The Humboldt County School District's Bloodborne Pathogens Procedure Manual details the district's Exposure Control Plan, the Hepatitis B Vaccination Procedures, Training Programs for employees, and an accountability system through Medical and Training Records. Please refer to this manual for specific information. A copy is on file in each nurse'' and principal'' office.
The school nurse is responsible for initial training of new teachers, support staff, and food service personnel. The Humboldt County School District's Bloodborne Pathogens Procedure Manual, Section V, Training Programs, is the basis for the training class.
Update training for teachers and support staff is scheduled during a faculty meeting at the beginning of each school year. This short review is outlined in Section V of the Humboldt County School District's Bloodborne Pathogens Procedure Manual. See Appendix C for copies of handouts that can be used for education classes or on an individual basis at the time of an exposure incident.
In the event of an exposure incident during school hours, the nurse will evaluate the incident using the Nursing Protocol for Assessment of Bloodborne Pathogens Exposure Incident. The Humboldt County School District Nurse Evaluation of Employee Exposure to Bloodborne Pathogens or OPIM form is completed. (See Appendix C)
In an employee exposure incident occurs after school hours, the procedure for medical follow-up is outlined in the Humboldt County School District's Bloodborne Pathogens Procedure Manual.
A copy of the Humboldt County School District's HIV Positive Policy, J.G.C.B. is included in Appendix C for reference.
NURSING PROTOCOL FOR ASSESSMENT OF BLOODBORNE PATHOGENS EXPOSURE INCIDENT
Bloodborne Pathogens exposure incident is specific contact between blood or other potentially infectious materials and an open wound, non-intact skin, or mucous membrane (eye, nose, and mouth).
Non-intact skin is skin with dermatitis, abrasions, chafing, cuts, or hangnails.
1. Needle stick/glass cut injury.
2. Contamination through splashing into the mucous membrane of the mouth, noses, and eyes.
3. Contact with blood or potentially infectious material and existing cuts, chapped or abraded skin, hangnails, or dermatitis. Freshly shaven skin is considered non-intact skin.
4. Prolonged skin contact with blood.
5. Human bites that break the skin.
IMMEDIATE SELF CARE FOLLOWING EXPOSURE CRITERIA:
1. Skin: Wash the affected area with soap and water using friction to help clean all surface areas of exposed part. Rinse the affected area with water.
2. Eyes: Flood eyes with warm water.
3. Nose: Blow nose to clean inside.
4. Mouth: Rinse mouth with water.
5. Cuts/Wounds: Hold so that blood flows freely. Milk the wound to encourage free flow of blood. Wash with soap and water.
6. Clothes: Change clothes if fabric is soaked with blood to prevent prolonged skin contact with blood and avoid transfer of pathogens to another area.
TWO SCREENING TECHNIQUES TO CHECK THE INTEGRITYOF THE SKIN:
1. Rinse the affected area with 70% isopropyl alcohol. Stinging of the skin
From the alcohol is an indication of non-intact skin.
2. Rinse the area with hydrogen peroxide. Bubbling of the peroxide is an indicator of a break in the skin.
3. Rinse the skin thoroughly after the application of either alcohol or hydrogen peroxide.
CONFIRMED EXPOSURE INCIDENT:
If it is determined that the suspected incident is a valid bloodborne pathogen exposure incident, the procedure as detailed in the District's Bloodborne Pathogens Procedure Manual will be followed.
1. The employee will report the incident to his/her supervisor.
2. The Exposure Incident Form must be completed and returned to the supervisor.
3. An appointment will be scheduled within 24 hours for medical consultation with the employee's personal physician. An employee may choose to go to the Emergency Room if an appointment is not readily available.
4. Employee will need to take a copy of the Exposure Incident Form to the medical consultation.
Exposure does not mean infection. Risk for infection is dependent on:
1. Health of the individual, resistance, and presence of chronic conditions.
2. Dose of the pathogen - how much fluid is involved and how many pathogen particles are in the fluid.
3. Virulence of the pathogen.
PROTOCOL FOR EVALUATION OF STUDENT EXPOSURE TO BODY FLUIDS/BLOODBORNE PATHOGENS:
Students may come into contact with infectious organisms through contact with body fluids of other persons, biting incidents, pin/needle poking incidents.
Incidents in which there is contact with body fluids will be evaluated on an incident by incident basis to determine the conditions of the skin at the point of contact on the exposed person.. The school nurse will evaluate skin integrity and the established procedure will be followed. (Procedure: Either Hydrogen Peroxide of 70% isopropyl alcohol is poured on the skin exposed to blood/body waste in an effort to determine the intact status of the skin. Intact skin will provide no response to the presence of either hydrogen peroxide or alcohol other than the sensation of the presence of cold liquid. If the skin is broken there will be bubbling at the site in the presence of hydrogen peroxide or a stinging sensation in the presence of isopropyl alcohol.
An incident in which the skin of another student is pierced by a non-sterile hypodermic needle will be considered as a bloodborne pathogens exposure incident.
Incidents in which the skin of a student is pierced by an act of another student using sharp objects or implements as a knife, pin, needle, the incident will be evaluated as an exposure incident depending on the circumstances:
If the implement used in the incident is known to have had no prior contact with blood or tissue, the incident will be treated as an incident needing first aid treatment; tetanus shot appraisal, and possible preventive infection education. It will not be treated as a bloodborne pathogens exposure incident.
If the implement used in the skin piercing incident has the possibility of previous contact with blood or tissue, the incident will be considered as a bloodborne pathogens exposure incident even though the risk of exposure is minimal. For example, sewing needles may have been used in an ear piercing or tattooing incident. A student to student needle poking incident carries with it the possibility of transfer of blood via the needle from one student to the next.
Biting incidents in which the skin is broken carry the risk of bloodborne pathogens exposure for the victim and the aggressor. Hepatitis B Virus can be transmitted in the saliva of infected persons. Biting incidents will be treated as an exposure incident if the skin has been broken. (The wearing of long sleeves is considered a common sense approach of self-protection for persons who work with known biters.)
STUDENT TO STUDENT EXPOSURE INCIDENT FOLLOW-UP:
1. The nurse will evaluate the integrity of the skin at the exposure
2. All incidents will be reported to the principal for further evaluation.
3. The principal will contact the parent/guardian of the student to explain the incident of possible exposure and the option of medical evaluation for further recommendations in the situation.
4. The entire incident must be clearly documented both from the bloodborne pathogens exposure viewpoint and from the student disciplinary measure viewpoint if indicated.
ADDITIONAL HELPFUL INFORMATION:
The risk of exposure to the Hepatitis B Virus or the Human Immunodeficiency Virus in the above-described incidents is minimal. However, in keeping with the concept of Universal Precautions, validated exposure incidents must be given careful consideration. The choice of medical evaluation belongs to the parent/guardian. The Humboldt County School District is not financially responsible for medical evaluation.
Concern for exposure to the Hepatitis B Virus is important. The virus is resilient and been shown, in some instances, to remain infectious on environmental surfaces for at least a month at room temperature. (Epidemiology and Prevention of Vaccine-Preventable Diseases, a publication from the Center for Disease Control and the Department of Health and Human Services.)
If medical evaluation indicates the need for Hepatitis B Immune Globulin following exposure to blood or other body fluids, the treatment must be given within 7 days of the exposure incident. Therefore, evaluation of the incident and contact with the student's parent/guardian needs to be on a timely basis.