Blood. Human blood, human blood components and products made from human blood. Also included are medications derived from blood, such as immune globulins, albumin, and factors 8 and 9.

Bloodborne pathogens. Pathogenic microorganisms that are present in human blood and can cause disease in humans. Examples of these pathogens include:

(a) Human immunodeficiency virus (HIV);

(b) Hepatitis B virus (HBV);

(c) Hepatitis C virus, malaria;

(d) Syphilis;

(e) Babesiosis;

(f) Brucellosis;

(g) Leptospirosis;

(h) Arboviral infections;

(i) Relapsing fever;

(j) Creutzfeld-Jakob Disease;

(k) Human T-lymphotrophic virus Type I;

(l) Viral Hemorrhagic Fever.

Clinical laboratory. A workplace where diagnostic or other screening procedures are performed on blood or other potentially infectious materials (OPIM).

Contaminated. The presence or the reasonably anticipated presence of blood or other potentially infectious materials (OPIM) on an item or surface.

Contaminated laundry. Laundry that has been soiled with blood or other potentially infectious materials (OPIM) or may contain contaminated sharps.

Contaminated sharps. Any contaminated object that can penetrate the skin including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires.

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.

Exposure incident. A specific eye, mouth, other mucous membrane, nonintact skin or parenteral contact with blood or other potentially infectious materials (OPIM) that results from the performance of an employee's duties. Examples of nonintact skin include skin with dermatitis, hangnails, cuts, abrasions, chafing, or acne.

Handwashing facilities. A facility providing an adequate supply of running potable water, soap and single-use towels or air drying machines.

Licensed health care professional. A person whose legally permitted scope of practice allows him or her to independently perform the activities required by this rule.

Needleless systems. A device that does not use needles for any of the following:

(a) The collection of bodily fluids or withdrawal of body fluids after initial venous or arterial access is established;

(b) The administration of medication or fluids;

(c) Any other procedure involving the potential for occupational exposure to bloodborne pathogens due to percutaneous injuries from contaminated sharps.

Occupational exposure. Reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or OPIM that may result from the performance of an employee's duties.

Other potentially infectious materials (OPIM). Includes all of the following:

(a) 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.

(b) Any unfixed tissue or organ (other than intact skin) from a human (living or dead).

(c) 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.

(d) Blood and tissues of experimental animals infected with bloodborne pathogens.

Parenteral contact. When mucous membranes or skin is pierced by needle sticks, human bites, cuts, or abrasions.

Personal protective equipment (PPE). Specialized clothing or equipment worn by an employee for protection against a hazard. General work clothes (for example, uniforms, pants, shirts, or blouses) not intended to function as protection against a hazard are not considered to be PPE.

Production facility. A facility engaged in industrial-scale, large-volume or high-concentration production of HIV or HBV.

Regulated waste. Regulated waste is any of the following:

(a) Liquid or semiliquid blood or other potentially infectious materials (OPIM);

(b) Contaminated items that would release blood or OPIM in a liquid or semiliquid state, if compressed;

(c) Items that are caked with dried blood or OPIM and are capable of releasing these materials during handling;

(d) Contaminated sharps;

(e) Pathological and microbiological wastes containing blood or OPIM.

Research laboratory. A laboratory producing or using research-laboratory-scale amounts of HIV or HBV. Research laboratories may produce high concentrations of HIV or HBV but not in the volume found in production facilities.

Safer medical devices. Medical devices that have been engineered to reduce the risk of needle sticks and other contaminated sharps injuries. These include not only sharps with engineered sharps injury protections and needleless systems but also other medical devices designed to reduce the risk of sharps injury exposures to bloodborne pathogens. Examples include blunt suture needles and plastic or Mylar-wrapped glass capillary tubes.

Secondary duty. Any job expectation outside the primary job duties assigned to that position.

Sharps with engineered sharps injury protections (SESIP). A nonneedle sharp or a needle device used for withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids, with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident.

Source person. A person, living or dead, whose blood or other potentially infectious materials may be a source (OPIM) of occupational exposure to the employee. Examples include:

(a) Hospital and clinic patients;

(b) Clients in institutions for the developmentally disabled;

(c) Trauma victims;

(d) Clients of drug and alcohol treatment facilities;

(e) Residents of hospices and nursing homes;

(f) Human remains;

(g) Individuals who donate or sell blood or blood components.

Standard microbiological practices. Standard microbiological practices refer to procedures comparable to those outlined in the current edition of the Center for Disease Control "Biosafety in Microbiological and Biomedical Laboratories."

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. According to the concept of universal precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens.

This chapter provides requirements to protect employees from exposure to blood or other potentially infectious materials (OPIM) that may contain bloodborne pathogens. Examples of bloodborne pathogens are the human immunodeficiency virus (HIV) and hepatitis B virus (HBV).

This chapter applies to you if you have employees with occupational exposure to blood or OPIM, even if no actual exposure incidents have occurred.

Occupations that are typically covered by this chapter. The following list illustrates a number of jobs typically associated with tasks that involve occupational exposure to blood or OPIM. The absence of a particular job from the list does not suggest that it falls outside the scope of this chapter. At the same time, employees in jobs found on the list are covered only if they have occupational exposure.

(1) Health care occupations.

(a) Physicians and physicians assistants.

(b) Nurses, nurse practitioners, dental hygienists, and other health care employees in clinics and offices.

(c) Employees of clinical, dental, and diagnostic laboratories.

(d) Housekeepers in health care facilities.

(e) Staff in laundries that provide service to health care facilities.

(f) Tissue bank personnel.

(g) Employees in blood banks and plasma centers who collect, transport, and test blood.

(h) Freestanding clinic employees (for example, hemodialysis clinics, urgent care clinics, health maintenance organization (HMO) clinics, and family planning clinics).

(i) Employees in clinics in industrial, educational, and correctional facilities.

(j) Staff of institutions for the developmentally disabled.

(k) Hospice employees.

(l) Home health care workers.

(m) Staff of nursing homes and long-term care facilities.

(n) HIV and HBV research laboratory and production facility workers.

(o) Medical equipment service and repair personnel.

(p) Emergency medical technicians, paramedics, and other emergency medical service providers.

(q) Nuclear medical technologists.

(2) Occupations outside health care.

(a) Firefighters, law enforcement personnel, and correctional officers.

(b) Workers in laundries that service public safety institutions.

(c) Employees assigned to provide emergency first aid by their employer (as either a primary or secondary duty).

(d) Employees who handle or pick up regulated waste.

(e) Hotel/motel employees that clean up blood or OPIM.

(f) Employees of funeral homes and mortuaries.

To plan ways to protect your employees from the risk of exposure to blood or other potentially infectious materials.

(1) You must prepare a written exposure determination if your employees have occupational exposure to blood or other potentially infectious materials (OPIM).

This determination must be made without considering the use of personal protective equipment (PPE).

(2) You must make sure the exposure determination contains:

(a) A list of job classifications where all employees have occupational exposure;

(b) A list of job classifications where some employees have occupational exposure and a description of all tasks and procedures or groups of related tasks and procedures with occupational exposure for these employees.

(1) You must establish a written exposure control plan designed to eliminate or minimize employee exposure in your workplace.

(2) You must make sure the plan contains at least the following elements:

(a) The exposure determination, WAC 296-823-11005;

(b) A procedure for evaluating the circumstances surrounding exposure incidents, including documentation of the routes of exposure, and the circumstances under which the exposure incident happened;

(c) How and when you will implement applicable requirements of this rule.

(3) You must document the infection control system used in your workplace to protect employees from exposure to blood or OPIM.

(4) You must use universal precautions or other at least as effective infection control systems.

(5) You must solicit input in the identification, evaluation, and selection of effective safer medical devices. This input must be solicited from nonmanagerial employees responsible for direct patient care with potential exposure to contaminated sharps.

(6) You must document the process you used to solicit input and include the identity of the employees or positions that were involved.

(7) You must make sure the exposure control plan is reviewed and updated:

(a) At least annually; and

(b) Whenever necessary to:

(i) Reflect new or modified tasks and procedures which affect occupational exposure;

(ii) Reflect new or revised job classifications with occupational exposure;

(iii) Reflect changes in technology that eliminate or reduce exposure to bloodborne pathogens;

(iv) Document consideration and implementation of appropriate commercially available and effective safer medical devices designed to eliminate or minimize occupational exposure.

(8) You must make sure a copy of the exposure control plan is accessible at the workplace, when exposed employees are present. For example, if the plan is stored only on a computer, all exposed employees must be trained to operate the computer.

(9) You must make sure a copy of the plan is provided to the employee or their representative within fifteen days of their request for a copy.

To train your employees about their risk of exposure to bloodborne pathogens and ways to protect themselves.

(1) You must make sure all employees with occupational exposure participate in a training program that is:

(a) Provided at no cost to them; and

(b) Conducted during compensated working hours.

(2) You must provide training when any of the following occur:

(a) Before assigning tasks where occupational exposure might occur;

(b) At least annually and within one year of the previous training.

(3) You must make sure the content and vocabulary of your training materials are appropriate to the educational level, literacy, and language of your employees.

(4) You must make sure the person conducting the required training is knowledgeable about the subject matter as it relates to your workplace.

(5) You must make sure the training program contains at least the following elements:

(a) An accessible copy of this chapter and an explanation of the contents;

(b) A general explanation of the epidemiology and symptoms of bloodborne diseases;

(c) An explanation of how bloodborne pathogens are transmitted;

(d) An explanation of your exposure control plan and how the employee can obtain a copy of the written plan;

(e) An explanation of how to recognize tasks and other activities that could involve exposure to blood and other potentially infectious materials (OPIM);

(f) An explanation of the use and limitations of methods that will prevent or reduce exposure including:

(i) Equipment and safer medical devices;

(ii) Work practices;

(iii) Personal protective equipment.

(g) Information about personal protective equipment (PPE) including:

(i) The types;

(ii) Proper use and limitations;

(iii) Selection;

(iv) Location;

(v) Putting it on and taking it off;

(vi) Handling;

(vii) Decontamination;

(viii) Disposal.

(h) Information about the hepatitis B vaccine, including:

(i) Information about its effectiveness;

(ii) Safety;

(iii) Method of administration;

(iv) The benefits of being vaccinated;

(v) Offered at no cost to the employee for the vaccine and vaccination.

(i) Information about what actions to take and persons to contact when exposure to blood or OPIM occurs outside of the normal scope of work;

(j) An explanation of the procedure to follow if an exposure incident occurs, including:

(i) The method of reporting the incident;

(ii) The medical evaluation and follow-up that will be available.

(k) Information about the post-exposure evaluation and follow-up procedure following an exposure incident;

(l) An explanation of the signs and labeling or color-coding required by this chapter;

(m) An opportunity for interactive questions and answers with the trainer at the time of the training session.

You must provide additional training when you add or change tasks or procedures that affect the employee's occupational exposure.

(1) You must maintain training records for three years from the date of the training.

(2) You must include the following information in your training records:

(a) Dates of the training sessions;

(b) Contents or a summary of the training sessions;

(c) Names and qualifications of persons conducting the training;

(d) Names and job titles of all persons attending the training sessions.

(3) Provide these employee-training records upon request for examination and copying to any of the following:

(a) Employees;

(b) Employee representatives.

A training documentation form is provided for your use in the resource section of this chapter.

To make the vaccination available to your employees so they are protected from the hepatitis B virus (HBV).

(1) Employers must make sure that the hepatitis B vaccination series is available to all employees who have occupational exposure and that it is:

(a) Available at no cost to the employee;

(b) Available to the employee at a reasonable time and location;

(c) Administered by or under the supervision of a licensed physician or by another licensed health care professional;

(d) Provided according to recommendations of the United States Public Health Service that are current at the time these evaluations and procedures take place;

(e) Available to any employee who initially declines the vaccination but later decides to accept it while they are still covered by this chapter;

(f) Made available after the employee has received training required by this chapter and within ten working days of initial assignment.

(2) You must make sure participation in a prevaccination screening program for antibody status is not a condition for receiving hepatitis B vaccination.

(3) You must make sure that all laboratory tests are conducted by a laboratory licensed by the state or Clinical Laboratory Improvement Amendments (act) (CLIA).

(4) Make sure employees who decline the hepatitis B vaccination, offered by you, sign a form with this statement:

"I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself. However, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me."

(5) Exemptions:

(a) You are not required to provide the hepatitis B vaccination series to employees who meet any of the following:

(i) The employee has previously received the complete hepatitis B vaccination series;

(ii) An antibody test has revealed that the employee is immune to hepatitis B;

(iii) There are medical reasons not to give the vaccine.

(b) You are not required to provide the hepatitis B vaccination series to employees assigned to provide first aid only as a secondary duty, when you do all of the following:

(i) Make hepatitis B vaccination available to all unvaccinated first-aid providers who render assistance in any situation involving the presence of blood or OPIM. Vaccination must be made available as soon as possible, but no later than twenty-four hours after the incident;

(ii) Provide a reporting procedure that ensures all first-aid incidents that involve the presence of blood or OPIM are reported before the end of the work shift;

(iii) Document first-aid incidents that involve blood or OPIM, include at least:

(A) The names of all first-aid providers who rendered assistance;

(B) The time and date of the first-aid incident;

(C) A description of the first-aid incident.

Reference:

You can find more information about the United States Public Health Service recommendations for hepatitis B vaccination at http://www.cdc.gov/ncidod/diseases/hepatitis/b/index.htm.

The declination form can help you document employees who have declined the hepatitis B vaccine. You can find a copy of this form in the resource section of this chapter.

(1) You must obtain and provide the employee a copy of the evaluating health care professional's written opinion for hepatitis B vaccination within fifteen days of the employee's evaluation.

(2) You must make sure the health care professional's written opinion is limited to whether a hepatitis B vaccination is indicated and if the employee has received this vaccination.

(3) You must make sure that all other findings or diagnoses remain confidential and are not included in the written report.

These forms are available for your use in the resource section of this chapter.

To use feasible controls to eliminate or minimize occupational exposure to blood or other potentially infectious materials (OPIM).

If occupational exposure remains after implementing these controls, personal protective equipment must be used. See WAC 296-823-150, Personal protective equipment.

(1) You must use appropriate equipment and safer medical devices to eliminate or minimize employee exposure.

(2) You must use work practices designed to eliminate or minimize employee exposure.

(3) You must examine and maintain or replace equipment and safer medical devices on a regular schedule to make sure they remain effective.

(1) You must make sure that you don't bend, recap, or remove contaminated needles or other contaminated sharps unless you can demonstrate that there is no feasible alternative or that it's required by a specific medical or dental procedure.

Bending, recapping or needle removal must be done by using a mechanical device or a one-handed technique.

(2) You must make sure you don't shear or break contaminated needles.

(1) You must place contaminated reusable sharps immediately, or as soon as possible after use, in appropriate containers until properly decontaminated. Containers must be all of the following:

(a) Puncture resistant;

(b) Labeled or color-coded as described in this chapter;

(c) Leakproof on the sides and bottom;

(d) Meet the same requirements as the container for disposable sharps, except they do not need to be closable.

(2) You must store or process contaminated reusable sharps so employees aren't required to reach into the container or sink by hand.

(3) You must make sure reusable sharps containers aren't opened, emptied, or cleaned manually or in any other manner that would expose employees to contaminated sharps.

You must make sure all procedures involving blood or OPIM are performed so splashing, spraying, spattering, and generation of droplets are minimized.

Examples include:

(1) Appropriate operation and use of recommended controls for surgical power tools, lasers and electrocautery devices.

(2) Use of personal protective equipment when contact with blood or OPIM is reasonably anticipated.

(3) Making sure cleaning procedures do not generate unnecessary splashes, spraying, spattering, or generation of droplets.

(1) You must attach appropriate labels to:

(a) Containers used to store, transport, or ship blood or other potentially infectious materials (OPIM) including:

(i) Refrigerators;

(ii) Freezers.

(b) Sharps containers;

(c) Contaminated equipment;

(d) Laundry bags and containers;

(e) Specimen containers;

(f) Regulated waste containers.

(2) You must make sure that labels:

(a) Include the following symbol:

(b) Are all or mostly fluorescent orange or orange-red with lettering and symbol in a contrasting color.

(c) Are attached to the container by string, wire, adhesive, or other method so they can't become lost or accidentally removed.

(1) You must provide handwashing facilities that are readily accessible to employees, wherever feasible. If handwashing facilities are not feasible, provide either one of the following:

(a) Antiseptic towelettes;

(b) Antiseptic hand rub product along with clean cloth/paper towels.

(2) You must make sure employees clean their hands as soon as feasible after removing gloves and whenever there is the potential for contact with blood or other potentially infectious materials (OPIM).

(3) You must make sure employees do one of the following:

(a) Wash with soap and water;

(b) Use an appropriate waterless antiseptic hand rub product or towelettes, provided there are no signs of visible contamination;

(c) Use an appropriate waterless antiseptic hand rub product or towelettes followed by washing with soap and water as soon as possible, when hands are visibly contaminated and handwashing facilities are not immediately available.

(4) You must make sure employees wash any skin with soap and water, or flush mucous membranes with water as soon as feasible following contact with blood or OPIM.

(1) You must make sure eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is occupational exposure.

(2) You must make sure food and drink are not kept in refrigerators, freezers, shelves, cabinets, or on countertops or benchtops where there is a potential for exposure to blood or other potentially infectious materials (OPIM).

You must prohibit mouth pipetting or suctioning of blood or other potentially infectious materials (OPIM).

(1) You must place specimens of blood or other potentially infectious materials (OPIM) in an appropriate container that prevents leakage during collection, handling, processing, storage, transport, or shipping.

(2) You must make sure the container is properly labeled or color-coded and closed before being stored, transported, or shipped.

(a) If outside contamination of the container occurs, the container must be placed inside a second container that prevents leakage and is properly labeled or color-coded;

(b) If the specimen could puncture the container, the container must be placed inside a second container that:

(i) Is puncture-resistant;

(ii) Prevents leakage during handling, processing, storage, transport, or shipping;

(iii) Is properly labeled or color-coded.

This tool contains information about the handling and storage of criminal evidence. Criminal evidence contaminated with blood or OPIM is considered a specimen under the scope of this chapter. You can find a copy of this tool in the resource section of this chapter.

(1) You must examine equipment which could become contaminated with blood or other potentially infectious materials (OPIM) before servicing or shipping.

(a) Decontaminate this equipment and its parts as necessary unless you can demonstrate that decontamination isn't feasible.

(b) Attach an easily seen biohazard label to the equipment stating which portions remain contaminated.

(2) You must make sure that information on contaminated equipment is communicated to all affected employees, the servicing representative, and the manufacturer as appropriate, prior to handling, servicing, or shipping so that appropriate precautions will be taken.

(1) You must develop an appropriate written schedule for cleaning and decontamination based upon the following:

(a) The location within the facility;

(b) Type of surface to be cleaned;

(c) Type of contamination present;

(d) Tasks or procedures being performed in the area.

(2) You must clean and decontaminate environmental and working surfaces and all equipment after contact with blood or other potentially infectious materials (OPIM).

(3) You must decontaminate work surfaces with an appropriate disinfectant at these times:

(a) After completion of a procedure;

(b) Immediately or as soon as possible when surfaces are clearly contaminated or after any spill of blood or OPIM;

(c) At the end of the workshift if the surface could have become contaminated since the last cleaning.

(4) You must remove and replace protective coverings, such as plastic wrap, aluminum foil, or imperviously backed absorbent paper used to cover equipment and environmental surfaces, as soon as possible:

(a) When they clearly become contaminated;

(b) At the end of the workshift if they could have become contaminated during the shift.

(5) You must inspect and clean (on a regularly scheduled basis) all bins, pails, cans, and similar receptacles intended for reuse that have a reasonable likelihood for becoming contaminated with blood or OPIM.

Clean and decontaminate these types of receptacles immediately or as soon as possible when they are visibly contaminated.

(6) You must use a brush and dustpan, tongs, forceps, or other mechanical means to clean up broken glassware that may be contaminated.

These lists are available from the EPA Office of Pesticides, antimicrobial pesticides website at http://www.epa.gov/oppad001/.

(1) You must discard contaminated sharps immediately, or as soon as possible, in containers that are all of the following:

(a) Closable;

(b) Puncture resistant;

(c) Leakproof on sides and bottom;

(d) Appropriately labeled or color-coded;

(e) Easily accessible to personnel;

(f) Located as close as feasible to the immediate area where sharps are used or areas sharps can be reasonably anticipated to be found (for example, laundries);

(g) Maintained upright throughout use;

(h) Replaced routinely and not allowed to overfill.

(2) You must make sure when you move containers of contaminated sharps, the containers are:

(a) Closed prior to removal or replacement to prevent spilling or protrusion of contents during handling, storage, transport, or shipping; and

(b) Placed in a secondary container, if leaking is possible. The second container must be:

(i) Closable;

(ii) Constructed to contain all contents and prevent leakage during handling, storage, transport, or shipping;

(iii) Appropriately labeled or color-coded.

(3) You must make sure regulated waste other than sharps is placed in containers that are all of the following:

(a) Closable;

(b) Constructed to contain all contents and prevent leakage of fluids during handling, storage, transport, or shipping;

(c) Closed prior to removal to prevent spillage or protrusion of contents during handling, storage, transport, or shipping;

(d) Placed in a second container if outside contamination of the primary regulated waste container occurs.

(4) You must make sure the second container is appropriately labeled or color-coded.

(5) You must dispose of all regulated waste according to applicable state and county regulations.

(1) You must handle laundry contaminated with blood or other potentially infectious material (OPIM) as little as possible and with a minimum of agitation.

(2) You must bag contaminated laundry or put it into a container at the location where it was used.

(a) Do not sort or rinse at the location of use.

(b) Place and transport contaminated laundry in bags or containers that are properly labeled or color-coded.

(c) If your facility ships contaminated laundry off-site to a second facility that doesn't use an infection control or isolation system when handling all of their soiled laundry, your facility must place the laundry in red bags or containers that are appropriately labeled.

(3) You must place and transport wet contaminated laundry that is likely to soak through or leak to the outside, in bags or containers that will prevent such leakage.

To provide and make sure personal protective equipment is used when work practices and controls will not fully protect your employees from the risk of exposure to blood or other potentially infectious materials.

(1) You must provide at no cost to employees, appropriate personal protective equipment such as:

(a) Gloves;

(b) Gowns;

(c) Laboratory coats;

(d) Face shields or a combination of masks and eye protection;

(e) Mouthpieces;

(f) Resuscitation bags;

(g) Pocket masks;

(h) Other ventilation devices.

(2) You must make sure that employees use appropriate PPE.

(a) In rare and extraordinary circumstances, employees can briefly and temporarily choose not to use PPE. If in their professional judgment, they believe that using PPE would prevent the delivery of health care or public safety services or pose an increased hazard to themselves or co-workers.

(b) If the employee makes this judgment, you must investigate and document to determine if changes can be made to prevent future occurrences of the same situation.

(3) You must make sure that appropriate PPE, in sizes to fit your employees, is readily accessible at the worksite orissued to employees.

(4) You must make sure employees remove all PPE before leaving the work area.

(1) You must make sure gloves appropriate to the situation are worn when:

(a) It can be reasonably anticipated that the employee may have hand contact with blood, other potentially infectious materials (OPIM), mucous membranes, or skin that is not intact;

(b) Handling or touching contaminated items or surfaces;

(c) Performing vascular access procedures, for example, drawing blood or inserting an IV.

(2) You must do the following when you are an employer in a volunteer blood donation center and you make the judgment that employees do not require routine use of gloves when performing phlebotomies:

(a) Periodically reevaluate your decision not to require gloves;

(b) Make gloves available to all employees who wish to use them for phlebotomy (blood drawing);

(c) Do not discourage the use of gloves for phlebotomy;

(d) Require that gloves be used for phlebotomy in any of the following circumstances:

(i) When the employee has a cut, scratch, or other break in the skin of his or her hand or wrist;

(ii) When the employee judges that hand contamination with blood may occur; for example, when performing phlebotomy on an uncooperative individual;

(iii) When the employee is receiving training in phlebotomy.

(3) You must make sure employees who are allergic to the gloves that are normally provided have ready access to at least one of the following:

(a) Nonlatex gloves;

(b) Glove liners;

(c) Powderless gloves;

(d) Other similar alternatives.

(4) You must replace disposable (single use) gloves such as surgical or examination gloves:

(a) As soon as practical when contaminated;

(b) As soon as practical if they are torn or punctured;

(c) When their ability to function as a barrier is compromised.

(5) Make sure disposable (single use) gloves are used only once.

(6) Discard utility gloves if they are cracked, peeling, torn, punctured, or show other signs of deterioration or when their ability to function as a barrier is compromised.

You may decontaminate utility gloves for reuse if they can continue to function as a barrier.

You must make sure either chin-length face shields or a combination of masks and eye protection are used, whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials (OPIM) may be generated and eyes, nose, or mouth contamination can be reasonably anticipated.

(1) You must make sure appropriate protective clothing is worn when splashes to skin or clothes are reasonably anticipated. The type and characteristics will depend upon the sort of work being done and how much exposure is anticipated.

(2) You must remove a garment as soon as feasible if blood or other potentially infectious materials (OPIM) penetrate it.

You must make resuscitator (emergency ventilation) devices readily available and accessible to employees who can reasonably be expected to perform resuscitation procedures.

(1) You must clean, repair, replace, launder, and dispose of personal protective equipment required by this chapter, at no cost to the employee.

(2) You must make sure when PPE is removed, it is placed in an appropriately designated area or container for storage, washing, decontamination, or disposal.

To make sure employees who have been exposed to blood or other potentially infectious materials (OPIM) have appropriate post-exposure evaluation and follow-up available.

(1) You must make immediately available a confidential post-exposure evaluation and follow-up to all employees with occupational exposure to blood or OPIM who report an exposure incident.

(2) You must make sure that the post-exposure medical evaluation and follow-up are all of the following:

(a) Immediately available following an exposure incident;

(b) Confidential;

(c) At no cost to the employee;

(d) At a reasonable time and place;

(e) Administered by or under the supervision of a licensed physician or by another licensed health care professional;

(f) Provided according to recommendations of the United States Public Health Service current at the time these evaluations and procedures take place.

(3) You must make sure that the evaluation and follow-up includes at least these elements:

(a) Documentation of the routes of exposure, and the circumstances under which the exposure incident happened;

(b) Identification and documentation of the source individual, unless you can establish that identification is infeasible or prohibited by state or local law;

(c) Collection and testing of blood to detect the presence of HBV and HIV;

(d) Post-exposure preventive treatment, when medically indicated, as recommended by the United States Public Health Service;

(e) Counseling;

(f) Evaluation of reported illnesses.

(4) You must make sure that all laboratory tests are conducted by a laboratory licensed by the state or Clinical Laboratory Improvement Amendments Act (CLIA).

You must arrange to test the source individual's blood for HBV and HIV as soon as feasible after getting their consent.

(1) If you do not get consent, you must establish that legally required consent can not be obtained.

(2) When the law does not require the source individual's consent, their blood, if available, must be tested and the results documented.

(3) Exemption: When the source individual is already known to be infected with HBV or HIV, you do not need to test their status.

(1) You must make sure the results of the source person's blood test are provided to the exposed employee, if possible.

(2) You must make sure the exposed employee is informed of applicable laws and regulations regarding disclosure of the identity and infection status of the source person.

You must arrange to have the exposed employee's blood collected and tested as soon as feasible after consent is obtained.

(1) If the employee consents to baseline blood collection, but does not give consent at that time for HIV serologic testing, the sample must be preserved for at least ninety days.

(2) If, within ninety days of the exposure incident, the employee chooses to have the baseline sample tested, it must be done as soon as possible.

You must provide all of the following information to the health care professional evaluating an employee after an exposure incident:

(1) A copy of WAC 296-823-160;

(2) A description of the job duties the exposed employee was performing when exposed;

(3) Documentation of the routes of exposure and circumstances under which exposure occurred;

(4) Results of the source person's blood testing, if available;

(5) All medical records that you are responsible to maintain, including vaccination status, relevant to the appropriate treatment of the employee.

(1) You must obtain and provide to the employee a copy of the evaluating health care professional's written opinion within fifteen days of the completion of their evaluation.

(2) You must make sure the health care professional's written opinion is limited to the following information:

(a) That the employee has been informed of the results of the evaluation;

(b) That the employee has been told about any medical conditions resulting from exposure to blood or other potentially infectious materials (OPIM) which need further evaluation or treatment.

(3) You must make sure that all other findings or diagnoses remain confidential and are not included in the written report.

To establish and maintain medical records, and record all occupational injuries resulting from contaminated needle sticks or cuts from contaminated sharps.

(1) You must establish and maintain an accurate medical record for each employee with occupational exposure.

(2) You must make sure this record includes all of the following that apply:

(a) Name and Social Security number of the employee;

(b) A copy of the employee's hepatitis B vaccination status, including the dates of all the hepatitis B vaccinations;

(c) Any medical records related to the employee's ability to receive vaccinations;

(d) The HBV declination statement;

(e) A copy of all results of examinations, medical testing, and follow-up procedures related to post-exposure evaluations;

(f) Your copy of the health care professional's written opinion;

(g) A copy of the information provided to the health care professional as required.

(3) You must make sure that employee medical records are:

(a) Kept confidential;

(b) Not disclosed or reported to any person, without the employee's written consent, except as required by this section or as may be required by law.

(1) You must follow the requirements in chapter 296-27 WAC, Recordkeeping and reporting, for recording occupational injuries and illnesses including needle stick and sharps injuries, unless you meet one of the exemptions specified in WAC 296-27-00103 or 296-27-00105.

(2) If you are not exempt from the recordkeeping requirements in chapter 296-27 WAC, then you must also record the type and brand of device involved in injuries resulting from a needle stick or cut with a sharps that is contaminated with another person's blood or other potentially infectious material on the OSHA 300 log or equivalent form.

To implement and enforce these additional rules in research laboratories and production facilities engaged in the culture, production, concentration, experimentation, and manipulation of HIV and HBV.

(1) You must prepare or adopt a biosafety manual. This manual must be:

(a) Periodically reviewed;

(b) Updated at least annually or more often, if necessary.

(2) You must make sure employees are:

(a) Advised of potential hazards;

(b) Required to read and follow instructions about practices and procedures.

(3) You must establish written policies and procedures where only authorized persons can enter work areas and animal rooms.

(1) You must make sure only authorized persons are allowed to enter the work areas and animal rooms. Authorized persons must:

(a) Have been advised of the potential biohazard;

(b) Meet any specific entry requirements;

(c) Comply with all entry and exit procedures.

(2) Keep laboratory doors closed when work involving HIV or HBV is in progress.

(1) You must incinerate or decontaminate all regulated waste by a method known to effectively destroy bloodborne pathogens, such as autoclaving.

(2) You must make sure to place materials to be decontaminated away from the work area in a container that is:

(a) Durable;

(b) Leakproof;

(c) Appropriately labeled, or color-coded;

(d) Closed before being removed from the work area.

(3) You must incinerate or decontaminate all waste from work areas and from animal rooms before disposal.

(4) You must make sure an autoclave is available for decontamination of regulated waste.

(1) You must make sure appropriate personal protective clothing is used in work areas and animal rooms. Examples of appropriate personal protective clothing include:

(a) Laboratory coats;

(b) Gowns;

(c) Smocks;

(d) Uniforms.

(2) You must decontaminate protective clothing before it is laundered.

(3) You must make sure employees remove protective clothing before leaving their work area.

(4) You must take special care to avoid skin contact with other potentially infectious materials (OPIM).

(5) You must wear gloves when handling infected animals and when you can not avoid making hand contact with OPIM.

(6) You must conduct all activities involving OPIM in biological safety cabinets or other physical-containment devices within the containment module. No work with OPIM must be conducted on the open bench.

(a) Appropriate certified biological safety cabinets (Class I, II, or III) or personal protection or physical containment devices must be used for all activities with OPIM that pose a threat of exposure to droplets, splashes, spills, or aerosols.

(b) Appropriate personal protection and physical containment devices include:

(i) Special protective clothing;

(ii) Respirators;

(iii) Centrifuge safety cups;

(iv) Sealed centrifuge rotors;

(v) Containment caging for animals.

(c) Biological safety cabinets must be certified when installed or moved, and at least annually.

You must protect vacuum lines with liquid disinfectant traps and high-efficiency particulate air (HEPA) filters or filters of same or greater efficiency. Make sure filters are checked routinely and maintained or replaced as necessary.

You must use hypodermic needles and syringes only for parenteral injection and aspiration of fluids from laboratory animals and diaphragm bottles.

(1) Use only needle-locking syringes or disposable syringe-needle units (when the needle is integral to the syringe) for the injection or aspiration of other potentially infectious materials (OPIM).

(2) Use extreme caution when handling needles and syringes.

(3) The needle must not be bent, sheared, replaced in the sheath or guard, or removed from the syringe after use.

(4) Place the needle and syringe promptly in a puncture-resistant container and autoclave or decontaminate before reuse or disposal.

(1) You must make sure appropriate professional staff or others, properly trained and equipped to work with concentrated potentially infectious materials, immediately contain and clean up all spills.

(2) You must make sure that employees report a spill or accident that results in an exposure incident immediately to the laboratory director or other responsible person.

(1) You must post signs at the entrance to work areas and all access doors when other potentially infectious materials (OPIM) or infected animals are present in the work area or containment module.

(2) You must make sure signs:

(a) Contain the following symbol and information:

(Name of the infectious agent.)

(Special requirements for entering the area.)

(Name, telephone number of the laboratory

director or other responsible person.)

(b) Are all or mostly fluorescent orange-red with lettering and symbol in a contrasting color.

(1) You must provide initial training to employees in HIV or HBV research laboratories or production facilities in addition to the training required in WAC 296-823-120.

(2) You must make sure that employees demonstrate proficiency in the following:

(a) Standard microbiological practices and techniques;

(b) The practices and operations specific to the facility before being allowed to work with HIV or HBV.

(3) You must provide a training program to employees working with HIV or HBV who have no prior experience in handling human pathogens.

(a) Initial work activities must not include the handling of infectious agents.

(b) A progression of work activities must be assigned as techniques are learned and proficiency is developed.

(4) You must make sure that employees participate in work activities involving infectious agents only after proficiency has been demonstrated.

You must make sure each work area contains a sink for handwashing and an eyewash facility is readily available.

For HIV and HBV production facilities, the sink must be operated automatically or by foot or elbow and must be located near the exit door of the work area.

(1) You must separate the HIV and HBV work areas from areas that are open to unrestricted traffic flow within the building.

(2) You must use two sets of doors to separate HIV and HBV work areas from access corridors or other contiguous areas.

(3) You must make sure the surfaces of doors, walls, floors, and ceilings in the work area are water resistant so they can be easily cleaned. These surfaces must be sealed or capable of being sealed to facilitate decontamination.

(4) You must make sure access doors to the work area or containment module are self-closing.

(5) You must provide a ducted exhaust-air ventilation system.

(a) This system must create directional airflow that draws air into the work area through the entry area and you must verify this airflow.

(b) The exhaust air must:

(i) not be recirculated to any other area of the building;

(ii) Be discharged to the outside;

(iii) Be dispersed away from occupied areas and air intakes.

(6) Make sure an autoclave for decontamination of regulated waste is available within or as near as possible to the work area.