink shall nt be stred in refrigeratrs, freezers r cabinets where bld r OPIM are present r ther areas f pssible cntaminatin, such as cunter tps. See the Emry University Cnsumptin and Strage f Fd and Beverages in Labratry Areas. Observe signs and pstings. Access t certain wrk areas may be restricted during the use f hazardus materials r special prcedures. Special attentin needs t be given t pen lesins, dermatitis r ther breaks in the skin cmprmising skin barrier prtectin. Apprpriate glves, such as medical exam glves, must be wrn. Additinal barrier prtectin may need t be emplyed until the cnditin reslves. Labratry drs must be kept clsed. 4.0 Engineering Cntrls and Wrk Practices Engineering cntrls are used in cmbinatin with wrk practices and PPE t minimize r eliminate persnnel expsure t human bld and OPIM. It is the department supervisr and/r PI s respnsibility t make sure tasks and prcedures are reviewed t determine where engineering cntrls can be implemented r updated.

13 Versin: 13 Page: 13 f 25 EHSO will wrk with supervisrs and persnnel t review areas t identify lcatins where: Engineering cntrls are currently emplyed. Engineering cntrls can be updated. Engineering cntrls are nt currently emplyed, but where such cntrls culd be beneficial. 4.1 Hand Washing Facilities Hand washing facilities are readily accessible t persnnel wh have a ptential fr expsure. If handwashing facilities are nt immediately available, antiseptic cleanser r antiseptic twelettes may be used. Hwever, when antiseptic r antiseptic twelettes are used, persnnel must wash their hands with sap and water as sn as pssible. Individuals must wash their hands immediately, r as sn as feasible, after remval f glves r ther PPE. 4.2 Sharps See the Emry University Safe Use f Sharps Guidelines. A high degree f cautin is t be taken while using and dispsing f sharps. Sharps include items such as needles, syringes, slides, pipettes, capillary tubes, scalpels, razr blades, etc. The use f sharps is minimized. Immediately after use, cntaminated nn-reusable sharps must be dispsed f in sharps cntainers (see Sharps Cntainers). Sharps with engineered sharps injury prtectin (safe sharps) include items such as self-sheathing needles, self-sheathing scalpels, and plastic capillary tubes and ther safer medical devices and needleless systems. These and ther safer sharps technlgy may be used fr but nt limited t withdrawing bdy fluids, inculating animals, accessing a vein r artery, r administering medicatins. These devices are reviewed, intrduced, and used in the wrkplace where apprpriate. Emry s Needlestick Preventin Cmmittee cnsiders recent changes in technlgy that eliminate r reduce expsure t bldbrne pathgens. Prir t making safer medical devices available fr emplyee use, cnsideratin is given t the device s ability t eliminate r minimize ccupatinal expsure. Brken glassware, which may be cntaminated, is nt picked up directly with the hands. It is cleaned up using mechanical means, such as a brush and dustpan, vacuum cleaner, tngs, cttn swabs r frceps. Reusable sharps that are cntaminated with bld r OPIM are nt stred r prcessed in a manner that requires emplyees t reach by hand int the cntainers where these sharps have been placed. Reusable sharps need t be cllected in specific sharps cntainers which are puncture resistant, leak prf n the sides and bttm. Reusable sharps must be autclaved r decntaminated befre reuse. 4.3 Needles and Syringes Cntaminated needles must nt be bent, sheared, replaced in the sheath r guard, r remved frm the syringe fllwing use and are dispsed f in a

14 Versin: 13 Page: 14 f 25 labeled, sharps cntainer. Recapping f needles is permissible nly if n ther alternate methd is feasible and shall be dne nly thrugh a mechanical device r ne-handed technique. Labs can review EHSO s Safe Use f Sharps Guidelines fr a descriptin and prtrayal f the ne-handed technique. Hypdermic needles and syringes are used nly fr parenteral injectins and aspiratin f fluids frm labratry animals. Only needle-lcking syringes r dispsable syringe-needle units (i.e., the needle is integral t the syringe) are used fr the injectin r aspiratin f ther ptentially infectius materials. 4.4 Sharps Cntainers Cntainers fr the dispsal f sharps (needles, syringes, scalpels, cntaminated Pasteur pipettes) must be clsable, leak-prf n sides and bttm, punctureresistant, labeled with a bihazard warning label and dispsed f in accrdance with the Emry University Safe Use f Sharps Guidelines. These cntainers must be maintained upright thrugh use, easily accessible t persnnel, lcated as clse as feasible t the immediate area f use r as reasnably can be anticipated t be fund, are replaced rutinely and are nt allwed t verfill. Sharps cntainers are clsed immediately prir t remval r replacement t prevent spillage r prtrusin f cntents during handling, strage, transprt r shipping. The sharps cntainer is placed in a secndary cntainer prvided by Emry s bimedical waste vendr. The secndary cntainer shall be clsable, cnstructed t cntain all cntents and prevent leakage during handling, strage, transprt, r shipping and labeled apprpriately. 4.5 Reusable Cntainers All cntainers intended fr reuse which have a ptential fr becming cntaminated with bld r OPIM, shall be inspected, cleaned, and decntaminated n an as-needed basis and cleaned and decntaminated immediately after use, r as sn as pssible upn visible cntaminatin. Reusable cntainers that have been cntaminated with bld r ther ptentially infectius materials shall be washed and decntaminated prir t reprcessing. The prcess in which washing r decntaminatin is perfrmed shuld be based n minimizatin f expsure t bldbrne pathgens r OPIM. Reusable cntainers must nt be pened, emptied, r cleaned manually r in any ther manner which wuld expse emplyees t the risk f percutaneus injury. 4.6 Cntainers fr Specimens f Bld r OPIM Specimens f bld r OPIM must be placed in a cntainer that prevents leakage during cllectin, handling, prcessing, strage, transprt, r shipping. The cntainer fr strage, transprt, r shipping must be red r labeled with a bihazard symbl and clsed prir t being stred, transprted, r shipped. When transprting samples, the primary cntainers must be packed int a secndary cntainer. Labeling with a bihazard symbl is als required when such specimens/cntainers are transprted within buildings. Hwever, when a facility utilizes Universal Precautins in the handling f all specimens, the

15 Versin: 13 Page: 15 f 25 labeling/clr-cding f specimens is nt necessary prvided that cntainers are recgnizable as cntaining specimens. This exemptin nly applies while such specimens/cntainers remain within the facility. If utside cntaminatin f the primary cntainer ccurs, the primary cntainer must be placed within a secnd cntainer that prevents leakage during handling, prcessing, strage, transprt, r shipping and is labeled r clr-cded. If the specimen can puncture the primary cntainer, the primary cntainer must be placed within a secndary cntainer that is puncture-resistant in additin t the characteristics mentined abve. Cntainers f bld, bld cmpnents, r bld prducts that are labeled as t their cntents and have been released fr transfusin r ther clinical use are exempted frm the labeling requirements Fr mre infrmatin n the packaging and transprt f bilgical and infectius material cntact EHSO. 4.7 Autclaves Autclaves may be used fr the decntaminatin f items such as reusable equipment, bihazardus waste, and ther materials necessary t be sterilized. Prir t using any autclave fr the first time, persnnel must be infrmed by their PI r Department supervisr/lab manager n prper prcedures and ptential hazards, e.g. heat expsure, pressurized vessel. Autclaves will cntinue t be examined and mnitred n a regular basis t ensure effectiveness. Cntact EHSO at fr mre infrmatin. 4.8 Bilgical Safety Cabinets Activities invlving ptentially infectius materials that pse a threat f expsure t drplets, splashes, spills, r aersls shall be cnducted in BSCs r ther physical cntainment devices within the cntainment facility. This wrk shall nt be cnducted n the pen bench, in a chemical fume hd, r in a laminar flw hd. Apprved Class II BSCs r ther apprpriate physical cntainment devices shall be used under the fllwing cnditins: Whenever prcedures with high ptential fr creating expsure t infectius aersls, drplets, splashes r spills are cnducted, these may include: centrifuging, grinding, blending, vigrus shaking r mixing, snic disruptin, pening cntainers f infectius materials whse internal pressures may be different frm ambient pressures, inculating animals intranasally, and harvesting infected tissues frm animals r eggs. Whenever high cncentratins r large vlumes f bld and OPIM are used, such materials may be centrifuged in the pen labratry if sealed heads r centrifuge safety cups are used and if they are pened nly in a BSC. Certified bilgical safety cabinets r ther apprpriate cmbinatins f persnal prtectin r physical cntainment devices, such as special prtective clthing, respiratrs, centrifuge safety cups, sealed centrifuge rtrs, and cntainment caging fr animals must be used fr all activities with ther ptentially infectius materials that pse a threat f expsure t drplets, splashes, spills, r aersls. Fr additinal infrmatin n the different types, prper use f, and maintenance

16 Versin: 13 Page: 16 f 25 f BSCs, refer t Appendix A f Bisafety in Micrbilgical and Bimedical Labratries. BSCs must be certified when installed, whenever they are mved, and at least annually. Cntact EHSO at fr mre infrmatin. 4.9 Ducted Exhaust Air Ventilatin System The directinal airflw created by the ducted exhaust air ventilatin system shall draw air int the wrk area and disperse the exhaust away frm ccupied areas and air intakes by discharging t the utside. The prper directin f the airflw shall be checked by labratry persnnel fr negative airflw during the labratry self-inspectin prcess. EHSO shall validate the results during the labratry validatin. Cntact Facilities if the airflw is determined t be psitive. 5.0 Administrative Cntrls and Wrk Practices 5.1 Signs and Labels Cmmunicatin f Hazards t Persnnel Bihazard warning labels must be flurescent range r range-red, r predminantly s with letters and symbls in a cntrasting clr. Bihazard warning labels shall be affixed t cntainers f infectius waste, refrigeratrs, incubatrs and freezers cntaining bld r OPIM, sharps cntainers, laundry bags and cntainers, cntaminated labratry equipment r ther cntainers used t stre r transprt bld r OPIM. Bihazard warning labels must be affixed as clse as feasible t the cntainer by string, wire, adhesive r ther methd that prevents their lss fr unintentinal remval. Red bags r red cntainers may be substituted fr labels n cntainers f infectius waste. Regulated waste that has been decntaminated is exempt frm the labeling requirement. Equipment that has becme cntaminated with bld r OPIM shall be decntaminated prir t it being serviced r shipped, unless the persnnel can demnstrate that decntaminatin f such equipment r prtins f such equipment is nt feasible. The equipment shall be labeled with the bihazard warning label, and an Emry University Equipment Hazard Tag shall be cmpleted which identifies which prtins remain cntaminated. A bihazard hazard warning sign shall be psted n all access drs when bldbrne pathgens, OPIM r infected animals are present in the wrk area r the area is designated as BSL2 r higher. 5.2 Husekeeping Labratry persnnel shall maintain all equipment and wrk surfaces in a sanitary wrking cnditin. Wrk surfaces are cleaned and decntaminated with an apprpriate disinfectant in all f the fllwing circumstances: After cmpletin f prcedures. When surfaces are vertly cntaminated.

17 Versin: 13 Page: 17 f 25 Immediately when bld r OPIM is spilled. Custdial staff shall implement and maintain a written cleaning schedule fr the research facility. The schedule shall include methds f decntaminatin based upn the lcatin within the facility, type f surface t be cleaned, type f sil present and tasks r prcedures perfrmed in area. Prtective cvering such as plastic wrap, aluminum fil r imperviusly-backed absrbent paper may be used t cver equipment and envirnmental surfaces. These cverings shall be remved and replaced when they becme vertly cntaminated r at the end f the wrk shift if they have becme cntaminated during that shift. 5.3 Persnal Prtective Equipment (PPE) PPE will be chsen based n the anticipated expsure t bld r OPIM. The PPE will be cnsidered apprpriate nly if it des nt permit bld r OPIM t pass thrugh r reach the persnnel s clthing, skin, eyes, muth, r ther mucus membranes under nrmal cnditins f use and fr the duratin f time which the PPE will be used. Supervisrs will enfrce the use f PPE by persns in the wrk area. Sme facilities may have specific PPE guidelines, e.g., Yerkes Natinal Primate Research Center. The supervisr must ensure that the emplyee uses apprpriate PPE unless the supervisr shws t EHSO that the emplyee temprarily and briefly declined t use PPE when, under rare and extrardinary circumstances, it was the emplyee's prfessinal judgment that in the specific instance its use wuld have prevented the delivery f healthcare r public safety services r wuld have psed an increased hazard t the safety f the wrker r c-wrker. When the emplyee makes this judgment, the circumstances must be investigated and dcumented by EHSO in rder t determine whether changes can be instituted t prevent such ccurrences in the future. Persnnel shall rutinely use apprpriate barrier precautins t prevent skin and mucus membrane expsure when wrking with human bld r OPIM. PPE must be remved prir t leaving the wrk area. Emry will ensure that apprpriate PPE in the apprpriate sizes is readily available at the wrksite r is issued t emplyees. PPE will be supplied, cleaned, laundered, repaired r replaced, and dispsed f by Emry at n cst t persnnel. See the Emry University Prcurement Website fr mre infrmatin. PPE that is cntaminated r penetrated by bld r OPIM must be remved immediately r as sn as feasible. When PPE is remved it must be placed in an apprpriately designated area r cntainer fr strage, washing, decntaminatin, r dispsal. 5.4 Glves Glves shall be wrn: When handling any bld r OPIM. When handling items r surfaces cntaminated r ptentially cntaminated with bld r OPIM. When servicing equipment/facilities where surfaces may be cntaminated.

18 Versin: 13 Page: 18 f 25 Dispsable glves shall nt be used when visibly siled, trn, punctured, r when their ability t functin as a barrier is cmprmised. Glves shall be changed when visibly cntaminated and prir t leaving the wrk area; The Beak Methd shall be used t prevent cntaminatin f bare hands upn glve remval. Using ne glved hand, pinch and pull the base f the ther glved hand. Use the middle finger t scp the cuff f the glve and pull the glve inside ut ver all the fingers and thumb t frm a beak. With the beaked hand, pinch the ppsite glve at the base and pull the cuff s that it rlls inside ut and ff the hand. Dispse the glve int the apprpriate waste cntainer. With the unglved hand, use the index finger t pull the beaked glve ff at the base f the beak and dispse. A brief infgraphic and vide demnstrating the Beak Methd can be viewed here. Registratin is required t view the vide. Dispsable r single use glves must nt be washed r decntaminated fr reuse. Persnnel that are allergic t glves nrmally prvided shall be prvided with hypallergenic glves, glve liners, pwderless glves, and ther similar alternatives; and Utility glves (e.g., rubber husehld glves) may be used fr husekeeping chres invlving ptential bld cntact and fr instrument cleaning and decntaminatin prcedures. Utility glves may be decntaminated and reused, but shall be discarded if they are peeling, cracked, r disclred, r if they have punctures, tears, r shw ther evidence f deteriratin r inability t functin as a barrier. Phlebtmies may be necessary fr persnnel and the use f glves can be ptinal based n the prfessinal judgement f the supervisr. Persnnel must nt be discuraged frm using glves during phlebtmy. Glves must be available t all emplyees wh wish t use them. Glves must be used fr phlebtmy in the fllwing circumstances: When the emplyee has cuts, scratches, r ther breaks in the skin When the emplyee judges that hand cntaminatin with bld may ccur, fr example, when perfrming phlebtmy n an uncperative surce individual r when in phlebtmy training. 5.5 Prtective Clthing Lab cats, dispsable gwns, aprns r fluid resistant clthing shall be wrn during prcedures that are likely t generate splashes f bld, ther bdy fluids r OPIM. Surgical caps r hds and she cvers r bts shall be wrn, where apprpriate, if there is a reasnable anticipatin f grss cntaminatin. Lab cats shall be cleaned and laundered as needed r when the garment is siled with bld r OPIM. Lab cats must be cleaned by an Emry apprved vendr. Lab cats must nt be taken hme r t a dry cleaning service. 5.6 Masks, Eye Prtectin, Face Shields and Respiratrs

19 Versin: 13 Page: 19 f 25 Surgical masks in cmbinatin with eye prtectin (gggles, glasses with side shields, r face shields) shall be wrn whenever splashes, spray, splatter, r drplets f bld r OPIM may be generated, and when eye, nse r muth cntaminatin can be reasnably anticipated. Persnnel using respiratrs, including dispsable dust mist and High-Efficiency Particulate Air (HEPA) respiratrs (N95s r N100s) shall participate in the Emry University Respiratry Prtectin Prgram. Persnnel using respiratrs must receive medical clearance, apprpriate training, and fit testing annually. Cntact EHSO fr further details. Surgical masks shall nt be used as an alternative t a respiratry prtectin device. 5.7 Decntaminatin Decntaminatin will be accmplished by utilizing an apprpriate disinfectant such as bleach r ther EPA-registered disinfectants. A list f EPA-registered disinfectants can be fund here. Chlrine-cntaining slutins have brad-spectrum activity. Sdium hypchlrite is the mst cmmn base fr chlrine disinfectants. Accrding t CDC, cmmn husehld bleach (5% sdium hypchlrite) can be diluted 1/10 t 1/100 with water t yield a satisfactry disinfectant slutin fr HIV and ther BBPs. Diluted slutins may be kept fr extended perids if kept in a clsed cntainer and prtected frm light. A 1:50 dilutin f chlrine bleach stred at rm temperature in a clsed plastic cntainer will deterirate t the equivalent f a 1:100 dilutin after ne mnth (Amer. J. Nursing, 93: ). Hwever, it is recmmended t use freshly prepared slutins fr spill clean-up purpses. Excess rganic materials inactivate chlrine-cntaining disinfectants and are strng xidizers and very crrsive. All bins, pails, cans, and similar receptacles intended fr reuse which have a reasnable likelihd fr becming cntaminated with bld r ther ptentially infectius materials must be inspected and decntaminated n a regularly scheduled basis and cleaned and decntaminated immediately r as sn as feasible upn visible cntaminatin. Cntaminated materials that are t be decntaminated at a site away frm the wrk area must be placed in a durable, leakprf, labeled r clr-cded cntainer that is clsed befre being remved frm the wrk area. 5.8 Vacuum Lines Vacuum lines shuld be prtected with liquid disinfectant traps and HEPA filters r filters f equivalent r superir efficiency. Filters must be checked rutinely and maintained r replaced as necessary. 5.9 Regulated Medical Waste Dispsal Including Sharps Cntainer Dispsal Persnnel must fllw site-specific prcedures fr dispsal f bihazardus wastes, including bld specimens r bld prducts. Befre dispsal all waste frm wrk areas and frm animal rms shall either be incinerated r decntaminated by a methd such as autclaving knwn t effectively destry bldbrne pathgens Regulated waste must be placed in cntainers which are: clsable; cnstructed

20 Versin: 13 Page: 20 f 25 t cntain all cntents and prevent leakage f fluids during handling, strage, transprt r shipping; labeled r clr-cded, and clsed prir t remval t prevent spillage r prtrusin f cntents during handling, strage, transprt, r shipping. If utside cntaminatin f the regulated waste cntainer ccurs, it must be placed in a secndary cntainer. The secndary cntainer must be clsable; cnstructed t cntain all cntents and prevent leakage f fluids during handling, strage, transprt, r shipping; labeled r clr-cded and clsed prir t remval t prevent spillage r prtrusin f cntents during handling, strage, transprt, r shipping Laundry Dispsable lab cats, twels, unifrms, and ther garments that are cntaminated r ptentially cntaminated with bld r OPIM shall be dispsed f as regulated medical waste. The cntaminated laundry must be placed in a bag r cntainer which is labeled with the bihazard symbl. Bihazard warning labels must be mstly flurescent range r range-red, with letters and symbls in a cntrasting clr. Whenever cntaminated laundry is wet and presents a reasnable likelihd f sak-thrugh f r leakage frm the bag r cntainer, the laundry shall be placed and transprted in bags r cntainers which prevent sak-thrugh and/r leakage f fluids t the exterir. Duble plastic bags can be used. Cntaminated laundry must be bagged r cntainerized at the lcatin and handled as little as pssible with minimal agitatin. Cntaminated laundry must nt be srted r rinsed at the lcatin f use. Emplyees wh have cntact with cntaminated laundry must wear prtective glves and ther apprpriate PPE Human Cell Cultures Treat all human cell lines as OPIM. Established human cell lines 1 that are characterized 2 as free f cntaminatin frm human hepatitis viruses, human immundeficiency viruses and ther recgnized bldbrne pathgens, are nt t be cnsidered as OPIM and are nt cvered by the OSHA Bldbrne Pathgens Standard. Established human r animal cell lines that are ptentially infected r cntaminated with bldbrne pathgens are cvered by the Bldbrne Pathgens Standard. The final judgment fr making the determinatin that human r animal cell lines in a culture are free f bldbrne pathgens will be made by the BSO in cnsultatin with the department supervisr/research grup, and in accrdance with the requirements f the Bldbrne Pathgen Standard. Dcumentatin that such cell lines are nt OPIM shall be n file with the department supervisr. All primary human cell explants and in vitr passages f human tissue explant cultures (human cell strains) must be regarded as cntaining bldbrne pathgens and are subject t Universal Precautins and the requirements f this ECP. Nn-transfrmed, human cell strains characterized by dcumented, reasnable labratry testing, t be free f HIV, hepatitis viruses, r ther bldbrne pathgens may be exempted frm the ECP requirements. Hwever,

21 Versin: 13 Page: 21 f 25 tissue explants r subsequent cultures derived frm human subjects knwn t carry bldbrne pathgens (e.g., HIV, HBV) r deliberately infected with bldbrne pathgens, must be handled in accrdance with the Bldbrne Pathgens Standard and Emry s ECP. The same applies fr animal tissues and explants r cell lines cntaminated by deliberate infectin with bldbrne pathgens. 6.0 Emergency and Medical Prcedures 6.1 Emergency Prcedures All persnnel wrking in labratries shuld review emergency prcedures in the Emry Just in Time Guide t Campus Emergencies psted in University labratries and available n the web, Persnnel must wash hands and any ther skin with sap and water, r flush mucus membranes with water immediately r as sn as feasible fllwing cntact f such bdy areas with bld r ther ptentially infectius materials. 6.2 Spills Spills must be immediately cntained and cleaned up by trained staff. Trained staff must handle all spills f bld r OPIM in accrdance with the Emry University Bisafety Manual and the campus emergency guide. Fr instructins n when and hw t cleanup and reprt spills t EHSO Spill Team refer t the Majr Spills f Hazardus Materials page. The EHSO Spill Team can be cntacted at (24 hur respnse line). Spills r accidents that result in an expsure incident must be immediately reprted t Occupatinal Injury Management (OIM), EHSO and the labratry supervisr. Click here t link t the PepleSft reprting system. 6.3 Reprting f Expsures, Injuries and Illnesses It is mandatry that all wrk-related expsures t human bld, tissues, OPIM, wrk related injuries r wrk related illnesses shall prmptly be reprted t OIM lcated at Emplyee Health Services (EHS) and the affected individual s supervisr t ensure adequate medical attentin is given and prper recrds are maintained. If an injury r expsure ccurs after nrmal wrk hurs, persnnel are t fllw the University s after-hurs reprting prcedures. If ever in dubt, persnnel shuld dial the University emergency PIC#50464 t reach the Emplyee Health/Wrkers Cmpensatin Nurse n call. Persnnel must infrm OIM lcated at Emplyee Health Services and their supervisr as sn as pssible r n later than the next wrkday. Persnnel frm Yerkes must infrm the Safety Officer at Yerkes and their supervisr as sn as pssible r n later than the next wrkday. If persnnel btain medical attentin frm their wn physician fr a wrk-related expsure, injury, r illness, they still must reprt the incident t OIM at Emplyee Health Services and their supervisr as sn as pssible r n later than the next wrk day. If persnnel have an injury r expsure at an Internatinal site where studies are

22 Versin: 13 Page: 22 f 25 being carried ut, they must reprt t the BSO as sn as pssible. Refer t Hw t Reprt an Accident fr detailed infrmatin depending n lcatin, time and type f expsure accident. 6.4 Health Surveillance The initial evaluatin will be given prir t the jb assignment and shall include an ccupatinal/medical histry, including HBV vaccinatin status and any medical prblem that culd interfere with a persnnel's ability t use PPE r receive vaccinatin. The health assessment is limited t thse systems and areas which, in the pinin f the examining physician, need t be evaluated t determine whether any medical prblems exist t meet the abve criteria. Persnnel with impaired immune systems shuld ntify EHS and receive cunseling abut the ptential risk assciated with patient care r handling bihazardus materials. Such impaired persnnel shall cntinue t fllw recmmendatins fr infectin cntrl t minimize risk f expsure t infectius agents. An accurate recrd fr each persnnel subject t medical surveillance under this dcument will be maintained and will include: The name and emplyee ID number f the individual. A cpy f his/her HBV vaccinatin status, including the dates f all the HBV vaccinatins and any medical recrds relative t the persnnel's ability t receive vaccinatin. A histry as it relates t the persnnel's ability t wear prtective clthing and equipment and receive vaccinatin r the circumstance f an ccupatinal expsure incident. A cpy f all results f physical examinatins, medical testing and fllw-up prcedures as they relate t the persnnel's ability t wear prtective clthing and equipment and receive vaccinatin r t pst-expsure evaluatin fllwing an ccupatinal expsure incident. A cpy f the physician's written pinin and a cpy f infrmatin prvided t the physician. The persnnel's medical recrds will be kept cnfidential and will nt be disclsed r reprted withut the persnnel's express written cnsent t any persn within r utside the wrkplace except as required r permitted by law. These recrds will be maintained in accrdance with OSHA requirements (29 CFR ). 6.5 HBV Vaccine HBV vaccinatin fr persnnel under Categry A: The cmplete Hepatitis B Vaccinatin cnsists f three dses (at mnth 0, mnth 1, and mnth 6) and a titer check (mnth 7). The vaccine will be ffered within ten wrking days f their initial assignment t wrk invlving the ptential fr ccupatinal expsure t bld r OPIM. A rutine bster dse(s) f HBV vaccine may be recmmended and shall be available t persns at risk f further expsure. This shall be determined by the examining physician. Persnnel wh decline the HBV vaccine will sign a cpy f the declinatin fr

23 Versin: 13 Page: 23 f 25 HBV vaccinatin. Persnnel wh initially decline the vaccine but wh later wish t have it may then have the vaccine prvided t them by EHS at n cst t the emplyee. Persnnel will nt participate in a prescreening prgram as a requirement fr receiving hepatitis B vaccinatin The supervisr has respnsibility fr assuring that the vaccine is ffered, administered, and any waivers are signed and submitted. Refer t the Emry University HBV- Immunizatin Review and Declinatin Frm (see Figure 2.0). Figure Example f Hepatitis B Declinatin Frm When, and if, a safe and effective HIV vaccine becmes available, it will be ffered t all persnnel ccupatinally expsed t bld r ther materials ptentially infectius fr HIV. Additinal vaccinatins fr specific infectius agents shall be prvided n an individual basis if safe and effective vaccines are available. 6.6 Sharps Injury Lg In accrdance with 29 CFR , Emry University will maintain a sharps injury lg f percutaneus injuries frm cntaminated sharps. The sharps injury lg shall be maintained fr the perid required by 29 CFR The sharps injury lg shall cntain, at a minimum: The type and brand f device invlved in the incident (if knwn). The department, lcatin r wrk area where the expsure incident ccurred. An explanatin f hw the incident ccurred, including bdy parts affected, bjects r substances invlved. The level f detail presented shuld be sufficient s that the intended evaluatin f risk and device effectiveness can be accmplished. The infrmatin in the sharps injury lg shall be recrded and maintained in a manner as t prtect the cnfidentiality f the injured emplyee. 6.7 Pst-Expsure Examinatin and Fllw-Up Emry will prvide each expsed emplyee with an pprtunity t have a cnfidential medical evaluatin and fllw-up appintment subsequent t a reprted ccupatinal expsure incident t bld r ther ptentially infectius material. The evaluatin and fllw-up appintment shall include, at a minimum,