**Notes: 

• The policy below addresses on-campus clinical sites only; off-campus clinical sites will have alternative policies that must be followed for that clinical site. 
  
• All pre-professional students must:
  
  • provide either a Hepatitis B vaccination waiver or proof of vaccination prior to beginning any observational experiences associated with the Pre-Professional Phase of this program.
    
  • Participate in an OSHA/Bloodborne Pathogens Policy Training session (administered by the Concentration in Athletic Training prior to starting observational experiences).  The date/time of the session is announced at each of the two Orientation Meetings (September; January)

INFECTION CONTROL/ OSHA GUIDELINES
In 1990, the Occupational Safety and Health Administration (OSHA) enacted a law entitled Occupational Exposure to Bloodborne Pathogens; (29 CFR 1910, 1030).  This regulation was promulgated in response to OSHA’s determination that “individuals whose occupational duties place them at risk of exposure to blood and other potentially infections materials are at risk of becoming infected with these bloodborne pathogens, developing disease and, in some cases, dying”.  The intent of the regulation is to minimize incidents of occupational exposure of bloodborne pathogens and other potentially infectious materials.

In compliance with OSHA’s bloodborne pathogen regulations, Louisiana State University has implemented an exposure control plan to minimize the risk of infection.  As part of the ongoing effort to minimize the risk, the Louisiana State University Athletic Training Department is strongly recommending that all pre-professional and athletic training students be vaccinated against the Hepatitis B Virus.  This vaccination is completed in a series of three (3) injections.

These injections are given at:

• (0) month,
  
• (1) month,
  
• and (6) months

The cost is $35.00 per injection for a total of $105.00 once completed. You do have the option for a tider that will evaluate the level of vaccine in your blood 2-3 months after completion of the injections for a cost of approximately $50.00.  The fee can be paid by check, cash or charge, but will not be permitted to be put on your fee bill.

In order to undergo the Hepatitis B vaccination, you must receive a written prescription from our health center physician or our team physician. Present this to the Shot Clinic at the LSU Student Health Center at the time of the vaccination.

The hours of the Shot Clinic are:
8:30am-11:00am         Monday - Friday
1:00pm-3:30pm           Monday - Thursday

You will be given an immunization card that you will be responsible to provide the Athletic Training Department as proof of vaccination. The Student Health Center will also maintain your shot record in your medical file at their facility.

SOUTHEASTERN CONFERENCE (SEC) GUIDELINES
The regulation 29 CFR 1910, 1030 is designed to lessen the potential health risk to employees as a result of exposure to bloodborne pathogens.  Louisiana State University’s Athletic Department has adopted the Southeastern Conference policies and procedures for competition addressing bloodborne pathogen protocols.  All students will be provided an in-service related to specific details of this manual. 

Due to the serious nature of bloodborne pathogens, it is very important that every medical facility has proper procedures to deal with the control of infections material to prevent the spread of diseases such as Hepatitis, HIV virus, and AIDS.  It is the duty of everyone on Louisiana State University’s athletic training staff to follow these procedures to safe guard themselves as well as the athletic training room and the athletes it serves.  State and federal regulations also require the safe handling of blood and blood infected materials in all medical facilities.  It is also required that any exposure shall be reported and a record of this report kept for the entire term of employment, plus 30 years.

Every student should have in his/her possession at practice or competition a Biohazards Kit.  This kit should contain, but is not limited to a pair of gloves, alcohol swab pads, gauze pads, and at least one red biohazard bag.  In the event that an athlete receives a cut or wound and blood is present, these materials are to be used.

Louisiana State University
Bloodborne Pathogen Exposure Control Plan

PURPOSE
The Occupational Safety and Health Administration (OSHA) published the Final Rule on bloodborne pathogens (BBP) in December 1991. This Exposure Control Plan has been written in accordance with 29 CFR 1910.1030 in order to comply with the OSHA regulation. The Exposure Control Plan is for all employees of Louisiana State University that may potentially be exposed to bloodborne pathogens. This program limits occupational exposure to blood borne pathogens which may cause illness among employees and others on campus.

SCOPE
This program covers all employees who could be reasonably anticipated, within the scope of their job duties, to come in contact with blood or other potentially infectious material. Infectious materials include any body fluid which can transmit pathogens, and any tissue, organs or other body parts (living or dead) which have the potential for harboring HIV or HBV organisms. It is expected that departments such as Student Health Center will have internal guidelines and procedures which expand on the basics included in this program.

DEFINITIONS
Blood - human blood, human blood components and products made from human blood.

Bloodborne pathogens - any pathogenic microorganisms that may be present in human blood and can cause human disease.

These pathogens include but are not limited to human immunodeficiency virus (HIV) and hepatitis B virus (HBV).

Contaminated - the presence or reasonably anticipated presence of blood or other potentially infectious materials on any item
or surface.

Decontamination - the 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 transmitting infectious particles and the surface or item is rendered safe for handling, use or disposal.

Employee - any permanent or temporary employee, graduate or undergraduate student that receives a University paycheck and could potentially be exposed to bloodborne pathogens in the course of their work.

Engineering controls - controls (e.g. use of sharps disposal containers, self-sheathing needles) that isolate or remove the bloodborne pathogens hazard from the workplace.

Exposure incident - a specific eye, mouth, other mucous membrane, non-intact skin or parenteral contact with blood or other potentially infectious materials that results from the performance of an employee's duties.

Handwashing facilities - a facility providing potable water, soap and single use towels or hot air drying machines.

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

Other potentially infectious materials- (Other than blood) means

(1) The following human body fluids:
semen
vaginal secretions
cerebrospinal fluid
synovial fluid
pleural fluid
pericardial fluid
peritoneal fluid
amniotic fluid
saliva in dental procedures
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); and

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

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

Personal Protective Equipment - specialized clothing or equipment worn by an employee for protection against a hazard.

Regulated waste- liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials.

Source individual - any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee.

Standard precautions - See universal precautions.

Sterilize - the use of a physical or chemical procedure to destroy all microbial life including highly resistant bacterial endospores.

Universal precautions- an approach to infection control in which all human blood and certain human body fluids are treated as if they are infected with HIV, HBV and other bloodborne pathogens.

Work practice controls- controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g., prohibiting recapping of needles by a two-handed technique).

Areas of Responsibility - Three areas of responsibility are central to the implementation of the Exposure Control Plan at Louisiana State University and they include:

1.  Occupational and Environmental Safety will manage and support the Bloodborne Pathogens Compliance
      Program. This includes:

• coordinating implementation of the Exposure Control Plan;
• developing, in cooperation with administrators, any additional bloodborne pathogens related  policies and practices needed to support the effective implementation of this plan;
• revising, updating and improving the Exposure Control Plan when necessary; and
• conducting periodic organizational audits to maintain an up-to-date Exposure Control Plan.

   2.  Deans, Directors, Department Chairs, Principal Investigators, Managers and Supervisors

• are responsible for compliance in their areas;
• must identify and provide information and training to all employees who have an anticipated risk of exposure to bloodborne pathogens;
• must maintain an up-to-date list of LSU personnel requiring training
• must maintain appropriate training records;
• and must ensure that proper exposure control procedures are followed.

   3.  Employees are responsible for following the Exposure Control Plan. They must:

• know what tasks have a potential occupational exposure to bloodborne pathogens;
• attend the bloodborne pathogens training session and annual retraining sessions;
• conduct all operations in accordance with work practice controls;
• follow the Universal Precautions listed in Section 6;
• develop good personal hygiene habits.

EXPOSURE DETERMINATION

The OSHA regulations require employers to list jobs in which all employees are potentially exposed, jobs in which some employees are potentially exposed, and to list the tasks which cause the employees to be potentially exposed. The OES staff has determined the following occupations at LSU to be at risk:

• All employees exposed
• University Police
• Athletic Department - Trainers, Equipment Managers
• Student Health Center personnel (physicians, nurses, nursing assistants, medical laboratory, x-ray personnel, and housekeeping)

          The following employees are exposed performing specific tasks:

• Custodians that clean medical exam areas and laboratory facilities where blood may be present.
• Plumbers that may be exposed to sanitary wastes as when working in sewers.
• OES personnel who handle biowaste material.
• College of Engineering, Civil Engineering/Environmental: studies involving sewage.
• College of Basic Sciences, Laboratory personnel: Animal HIV/HBV testing and experimentation.
• College of Agriculture, Laboratory personnel: Animal HIV/HBV testing and experimentation.
• School of Veterinary Medicine, Research laboratory personnel: working with human blood.
• Any employees that are required to respond to medical emergencies and are trained in First Aid and CPR are considered exposed.

CONTROL METHODS

Universal precautions are intended to prevent parenteral, mucous membrane, and non intact skin exposures of workers to bloodborne pathogens. All activities involving contact with human blood or other potentially infectious materials (including the handling of contaminated or potentially contaminated equipment) must be conducted as if dealing with contaminated infectious material. In circumstances in which differentiation between body fluid types is difficult or impossible, all body fluids must be considered potentially infectious materials. When performing activities involving potential contact the following standard practices shall be followed:

• Hands must be washed if there is any likelihood of contact with blood, body fluids or human tissue. If soap and water are not immediately available, an antiseptic towelette will be used as an interim measure.
• Gloves must be worn when contact with any of the following is anticipated or when breaks in the skin are present (Double gloves should be worn to protect breaks in the skin.): blood, body fluid, unfixed tissues, mucous membrane or contaminated surfaces.
• An impervious gown or apron must be worn if splattering of clothing is likely to occur.
• If splattering, atomization or aerosolization is anticipated, appropriate protective equipment (such as a mask and eye protection) must be worn at all times.
• Mouthpieces, resuscitation bags and other resuscitation devices must be made available to workers for use in areas where the need for resuscitation is likely. This includes emergency response personnel.

Engineering controls:
Use engineering controls to reduce the possibility of exposure. Such controls include equipment such as:
          self-sheathing needles
          biosafety cabinets
          autoclaves
          sharps puncture proof containers
          handwashing facilities
          eye wash stations
          biological safety cabinets
          ventilating laboratory hoods
         
Decontaminate equipment by autoclaving or using a 10% bleach and water solution. Autoclaves will be checked by the individual departments, to assure that proper sterilization occurs. Proper instrumentation will be used to verify that time, temperature, and steam are adequate.
    
Departments will review tasks and procedures performed to determine where engineering controls can be implemented or updated.
 
OES will upon request consult with departments to identify:

• areas where engineering controls are currently employed;
• areas where engineering controls can be updated;
• areas currently not employing engineering controls, but where engineering controls could be beneficial.

Work practices

Work practice controls such as those listed in PS 65 should be developed by each department where the potential for contamination exists. Examples of typical procedures include:

• Wash hands each time gloves are removed
• Follow department procedures for specific tasks to minimize exposure
• Do not eat, drink, smoke, apply cosmetics, etc, or handle contact lenses in exposure areas
• Do not store food where potentially infectious materials may be present.
• Label laboratories in which exposure may occur with a biohazard label.

Personal protective equipment

Use proper personal protective equipment. Personal protective equipment is provided by LSU at no cost to an employee with a potential occupational exposure to blood or potentially infectious material. This equipment might include: gloves
          gowns
          face shield/masks
          safety glasses
          goggles
          mouthpieces
          resuscitation bags
          pocket masks
          hoods
          shoe covers
    
The Department Manager or Supervisor will ensure that all work areas have appropriate personal protective equipment available to employees. Employees must be trained regarding the use of the appropriate personal protective equipment for their job classification and the tasks/procedures they perform.
    
To ensure that personal protective equipment is not contaminated and is in the appropriate condition to protect employees from potential exposure, the following practices are utilized:

• All personal protective equipment is inspected periodically by the department manager or supervisor and repaired or replaced as needed.
• Reusable personal protective equipment is cleaned, laundered and decontaminated as needed.
• Single-use personal protective equipment (or equipment that cannot, for whatever reason, be decontaminated) is disposed of through existing practices and procedures as outlined in the Housekeeping section below.

Housekeeping

Properly dispose of materials, using sharps containers or orange, biohazard labeled bags. Refrigerators, freezers, coolers and other containers used to store or transport blood or other potentially infectious materials must be labeled. (Contaminated laundry which is handled using universal precautions does not need to be labeled).

Blood which has been tested and found to be free of HIV or HBV and released for clinical use does not have to be labeled. Regulated waste  which has been contaminated does not need to be labeled.
    
Label and ship properly (see BFI).

Periodically clean various areas where exposure may occur on an established schedule.

MEDICAL SURVEILLANCE

"Hepatitis B Vaccination" Program and procedure for post-exposure evaluation and follow-up have been
established.

Vaccination Program

The vaccination program consists of a series of three inoculations over a six-month period. At the time of the bloodborne pathogen training, occupationally exposed employees will have the opportunity to read and sign a vaccination waiver form that will be turned in to the designated representative in their department (see appendix). Subsequent procedures, depending on their choice, will be coordinated by the department.

Individual departments are responsible for the vaccination program. Employees identified as having a reasonable anticipated risk of exposure to bloodborne pathogens will be registered with each department so that information will be accessible in the event of an emergency. All waiver forms must be completed when applicable and filed by the department. If the employee has received the vaccination at another institution, documentation must be obtained from that institution and filed by the department. The medical release form will also include the name of the institution and the dates of the series. Contact LSU Risk
Management at 388-3285 for further information and assistance.

Post-Exposure Evaluation and Follow-Up

It is important to remember that when an exposure has occurred prompt action is important and may be critical to the affected employee. Post exposure prophylaxis inoculations are effective only when given within a specific time period. If an employee is involved in an incident where exposure to bloodborne pathogens may have occurred, the employee should seek medical consultation and treatment expeditiously. Contact LSU Risk Management at 578-3285.
    
If contact with blood or other potentially infectious material occurs on skin with cuts, rashes, acne or dermatitis, wash the area for 10 minutes with soap and water. If blood or other potentially infectious material splashes in the eyes or on mucus membranes, flush the area for 15 minutes with water or normal saline. Then, report the incident to a supervisor.
    
Contact LSU Risk Management to coordinate treatment at the Student Health Center or other provider. Contact person is Sharon Gonzales (578-3285).

Medical Record keeping for Exposure Information

Risk Management must establish and maintain employee medical records relating to vaccination status of LSU employees. All information is confidential. Social Security numbers must be recorded. Information will not be disclosed without the employee's written consent, except as required or permitted by law.

Information regarding the source individual for the HIV/HBV infection will be managed by Risk Management.

INFORMATION AND TRAINING

All employees who have the potential for exposure to bloodborne pathogens must attend a comprehensive training program.

Employees will be retrained at least annually to keep their knowledge current. Retraining will be geared toward specific departments and job tasks. All new employees, as well as employees changing jobs or job functions, will be given any additional training their position requires by their new supervisor prior to beginning their new job assignments.

OES will maintain documentation that all employees who have potential exposure to bloodborne pathogens have received training.

Training Topics

The topics covered in the training program include:

• the Bloodborne Pathogens Standard;
• the epidemiology and symptoms of bloodborne diseases;
• the modes of transmission of bloodborne pathogens;
• the LSU Exposure Control Plan;
• appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials;
• a review of the use and limitations of methods that will prevent or reduce exposure, including:

            engineering controls, work practice controls, personal protective
equipment selection and use of personal protective equipment including:
types available, proper use, location, removal, handling, decontamination,
disposal;

• visual warning of biohazards including labels, signs and color-coded containers;
• the proper procedures and materials involved in the cleanup of spills of potentially infectious materials;
• information on the Hepatitis B Vaccine, including: its efficiency, its safety,

the method of administration, the benefits of vaccination, availability of post exposure vaccination;

• LSU's vaccination program actions to take and persons to contact in an emergency involving blood or other potentially infectious materials;
• the procedures to follow if an exposure incident occurs, including incident reporting;
• information on the post-exposure evaluation and follow-up including medical consultation;
• recommendations specific to a particular department and unique threats posed by potentially infectious materials in that department.

Training Methods

Training presentations make use of several training techniques including:
     personal instruction;
     videotape programs;
     computer aided interactive training;
     training manuals/employee handouts;
     employee review sessions.

Opportunity for employees to ask questions will be provided.

Trainers will be familiar with the OSHA Bloodborne Pathogen Standard, the LSU Exposure Control Plan, and required elements of the bloodborne pathogen training developed by OES staff.

Record keeping for Training

To facilitate the training of our employees, as well as to document the training process, training records will be maintained and will contain the following:
     Dates of all training sessions;
     Contents/summary of the training sessions;
     Names and qualifications of the instructors;
     Names of employees attending the training sessions.

The training instructor will send a copy of the sign-in form to OES for computerized record keeping purposes.

TREATMENT AND DISPOSAL OF BIOHAZARDOUS WASTE

INFECTIOUS WASTE--waste which contains pathogens with sufficient virulence and quantity that exposure to the waste by a susceptible host could result in an infectious disease.

POTENTIALLY INFECTIOUS WASTE--waste likely to be infectious by virtue of what it is or how it may have been generated in the context of health care or health care like activities. Includes:

• Cultures and stocks of infectious agents and associated biologicals from research and industrial laboratories
• Pathological wastes (human & animal)
• Blood, blood products, collection bags, tubes, vials (human & animal)
• Sharps used or generated in health care or laboratory settings
• Any contaminated disposable material (gloves, towels, etc.)
• SHARPS--needles, syringes, scalpel blades, pipettes, and other medical instruments capable of puncturing or lacerating skin.

TREATMENT OF POTENTIALLY INFECTIOUS WASTE

1. Incineration -- DEQ
2. Steam sterilization -- autoclaving at a temperature of > 120C (248F), and a pressure of at least 15 psi for at least 30 minutes.
3. Thermal inactivation -- dry heat of at least 160C (320F) at atm pressure for at least 2 hours.
4. Chemical disinfection -- the use of a chemical agent must obtain approval from the Office of Campus Safety.
5. Treatment of sharps -- incineration, encasement in plaster (or other product) within a tightly closed container, treatment that renders them unrecognizable as medical sharps.

DISPOSAL OF BIOHAZARDOUS WASTE

• Once treated, Potentially Infectious Waste may be disposed as non-infectious waste in a permitted sanitary landfill.
• Treated but still recognizable Potentially Infectious Waste shall carry a supplemental label specifying the treatment method used, date, and name of the person responsible for assurance of treatment.
• If arrangements have not been made with the School of Veterinary Medicine for disposal of biohazardous material, contact OES regarding disposal.

1910.1030 App A - Hepatitis B Vaccine Declination (Mandatory)

Produced by USDOL OSHA - Directorate of Safety Standards & Directorate of Health Standards

POST-EXPOSURE PROTOCOL:  ATHLETIC TRAINING STUDENTS AND PRE-PROFESSIONAL ATHLETIC TRAINING STUDENTS

In compliance with OSHA bloodborne pathogen regulations and standards, the Louisiana State University Athletic Department adheres to university policies for bloodborne pathogens exposures as per policies approved by the LSU Office of Risk Management.  The Athletic Training Department requires all staff, graduate assistants, athletic training students, and pre-professional athletic training students to adhere to bloodborne pathogens exposure incident policies.  In the event that an accidental bloodborne pathogens exposure does occur with an athletic training student or pre-professional athletic training student, then the exposed individual assumes all medical costs associated with the exposure.  The following steps outline the process for successfully meeting the exposure incident policies (NOTE:  for the following section, “Exposed individual” refers to the person who has been exposed to a bloodborne pathogen.):

1. Wash the exposed body site immediately with soap/hand disinfectant and large quantities of water for at least 10 minutes.  If exposure is to the eyes, use an eyewash or eyewash station to rinse eyes with large amounts of water.
2. Notify the supervising clinical instructor (or designated staff member) immediately.
3. Athletic Training Students and Pre-Professional Athletic Training Students must adhere to the following:
1. The exposed person should have the supervising clinical instructor (or designated staff member) immediately obtain and complete the Exposure Incident Report, and then submit to the Director of Athletic Training immediately upon completion:
2. The Director of Athletic Training (or designated staff member) will receive the information outlined in #3a above and will create a personal file for each exposure incident. 
3. The Director of Athletic Training (or designated staff member) will also place the “Exposure Follow-up Record” form in the file to be completed throughout the post-exposure evaluation process.
4. The Director of Athletic Training (or designated staff member) will meet with the exposed individual to complete the “Exposure Incident Protocol” form.  This form will be placed in the individual’s exposure incident file.
5. The Director of Athletic Training (or designated staff member) will meet with the exposed individual’s supervisor to locate the source individual (if applicable) and complete the “Identification and Documentation of Source Individual” form.  The completed form will be placed in the exposed individual’s incident file.
6. The exposed individual (athletic training student or Pre-Professional Athletic Training Student) must provide a blood sample within 24 hours of exposure incident.  This is drawn by a healthcare professional at the LSU Student Health Center for initial testing and post-exposure follow-up and consultation.  If the exposed individual gives voluntary consent to HBV/HIV antibody testing, the testing will take place as soon as possible (within 48 hours of exposure).

• If the LSU Student Health Center is closed during the 24 hour period post-exposure, the exposed individual may find an alternate healthcare facility to complete the initial blood sample and initial consultation. 

7. Documentation from the LSU Student Health Center must be submitted to the Director of Athletic Training (or designated staff member) prior to the student’s return to clinical activities, which will only provide specific information as it pertains to the exposed individual’s clearance to resume normal activities in the clinical setting.
8. If testing is administered and the results of the HIV are seronegative, then test will be repeated at the following intervals:  3 months, 6 months, and 12 months. The exposed individual is responsible for making and following up with these requested intervals.
9. Counseling for the exposed individual will be available from a designated counselor employed by the LSU Athletic Training Department or staff at the LSU Student Health Center.  The student may choose counseling services outside of the University.  Counseling will include understanding the potential risk of infection and to make decisions regarding the protection of personal contacts.
10. The Director of Athletic Training (or designated staff member) will provide the LSU Student Health Center and/or counselor the following information for review:

•  “Exposure Incident Report” form
• “Identification and Documentation of Source Individual” form
• Bloodborne Pathogens Policy of the LSU Athletic Department

11. The exposed individual will be responsible for submitting all medical records relevant to the appropriate treatment, including the exposed individual’s vaccination status (if requested by the LSU Student Health Center).
12. The exposed individual should take note of the following important information after completion of the post-exposure evaluation:

• Most reported seroconversations have taken place within 6-12 weeks.  The exposed individual should take proper precautions during the initial 12 weeks to prevent possible transmission of HBV/HIV to others.  The CDC and Surgeon General recommend proper precautions to include:
• Do not donate blood or plasma.
• Inform potential sex partners of possible exposure so that adequate precautions may be taken.
• Avoid pregnancy.
• Inform physicians, dentists, and other health care workers if potential exposure when seeking medical care so that proper precautions may be taken.
• Clean up and disinfect any spills of your blood or bodily fluids.
• Refrain from sharing items that may be contaminated with blood, such as razors or toothbrushes.