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Exposure
Control Manual
The following is
a reprint of the Report of the UW
Advisory Committee on Bloodborne Pathogens to Milo Gibaldi, 21 June 1994 Regarding
Proposed Revision of University of Washington Infection Control Policies Concerning
Health Care Providers Infected with Bloodborne Pathogens.
UNIVERSITY
OF WASHINGTON INFECTION CONTROL POLICIES CONCERNING HEALTH CARE PROVIDERS
INFECTED WITH BLOODBORNE PATHOGENS
The health care institutions of the University
of Washington are dedicated to providing medical care of the highest quality.
The doctors, dentists, nurses and other health care providers who work
in UW institutions are guided by a professionalism which includes service
to others and the principle that one must "do no harm." The health
care environment has always presented the risk of injury or illness to
both patients and providers as a consequence of medical care. For this
reason, all health care institutions have programs designed to minimize
risk, including infection control programs.
In the early 1980s, the AIDS epidemic added
a new dimension of risk to patients and providers. In response, the University
of Washington Health Sciences embarked on a still more comprehensive effort
to minimize the spread of infection. This effort included new policies
and procedures designed to protect health care providers and patients from
being accidentally infected during the course of treatment. Implementation
of these policies and procedurs is particularly important for containing
the transmission of human immunodeficiency virus (HIV), a bloodborne virus
which is currently incurable and generally fatal. The transmission of HIV
from patient to provider has been well documented.
Although HIV is more easily transmitted
from infected patients to providers, the smaller but definite risk that
this virus, as well as hepatitis B (HBV), can be transmitted from infected
providers to patients cannot be ignored. Because of this risk, the following
guideliens, based in part on the the report of the Subcommittee on Health
Care Providers with Immunodeficiency Virus, have been developed so tht
the University of Washington affiliated institutions can write responsible
infection control policies that will further minimize the risk of HBV and
HIV transmission in the workplace.
POLICIES
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Health Care Providers, defined as traditional
health care professionals, as well as student sand trainees, shall strictly
adhere toinstitutional policies and procedures for infection control. These
policies and procedures are found in the relevant infection control manuals
of each Medical Center. The institution will work the individuals whose
special needs may require modified barrier protection. Employees who fail
to practice these procedures are subject to disciplinary action based on
the circumstances of the event. Body Substance Isolation (BSI) is the standard
for infection control at the Univeristy of Washington Medical Centers.
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The academic departments, medical centers,
dental clinics, and Hall Health Student Center shall ensure that all Health
Care Providers receive appropriate training in infection control policies,
Body Substance Isolation and transmission and prevention of bloodborne
infections.
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Any Health Care Provider who experiences a
break in infection control technique which results in the exposure of a
patient to the Provider's blood should know or learn his/her serostatus.
In the event that the Provider is hepatitis B and/or human immunodeficiency
virus seropositive, the provider shall ensure that the patient is notified
that a blood exposure has occurred and is offered hepatitis B virus and/or
human immunodeficiency virus testing, counseling and prophylaxis, where
applicable. Whenever possible, the anonymity and confidentiality of the
source provider should be protected.
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Providers are not required to undergo serologic
testing for human immunodeficiency virus. Those Health Care Providers whose
duties are likely to expose them to a patient's blood or other body fluids
shall receive hepatitis B virus vaccine, show proof of protection, or have
a signed waiver on file in their appropriate department, and are encouraged
to consider voluntarily being tested for human immunodeficiency virus.
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Education regarding infection control practices,
communicable infections and diseases, and relevant University benefits
and programs shall be made available to all employees. On request, or as
necessary, counseling and appropriate referrals shall be provided to employees
regarding actual or potential exposures to communicable and infectious
diseases.
Employee Health benefits which the University
provides include Hepatitis B vaccine, immunizations, and, following occupational
exposure, confidential human immunodeficiency virus counseling and testing.
Health insurance, life insurance, and long
term disability (LTD) policies are provided by the University for all employees
and several optional LTD insurance plans are available for purchase by
employees. Employee's salaries are covered, in part, by State of Washington
Workers' Compensation for work related disabilities. Additional coverage
specific to Health Care Providers may be added as it becomes available.
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Certain surgical and dental procedures have
been reported in connection with the transmission of hepatitis B virus
from Health Care Providers to patients. To date, whenever the circumstances
of these transmissions have been investigated, the health care provider
associated with the transmission has been hepatitis B e antigen positive
(HBeAg+). Current scientific data provide insufficient documentation to
determine whether these or other procedures may lead to transmission of
human immunodeficiency virus from an infected Provider to a patient or
of hepatitis B virus to a patient from a hepatitis B surface antigen positive,
e antigen negative provider. However, any procedure that results in exposure
to a Health Care Provider's blood requires us to assume there is a risk
for transmission of any bloodborne pathogen. Therefore, Health Care Providers
who are hepatitis B surface antigen positive (HBsAg+) and hepatitis B e
antigen positive (HBeAg+) and/or human immunodeficiency virus seropositive
shall not perform any procedures which entail a significant risk of exposing
the patient to the provider's blood without prior consultation with the
University of Washington Advisory Committee on Bloodborne Pathogens.
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The University of Washington Advisory Committee
on Bloodborne Pathogens, established by the Vice President for Health Sciences,
is available to provide consultation to human immunodeficiency virus/hepatitis
B virus infected employees and students and their supervisors, administrators,
and credentialing committees regarding job requirements and workplace accommodation.
Health Care Providers may seek counsel from this committee before choosing
to disclose their human immunodeficiency virus/hepatitis B virus status
to their supervisor. The supervisor shall be responsible for defining job
requirements and providing reasonable accommodation.
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The course of study of a student or trainee
who is hepatitis B surface antigen positive and hepatitis B antigen positive
and/or human immunodeficiency virus seropositive and whose training requires
the performance of procedures that may expose a patient to the student's
blood shall be reviewed by the academic department or program and the Dean
to modify or exclude performance of these procedures whenever possible.
Every effort will be made to provide reasonable accommodation for each
student. Academic counseling shall be made available to students or trainees
who choose to alter their course of study.
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Confidentiality of all information pertaining
to these policies, including, but not limited to, knowledge of occupational
exposures, Providers' health status, requests for counseling or job accommodation,
or modification of an academic program, shall be strictly maintained in
accordance with state and institutional guidelines. Failure to maintain
confidentiality shall be grounds for disciplinary action.
The application of these policies shall reflect
a case by case approach, taking into account the unique characteristics of
each Provider and each job, and changes in the Provider's health status and
job requirements. This document shall be revised whenever appropriate to
reflect new medical and research findings and relevant policies and legislation.
06/20/91
VPHS
Revised 07/92
Revised 02/93
Revised 06/94
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