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HomeMy WebLinkAboutSOG 108.04 REVISED 7-2017_Occupational Exposure Reporting108.04 — Occupational Exposure Reporting Effective. 6/1/1999 Revised: 7/5/2017 Replaces: SOG 108.01 C I. Guiding PhilosophX Safety and accident prevention is everyone's job. National occupational safety and health standards have traditionally held that roughly 95% of all workplace accidents are by someone (by their action or inaction) at the employee, supervisor, manager, and/or at the organizational level. We are committed to working together and doing our best to: 10 Minimize accidents, injuries and exposures. 10 Create and sustain a "11'lllllllllNIK WSJ 1FIE11VI1 IFIlllS`11' culture based on our managed -risk philosophy. II. Purpose The purpose of this policy is to provide a standard process for minimizing the risk of, and communicating responsibilities related to, on -duty infectious disease and hazardous materials reportable exposures. III. Goals The goals of this policy are to: A. Detail prevention, reporting and documentation requirements and responsibilities for reportable occupational exposures. B. Provide guidance for remedial and/or corrective actions and disciplinary recommendations related to occupational exposures. IV. Definitions A. Accident — Damage or injury that occurs because of a risk that is poorly managed. B. Accountability — The obligation of an individual or organization to account for and justify one's actions and/or decisions, to accept responsibility and associated consequences, and to disclose the outcomes in a transparent manner. C. Aggravating Factors — Any facts regarding the circumstances surrounding an accident, injury or exposure that may increase responsibility for the occurrence. D. Air -borne Disease — Spread when droplets of pathogens are expelled into the air due to coughing, sneezing or talking. Many of these diseases require prolonged exposure for infection to occur, posing only minimal threat to emergency responders. However, there are preventive measures, such as wearing masks or maximizing ventilation, that help reduce these risks. Air -borne diseases of concern to emergency responders include meningitis, chicken pox, tuberculosis (TB), and influenza. E. Blood-borne Disease — A transmissible organism that replicates in the blood. The major transmission route is blood contact, but can also be from other body fluids that are indirectly linked with blood such as: semen, vaginal secretions, or a body fluid or substance containing blood. F. Confirmed Exposure — Cases where both of the following are TRUE: 1. A reportable infectious disease or detectable hazardous material is present, and has been confirmed by medical testing or environmental monitoring AND 2. A responder has had unprotected contact through a defined portal of entry. G. Damage — Cost of medical treatment + Cost of repairs + Cost of lost time. H. Duty Period — Shift that an individual was working (8 -hour, 10 -hour, 12 -hour, 24-hour). I. Exposure — Unprotected contact with a reportable infectious disease or detectable hazardous material resulting in a medically -recognized risk of disease transmission or injury. Fit for Duty — An individual is in a physical, mental, and emotional state which enables him/her to perform the essential tasks of his/her work assignment in a manner which does not threaten the safety or health of oneself, co-workers, property, or the public at large. K. Hazardous Material — Biological, chemical, radiological, and/or physical items or agents which have the potential to cause harm to humans, animals, or the environment, either by itself or through interaction with other factors. Hazardous materials are defined and regulated in the United States primarily by laws and regulations administered by the U.S. Environmental Protection Agency (EPA), the U.S. Occupational Safety and Health Administration (OSHA), the U.S. Department of Transportation (DOT), and the U.S. Nuclear Regulatory Commission (NRC). Each has its own definition of a "hazardous material." L. HBV — Acronym for the Hepatitis B virus; a virus that infects the liver. M. HCV — Acronym for the Hepatitis C virus; a virus that infects the liver. SOG 108.04 — Occupational Exposure Reporting Page 2 of 13 N. HIV — Acronym for the Human Immunodeficiency Virus; virus that causes acquired immune deficiency syndrome (AIDS), the most advanced stage of HIV infection. O. Immediate Supervisor — Person who was directly responsible for supervising the exposed individual at the time the exposure occurred. P. Lost Time Iniury —Injury sustained by an employee that will ultimately lead to the loss of productive work time in the form of worker delays or absenteeism. Q. Major Injuries — Those injuries requiring hospital admittance (firefighters or citizens). R. Minor Injuries — Those injuries to persons that require first aid only. S. Mitigating Factors — Any facts regarding the circumstances surrounding an accident, injury or exposure that may decrease responsibility for the occurrence. T. Moderate Iniuries —Those injuries that require the fire fighter to miss more than one Duty Period. U. Occupational Exposure to an Air -Borne Pathogen (TB, Meningitis, etc.) — Unprotected contact with an air -borne pathogen while on -duty resulting in medically -recognized risk of disease transmission. For disease transmission due to air -borne pathogens to occur an Exposure must include BOTH of the following: 1. A confirmed exposure from a patient suffering from a reportable infectious disease contractible through air -borne means. 2. Unprotected responder(s) (not wearing a mask) who have been proximate enough to the patient described above to inhale droplets of pathogens. V. Occupational Exposure to a Blood -Borne Pathogen (HIV, HBV, HCV) — Unprotected contact with a blood borne pathogen while on -duty resulting in medically -recognized risk of disease transmission. For disease transmission due to blood borne pathogens to occur (HIV, HBV, HCV), an Exposure must include BOTH of the following: Confirmed presence of infectious body fluid a. uIt ' TILINSMI 111L 11!11 lull, I � r: Blood semen vaginal ................................................................................................................................................................................................................................................................. fluids, breast milk, cerebrospinal fluid, peritoneal fluid, pleural fluid or synovial blood. b. �IU�'1VI 1VI I�CG� �" �1VC1�1'1VI' l�[�1�[1� l�ll�113 : Saliva, vomitus, urine, l�f��11U� I�� , � , ���iP�� �,1I�"i' l�l���l�[l�f,W"i' 1�IUal�Ci�.... feces, sweat, tears, respiratory secretions (unless visibly bloody). The risk of HBV or HCV transmission from non-bloody saliva is negligible. SOG 108.04 — Occupational Exposure Reporting Page 3 of 13 2. A Portal of Entry a. Percutaneous (i.e. Needlestick) b. Mucous Membranes (i.e. Mouth, Nose, Eyes) c. Cutaneous with Non -Intact Skin (i.e. Open wounds that are not covered or bandaged). � F B 01 1 F A C Ti 0 R S A R E IIIA 01 IR R E S E I11.4 T T I E R E I III Ill F DISE T IIIII I� II ! ............................................................................................................................................................................................................................................................................................................ No risk of transmission means that a Reportable Exposure DID NOT Occur. Further evaluation IS NOT required. W. Occupational Exposure to Hazardous Materials — Unprotected contact with detectable hazardous material while on -duty resulting in a medically -recognized risk of disease transmission or injury. For disease transmission or injury due to hazardous materials to occur, an Exposure must include BOTH of the following: 1. Environmental presence of detectable hazardous materials. 2. Portal(s) of Entry: a. Inhalation b. Absorption c. Ingestion d. Injection X. Occurrence — Single case or instance (of an accident, injury or occupational exposure). Y. Personal Protective Equipment (PPE) — Specialized clothing or equipment worn by an employee for protection against a hazard. Membersiim a the iii ilio Ipaiiia to reduce the risk of exIposwioe by iii iiiag piootective equiIpirneintiiil bl the statioins aindiii thefilo aIpIpaioatusl • The Department has authorized the use of first-aid equipment (band-aids, bandages, etc.) to cover open wounds on members' bodies while on -duty as a preventative measure. • Remember to cover ALL cuts or weeping abrasions, including those on lower extremities (in case of kneeling in contaminated fluids while providing treatment). Use the mask/eye shield combo provided to reduce the risk of body fluid contact with mucous membranes. SOG 108.04 — Occupational Exposure Reporting Page 4 of 13 Z. Possible Exposure — Cases where either: A reportable infectious disease or environmental hazardous material may be present, but has not yet been confirmed/denied by medical testing or environmental monitoring, or 2. A responder believes he/she may have had unprotected contact with a reportable pathogen or an environmental hazardous material. AA. Preventable — When an individual, group or supervisor(s): 1. Commits errors and/or fails to react reasonably to the errors of others. 2. Should have known about a potential hazard, but didn't. Have some responsibility for either: a. Causing, b. Failing to prevent, and/or c. Contributing to an injury, accident or exposure occurrence. BB. Reportable Exposure — Includes the following: Transmittal of reportable infectious body fluids (blood, semen, vaginal fluids, breast milk, cerebrospinal fluid, peritoneal fluid, pleural fluid or synovial blood) of a patient onto: a. MUCOUS .11i1E11i1KII .�E (mouth, nose, eyes) of the emergency services provider. b.�-liili . of the emergency services provider. 2. Any non -barrier protected contact of the emergency services provider with: a. MUCOUS 11i1E11i1KII .�E or .,�1�_ �JI.���h l���T � ICI.�� of a patient. b.released from a patient. c. 11AZAIUDOUS HATEIVINLS. 3. Any person to person contact in which a co -mingling of bloody respiratory secretions (saliva and sputum) between the patient and the emergency services provider may have taken place. V. Exposure Prevention, Reporting & Related Responsibilities A. Members will refer to and comply with 1.0 1 3 Uu )u„I.......,,....! � PI JR.!.�. PREVENTIONINFECTION CONTROL to minimize the risk of exposure and ........................................................................................................................................................................................................... disease. B. If a Member believes that he/she may have been possibly exposed to a reportable disease or hazardous material in the course of his/her j ob duties, he/she will: 1. Take immediate precautions to prevent further exposure to self and others. SOG 108.04 — Occupational Exposure Reporting Page 5 of 13 2. Immediately notify his/her immediate supervisor. 3. Complete and submit all required documentation prior to the end of his/her shift. 4. For confirmed exposures to reportable infectious diseases and as indicated by Public Health Department protocol, provide a baseline blood draw. ll,,,,ocations Ip r iiid'liiu g Ilblllood diraws cure noted liiunIli. iii 'iillll;�, IIIA �II� u�m u�mll� ur li u�,,,duty, Ilblll d dir w imust IIS urd'liiun t d' w tllh flI u�,,,duty 11)qputy GlKlef, C. The Immediate SUnervisor will: 1. Take immediate precautions to prevent further injury to self and others. 2. If required, insure that the member receives appropriate medical attention. Notify Fire Communications. If not linked with an existing incident, the Dispatcher will generate an event for the unit that the member was assigned to at the time of occurrence. 4. Conduct an initial inquiry of the events leading up to the exposure. The inquiry should determine the following: a. The cause(s) of the exposure. b. The relevant events leading up to the exposure. c. Any unsafe conditions which contributed to the exposure. d. Actions of the member which may have contributed to the exposure. e. Witnesses to the exposure. Instruct each witness to prepare comprehensive and detailed the On Duty Accident Injur LlExposure SuMlemental Statement of how the exposure occurred, and their involvement. f Recommendations to prevent a similar incident from recurring in the future. 6. Email an initial report summarizing the information gathered above to his/her chain of command, up to and including the Fire Chief. 7. Complete and submit all required documentation prior to the end of his/her shift. D. Fire -EMS Communications will notify and provide a brief description of occurrence to the following: 1. Member's on -duty Deputy Chief (or ranking member of that Section if not Operations) 2. City's Workers Compensation/Safety Coordinator SOG 108.04 — Occupational Exposure Reporting Page 6 of 13 3. Beaumont EMS Supervisor on -duty (M501) 4. BFR EMS Program Manager E. The on -duty Deputy Chief will insure: When notified of a Confirmed Exposure CIII When a Possible Exposure occurs at night or on the weekends CIII Anytime a member is very concerned about a possible HIV exposure: a. Coordinate with the Worker's Compensation/Safety Coordinator on the blood draw facility to utilize and the number of exposed member(s) requiring blood draw (Refer to Appendix B Baseline Blood Draw Locations). CONTACT INFORMATION FOR CITY WORKER'S COMPENSATION/SAFETY COORDINATOR MONDAY -FRIDAY, 0800-1700 HOURS 880-3777 AFTER HOURS, WEEKENDS & HOLIDAYS Cell phaine iii iirn b r is fin Dq:)uty Chief's offiii Ffire-EMS Carmirnwinicatians b. h II,IIIII , ireirnilnd Ciity WCl afety Coordinator ,, „, r insuire access o Iprolphylllactliic auntuiblotliics as pop. a§ [ , 'iillb. 12 gll , '„ wiiitllbliiun "Z' Ihouurs of ex osuure liif tllhme ex osuure Iiia C IISIII°°Illlllllllf;;°,Ilf;l, .......................................u.........................................................II............................................................................................................................................ c. Insuirebasdine I Illood draw has been coormmpl t d pirioirtothe end oUthe exposed ormm ormmlbeir(s) shift. 2. The reportable exposure is managed per this policy (See Appendix C for condensed exposure management flow chart). 3. Contact BFR Medical Program Manager or chain of command if issues arise. F. BEMS M501 will brief the Public Health Director on the reportable exposure. G. The Public Health Director will insure: 1. Notification of the receiving hospital and request that testing of the source person (SP) be performed, when necessary. 2. Confirmation of positive test results and any medical follow-up actions that are needed are communicated to: a. Source Person (SP) b. Exposed Person(s) SOG 108.04 — Occupational Exposure Reporting Page 7 of 13 c. City's Workers Compensation and Safety Coordinator d. Fire Department EMS Program Manager 3. Recommend prophylaxis/treatment, if advised by standard protocol for the particular pathogen. Ilh ,IIS,III°°,III,IIIIII;;;;'IIC,III,,,IIIIIII,,,„iiru liiuurIlhm ulllll(s) are provided iiaccess tIpiir llpll� 111 fm uatliiblotli pu.i a§ ( J.1b. 1..e a..ii.1 d. it1-lbIiiln............II�. iir :._ :f... .Il . llr 4. Court-ordered mandatory testing of persons suspected of exposing medical response personnel to reportable diseases, including HIV infection (Texas Health & Safety Code, Chapter 81, Section 3.12) is initiated, if required. 5. Adherence to exposure procedures & protocols developed by the Texas Department of State Health Services. H. City Workers Compensation and Safety Coordinator will: 1. Notify the facility that is to be used for the baseline blood draw with the number of personnel having blood drawn. 2. Coordinate with Public Health Director, on -duty Deputy Chief, BFR EMS Program Manager and Fire Administration Staff, as necessary. 3. If recommended by Health Department standard protocol for the particular pathogen, refer the employee(s) to a physician to direct follow up III III°°Ill 111 llf;;°,Ilf; „III°�IIIIII .. iir a lI nsuir tlI ugll�lll () are Ip r iiid' d' treatment. II ` ...... ..... access Ipiir llpll� 111 Ilii uwtliilb�lotlii ,s..o o ii.i, ; ,[., ;l,llb,,l,,,,,a,.i,dw,i..,llJ,i,i,,u] ",I,lio uur,,,f P. Uur, I. The Fire Department EMS Program Manager will: 1. Notify exposed member(s) and Fire Administration of the result of Source Person (SP) test findings. 2. IIS ......V III° IIIIII II III;;;;';III;; „III,,,IIIIII /„ Uur a liinsuir tlI ii mplll () cure Ipr iiidd access pier llpll� 111 tm ntmblii tm ,,,, ,n.,,,, , ;,,,:f ; iilll 111 ,,,, ilk, ',,,, iiitl�,Iii,l.n.,,,,,, , ,,,,lhouir ;,,,, ;:f,,,, Uur , Coordinate with the member, on -duty Deputy Chief, Public Health Director and staff, City Worker's Compensation/Safety Coordinator, and Fire Administration staff during this process to insure quality assurance and improvements to these procedures, as required. J. The Fire Chief, Section and Medical Branch Chiefs, and Administration Staff will: 1. IIS ,,,,,,,,,,,II ,III°°,III,III II III;;;;';III;; ,III,,,IIIIII , ,gllr a liinsuir tlI ii mll�lll () are Ipr iiid' d' accessto pier llpll� 111 tm u� tm blii tm In f iilll�lll u�d' wiiitllKlii un '7 Ihouir � sur , ......... ......... ......... .................. 2. Review recommendations on improving this procedure. SOG 108.04 — Occupational Exposure Reporting Page 8 of 13 3. Bring stakeholders together to come to consensus on recommendations. 4. Implement consensus recommendations. VI. Exposure Documentation Requirements A. For an employee to qualify for worker's compensation, the employee claiming occupational exposure must insure that: The exposure has been reported to the City Public Health Department within 72 hours of occurrence. 2. A sworn affidavit documenting the date and circumstances relating to the exposure has been completed. Within ten (10) days after the exposure, the employee had a test result that indicated an absence of reportable disease (reportable infectious diseases only). B. The immediate supervisor will submit the required documentation packet to the Deputy Chief on -duty prior to the end of his/her shift. Forms may be found at: G.\Shared Folder\➢Ea'orms. C.IIS AZARl'S TE III III II,,,S IE IP S R E IIC ICS III T TIII III II IE III II IE IIS II 1. 4:,1l1111. OF ilii",ili I� I lu I ilii iliililS"I iliilil� ilililMlRl 1111' [Completed by n..n;ne,nl�....:s:11. en1 vnson"] 2. INJURY i NVES"Il1lilii "Il IO ilililUlR11111' [Completed by n..n i-nedi.ale....,s;...,.. end] N-11) I i l: l: iliilil�ili 1 1C IIS ilii 11 .ili I�Sl� ililili Sly ili ili ili�ili lilt l i ilii STATE11 E T [Completed by posed rnernberf s) and a..c1n wjt.fle,;ss,es to the occurrence] D.II1HINPI 1IECT I S 11Y11SEASE EXPOSURE IIC ICS III T TIII III II IDIII II IIS I� II TS 1. 4:,1l1111. OF ilii",ili I� I lu I ilii iliililS"I iliilil� ilililMlRl 1111' [Completed by n..n :n :e.d.j l.�....:s:11. en1 vn son"] 2. INJURY i NVES"Il1lilii "Il IO ilililUlR11111' [Completed by n..n:n:e.dn:.ale....s:...,.. end] SOG 108.04 — Occupational Exposure Reporting Page 9 of 13 3. ON-11H)TV STATEMENT [Completed by posed rncrnbcrLs) and each witnesses to the L -------- .................................................................................................. occurrence] 4. BIN[t IMPOSUME IVE1110111' [Completed L by exposed rncrnbcr(s).1 ....... 5. INUM""TIOU S INKEAWE NNNUBAVI'T [Completed by exposed rn crnbcrf s).1 6. INKEAWE [Completed L bygxnoscd rncrnbcr(s).1 ....... E. The Immediate Supervisor of the exposed member(s) is responsible for: 1. Conducting the initial inquiry of the events leading up to the exposure. 2. Emailing an initial report to his/her chain of command, up to and including the Fire Chief. 3. Accurately and completely documenting the cause and applicable preventative actions relating to the exposure on required forms. 4. Completing an NFIRS report and associated casualty reports for each person exposed. 5. Quality checking the forms and reports for accuracy and correcting any deficiencies. 6. Submitting the required forms packet to his/her Deputy Chief j1p. [10ir to tjme end of IKlsfly eiirsIKlft. .......................................................................................................................... E. The Deputy Chief on -duty is responsible for: 1. Insuring all required forms and reports are completed. 2. Quality checking forms and reports for accuracy and insuring deficiencies are corrected. 3. Submitting the forms packet to Fire Administration no later tjan tl�e inext lb u al..n. gs s d.u. F. The Fire Chief and Administration Staff are responsible for: 1. Reviewing forms for completeness and accuracy and insuring deficiencies are corrected. SOG 108.04 — Occupational Exposure Reporting Page 10 of 13 2. Entering of pertinent data into the TCFP injury reporting system. Routing appropriate exposure documentation and reports to: a. City Human Resources Department—Worker's Compensation/Safety Coordinator b. City Public Health Department c. City Attorney's OfficeLiability Administrator 4. Coordinating with Human Resources department on worker's compensation issues. Insuring adherence to City policies: a. 3.6 — Worker's Compensation/Accident Reporting b. 3.9 — Infectious Disease in the Workplace VII. Options for Corrective Action and/or Disciplinary Recommendations A. Retraining is an example of remedial corrective action, and is not considered discipline. Remedial corrective actions may be recommended alone, or in conjunction with, discipline. B. Members should be aware discipline can be imposed when violations of civil service law and/or rules, or department rules, regulations or guidelines are sustained, regardless of the disposition of alleged criminal charges. C. Violations and corresponding corrective actions and/or minimum recommended discipline are indicated in Appendix A. Consequence recommendations for fourth and subsequent accidents will be considered on a case by case basis. D. Mitigating and aggravating factors are those which would cause employees to deviate, in an exaggerated manner, from normal behavior. In these cases, the factors involved will be considered by the Investigator, the Safety Committee and the Disciplinary Review Board (DRB). If the Safety Committee and/or DRB determine that sufficient cause exists, these factors may be cited to recommend corrective actions and/or discipline outside of the established discipline levels. 2. Deviation from normal disciplinary levels will be the exception to the rule and will be limited to rare and unusual situations. 3. If the Safety Committee and/or DRB use aggravating or mitigating factors to deviate, they shall provide written justification to the Fire Chief. E. Per civil service law, suspensions in excess of 15 days are offered at the discretion of the Fire Chief, and are not subject to appeal. Any offers that are refused will revert to indefinite suspension. SOG 108.04 — Occupational Exposure Reporting Page 1 1 of 13 Appendix A – Consequence Matrix—Exposure Violations Consequence Matrix—Exposure Violations (Per civil service law, suspensions are in calendar days) *Maximum consequence is up to and including indefinite suspension, based on the circumstances. Violation First Offense Second Offense Third Offense Gross disregard of safety procedures Fifteen (15) day Thirty (30) day Sixty (60) day resulting in exposure to person(s) suspension suspension suspension Failure to maintain an acceptable exposure Six (6) day Twelve (12) day Twenty-four (24) safety record suspension suspension day suspension Failure to complete routine safety checks of Written Two (2) day Four(4)day vehicles or equipment, resulting in exposure to person(s) Reprimand suspension suspension Failure to properly supervise members Written Two (2) day Four(4)day assigned under his/her supervision Reprimand suspension suspension Written Two (2) day Four(4)day PIliININ1PAU11i exposure Reprimand suspension suspension *Examples cited above are not all inclusive and as such are not limited to those listed above. Appendix B – Baseline Blood Draw Locations (updated 4/2017) • City of Beaumont Heallth Department (3040 College Street) o Hours: 0800-1700 Monday -Friday • Beaumont Farnli]y Practice (6450 Folsom Drive) o Hours: 0800-1700 Monday -Friday • Baptist Hospitalll Emergency (3080 College Street) o 24-hour operation • Clhrliistus-St. Elllliiz:allbefhm HospitWErnergency (2830 Calder) o 24-hour operation SOG 108.04 — Occupational Exposure Reporting Page 12 of 13 Appendix C — Exposure Management Flow Chart (Refer to SOG 108.04 for detailed guidance) Ipmeuend i�IlPds er emgpae�alr-. Irmlmmadiia�PYI PIECIW�II'E'L'�e �������II�I�I���III��IIIIIII���/IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�������������� IIIIIIIII IIIIIIIII IIIIIIIII „I meriduuNhamam9pu�eulre6,Ipurfmodemedical afirisban,dnaedlad. mea* Fha EIUS Cmrmu6m9mm. Unhi& nialll gmIm*g & compWE dDcanEnbimn Per,poky. 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SOG 108.04 — Occupational Exposure Reporting Page 13 of 13