HomeMy WebLinkAboutGO 92-01 Infectious Disease ControlADM-05.1
INFECTIOUS
DISEASE
CONTROL
Date of Issue General Order Number MAY 08, 1992 92-01
Effective Date Section Code February 9, 2015 ADM-05
Reevaluation Date Amends / Cancels March 2018
C.A.L.E.A. Reference
INDEX AS:
Acquired Immune Deficiency Syndrome (AIDS)
Hepatitis B Virus (HBV) Human Immunodeficiency Virus (HIV)
Infectious Disease
Infectious Disease Exposure
PURPOSE:
The purpose of this directive is to establish uniform guidelines for the handling of situations which pose an infectious disease exposure risk to humans, and
specifically to police officers.
This order consists of the following numbered sections: I. Introduction
II. Policy
III. Definitions IV. Procedure
V. Personal Protective Equipment
VI. Disinfection, Decontamination, and Disposal
VII. Handling of Persons and Employee Conduct
VIII. Employee Management
ADM-05.2
I. INTRODUCTION
The Hepatitis A/B Viruses (HAV / HBV) have long been recognized as being capable of causing illness and/or death. Similarly, Human Immunodeficiency
Virus (HIV), also referred to as Acquired Immune Deficiency Syndrome (AIDS), is
known to cause the same effect on the human body.
Research has demonstrated that when proper barrier techniques are utilized, transmission of HBV and HIV can be prevented. Since law enforcement officers
work in environments that provide inherently unpredictable risks of exposure,
general infection-control procedures must be adapted to the work situations.
Personal protection measures must be exercised in all situations that have a
likelihood of exposure to infectious diseases.
II. POLICY
It is the policy of the Police Department to provide methods and equipment sufficient to protect its employees from exposure to infectious diseases that cause or are likely to cause death or serious
physical harm. The Department shall maintain a safe working environment for all employees.
Adequate training, personal protective equipment, medical precautions, and records shall be
available to all employees.
III. DEFINITIONS
OSHA Rule 29 CFR 1910-1030; Exposure Control Plan for Bloodborne Pathogens
Term Definition
Blood Human blood, human blood components and products
made from human blood.
Bloodborne Pathogens Pathogenic microorganisms that are present in human blood and can cause disease in humans. These
pathogens include, but are not limited to, Hepatitis B
Virus (HBV) and Human Immunodeficiency Virus (HIV).
Body Fluids Fluids that have been recognized by CDC as directly linked to the transmission of HIV and/or HAV / HBV
and/or to which universal precautions apply; blood,
semen, blood products, vaginal secretions,
cerebrospinal fluid, synovial fluid, pleural fluid,
peritoneal fluid, pericardial fluid, amniotic fluid, and concentrated HIV or HAV / HBV viruses.
Contaminated The presence or the reasonably anticipated presence
of blood or other potentially infectious materials on an item or surface.
Contaminated Laundry Laundry which is wet with blood or other potentially
infectious materials and presents a reasonable
likelihood of soakthrough or leakage from the bag or container; laundry which may contain sharps.
ADM-05.3
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.
Disinfect To inactivate virtually all recognized pathogenic microorganisms, but not necessarily all microbial forms
(e.g., bacterial endospores) on inanimate objects.
Engineering Controls Controls that isolate or remove the 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.
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. This definition excludes incidental exposure that may take place on
the job, and that are neither reasonably nor routinely
expected and that the worker is not required to incur in
the normal course of employment. Other Potentially
Infectious Materials (1) The following body fluids: Semen, vaginal
secretions, cerebrospinal fluid, synovial fluid, pleural
fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, and any body fluid that is visibly contaminated with blood;
(2) Any unfixed tissue or organ (other than intact skin)
from a human (living or dead); and (3) HIV - or HAV / HBV - containing cell or tissue
cultures, organ cultures, and culture medium or other
solutions; and blood, organs or other tissues from
experimental animals infected with HIV or HAV / HBV. Parenteral Piercing mucous membranes or the skin barrier
through needlesticks, human bites, cuts, abrasions,
etc.
ADM-05.4
Personal Protective
Equipment (PPE) Specialized clothing or equipment worn by an
employee for protection against a hazard.
Source Individual Any individual, living or dead, whose blood, body fluids, tissues, or organs may be a source of exposure to the
employee. Examples include, but are not limited to,
hospital and clinic patients; clients in institutions for the
mentally retarded; trauma victims; clients of drug and alcohol treatment facilities; residents of hospices and nursing homes; human remains prior to embalming;
and individuals who donate or sell blood or blood
components.
Sterilize The use of a physical or chemical procedure to destroy all microbial life, including highly resistant bacterial
endospores.
Universal Precautions The term "universal precautions" refers to a system of infectious disease control which assumes that every direct contact with body fluids is infectious and requires
every employee exposed to direct contact with body
fluids to be protected as though such body fluids were
HAV / HBV or HIV infected. Therefore, universal precautions are intended to prevent health care workers from parenteral, mucous membrane and non-
intact skin exposure to bloodborne pathogens.
Work Practice Controls Controls that reduce the likelihood of exposure by altering the manner in which a task is performed.
IV. PROCEDURE
A. Modes and Risk of Infectious Disease Transmission
Hepatitis A/B Viruses (HAV / HBV) and Human Immunodeficiency Virus
(HIV) are considered infectious diseases by all health and medical resources. Both have been transmitted in occupational settings only by
contact with open wounds, chapped or weeping skin, or mucous
membranes to blood, blood-contaminated body fluids, or concentrated
virus. There is no evidence that HBV or HIV is spread through the air,
through food, or through routine, casual contact.
ADM-05.5
Although blood is the single most important source of HIV and HAV / HBV, police officers are often in adverse situations that make differentiation
between body fluids difficult. For example, poor lighting may limit the ability
to distinguish blood from other body fluids. Therefore, all body fluids shall
be treated as potentially hazardous under uncontrolled, emergency circumstances in which differentiation between body fluids is difficult. Additionally, all persons should be assumed to be infectious with HIV
and/or HBV.
The risk of exposure to infectious diseases can be minimized by the use of personal protection devices when circumstances dictate. Protection can be achieved through the use of equipment such as gloves, masks, and special
clothing designed to provide a barrier between the employee and a risk
source. The use of such equipment is often referred to as universal
precautions. Police officers must always be aware of potential exposure risk situations and do as much as possible to reduce the risk.
1. Cardiopulmonary Resuscitation (CPR)
Police personnel should be concerned with the possible HIV and HAV / HBV exposure through CPR administration. Therefore, gloves and a protective resuscitation mask ("pocket mask") with a one-way
valve must always be used when administering CPR. After such a
situation is completed, personnel and equipment must be cleaned.
2. Fights and Assaults
Fights and assaults can place an officer in a situation for potential
exposure from a wide range of causes such as human bites and
attacks with sharp objects. Such instances may occur during arrest, routine interrogations, domestic disputes, and booking operations. Hands on contact may result in the presence of body fluids and thus
a chance of exposure.
Extreme caution must be used in dealing with a suspect or prisoner with assaultive or combative behavior. When blood is present and a suspect displays combative or threatening behavior, an officer must
attempt to put on gloves as soon as conditions permit. Should the
clothing of an officer become exposed, it should be changed as soon
as possible. Suspects and prisoners may spit or throw body fluids onto an officer
during street contact or booking procedures. Any fluids or materials
should be removed with a disposable towel after donning gloves,
and the area then decontaminated with appropriate cleaning materials. Following clean-up, soiled towels and gloves should be disposed of in a proper manner.
ADM-05.6
3. Human Bites
Should an employee be bitten by anyone, the employee shall clean
the wound with soap and water as soon as possible. The employee
shall report the bite to a supervisor and obtain routine medical attention as soon as possible to prevent infection. Appropriate documentation of the incident must be completed, and should
include employee injury reports for permanent retention in the
employee's personnel file.
4. Searches and Evidence Handling
During searches and evidence handling, exposure to HIV and HAV /
HBV may be possible. Injuries such as puncture wounds, needle
sticks, or cuts pose a hazard during evidence handling and during searches of persons, vehicles, and places.
The following precautions can help reduce the risk of infection during
search situations:
a) Caution must be used when searching prisoner/suspects' clothing. Discretion should be used to determine if an
employee should search a prisoner/suspect's clothing or if the
prisoner/suspect should empty his or her own pockets.
b) A safe distance should always be maintained between an officer and a suspect.
c) An employee should wear protective gloves if exposure to
body fluids is likely to be encountered. d) If cotton gloves are to be worn for evidence handling, they
should be worn over protective, disposable gloves when
exposure to body fluids may occur.
e) A flashlight should be used when searching areas in which the available light does not permit adequate vision.
f) Containers such as purses and bags should be searched by
turning the container up-side-down to empty the contents. Small compartments must not be searched by the finger or hand-probe method.
g) Puncture-proof containers should be used to store any sharp
objects that may be contaminated with body fluids. h) Caution must be used when staples are used to seal
evidence so as not to tear gloves or puncture skin.
ADM-05.7
i) Wet or damp items of evidence should be air-dried prior to placement in any air-tight containers.
j) When practical and appropriate, puncture resistant gloves
should be worn anytime a search of a person, vehicle or place is conducted. All officers, and particularly those involved with identification and
crime scene processing, must be alert for the presence of sharp objects such as hypodermic needles, knives, razors, broken glass, nails, or other sharp objects. Sharp objects should not be handled
with unprotected, bare hands but rather by mechanical means, such
as forceps or tongs.
Contaminated evidence shall not be transported, handled, nor stored with or near any food items. An employee who has had contact with
or has been near contaminated items must not smoke or consume
food until after a thorough hand washing.
5. Deceased Persons and Body Removal
Officers should wear gloves and cover all cuts and abrasions before
touching a deceased person or removing a body. Precautions
should also be used when handling amputated limbs or other body parts. Safeguards should be followed for contact with the blood of anyone, regardless of whether the person is known or suspected to
be infected with HIV or HAV / HBV.
6. Autopsies Protective masks and eyewear or face shields, laboratory coats,
gloves, and waterproof aprons should be worn when attending an
autopsy. All autopsy material should be considered infected with
HIV and HAV / HBV. Should police equipment come in contact with body fluids or a contaminated surface, it must be thoroughly cleaned with appropriate chemical germicide.
7. Crashes With Injury
When responding to a vehicular collision or other type of accident where injuries are present, protective gloves should be worn if body
fluids are likely to be encountered. Additional protective equipment
should be worn if body fluids are extensive.
V. PERSONAL PROTECTIVE EQUIPMENT
Appropriate personal protective equipment should be used at any time there is a risk of exposure. For many situations, the chance that an employee will be
exposed to blood and other body fluids can be determined in advance. Therefore,
if the chance of exposure to body fluids is high, the employee should put on
ADM-05.8
protective equipment before dealing with the situation. Although several types of equipment are recommended for protection, those commonly used may not be all
that is available.
A. Gloves Gloves should be used in all situations in which exposure to body fluids
could occur. Extra pairs of gloves should always be available in case of
damage. Consideration in the choice of gloves should include dexterity,
durability, fit, and the task being performed. Thus, there is no single type of thickness or glove style that is appropriate for all situations.
Thin nitrile gloves may be the preference of patrol officers due to the ease
of storage and transportation. These gloves may tear easily when used
due to the thin design. Therefore, extra pairs should be available. In known hazardous situations, double-gloving is recommended. No gloves shall be used if they are peeling, cracked, discolored, punctured, torn, or have
evidence of deterioration.
Specially designed puncture-resistant gloves are issued to all officers and should be used whenever an officer is handling or searching an area where there is a chance of cuts or punctures occurring.
Heavy, rubber-type gloves may be the preference in situations where the gloves can be easily obtained. This type of situation may occur during crime scene processing. These gloves may be reused if cleaned after each
use with appropriate cleaning methods.
Gloves should be carried by each patrol officer and be available for incidents where exposure could occur. Similarly, gloves should be available at the police station for use during booking procedures and prisoner
handling.
B. Masks, Eyewear, and Gowns Masks, eyewear, and gowns shall be available in all patrol vehicles and at
the police complex. These protective barriers should be used in conjunction
with gloves when there is a situation where splashes of blood or other body
fluids could occur. All protective equipment shall be made of materials that are fluid-proof or fluid-resistant and shall protect all areas of exposed skin.
Should splashes or exposure occur when masks and gowns are not worn
and clothing becomes contaminated, the clothing should be removed as
soon as possible. Employees shall be permitted work time in which to change clothing. If at all possible, the clothing should be changed at the police station to avoid the contamination of an employee's residence.
Contaminated clothing should be bagged for laundering.
ADM-05.9
VI. DISINFECTION, DECONTAMINATION, AND DISPOSAL:
A. Cleansing and Decontamination of Body Fluids Spills
All spills and splashes of body fluids should be promptly cleaned using an
approved germicide. Visible materials should first be removed with
disposable towels or other appropriate means that will ensure against direct
contact with body fluids. Gloves shall be worn during cleaning operations. Eye protection and additional protective clothing shall be worn if splashing
is anticipated. Following any cleaning, employees shall wash hands and
any other body surface that may have been contaminated during cleaning.
The Department shall ensure that a supply of materials and germicides suitable for the cleaning of HIV and HAV / HBV contamination are available
at all times. Cleaning equipment should be used in accordance with the
manufacturers' recommendations. Plastic bags should be available for
removal of contaminated items from a contaminated area. All contaminated
items and cleaning equipment shall either be appropriately cleaned or disposed in a designated container at the police complex.
1. Hand Washing
Hands and other skin surfaces should be washed immediately and thoroughly if exposed or contaminated with body fluids. Hands
should always be washed after gloves are removed, even if the
gloves appear to be intact. Hands, and any other exposed skin
surface, should be washed with warm water and soap. Waterless
antiseptic hand cleanser should be available to all officers for use when hand-washing facilities are not available. No food substances
may be consumed following exposure to body fluids until after
thorough hand washing has been completed.
2. Laundry
Although contaminated clothing has a negligible risk of disease
transmission, employees shall treat all contaminated laundry with full
universal precautions. Clothing that has received spills or splashes
shall be removed as quickly after the exposure as possible. If possible, the clothing removal should be done at the Police
Department so as not to contaminate an employee's residence. All
sworn officers shall have an additional full uniform available in their
locker.
Clothing which has been contaminated with body fluids may be
bagged and transported for laundering at the expense of the
department. Although normal laundry cycles and detergent used to
the manufacturers' recommendations are satisfactory for the
cleaning of contaminated clothing, no employee shall be required to launder contaminated clothing if he or she does not wish. The
employee is responsible to ensure his or her supervisor is aware of
ADM-05.10
the need for laundry service. The supervisor shall ensure arrangements are made for the laundry service of the contaminated
clothing.
3. Decontamination and Cleaning of Protective Equipment Reusable protective equipment and interiors of police vehicles
contaminated with body fluids shall be cleaned as soon as possible
after exposure. If equipment is contaminated at locations other than
the police station, the equipment should be transported to the Police Department in bags. Cleaning germicides shall be available at the Police Department and should be used in accordance with the
manufacturers' recommendations. Employees involved with
equipment cleaning shall wear gloves during the process and
additional protection if necessary. 4. Contaminated Objects Disposal
Disposal of contaminated clothing, protective equipment, and all
other objects of concern shall be done by placement in a designated container at the Police Department. A designated container shall be available at all times and shall be emptied by only properly
authorized persons. The Police Department will arrange for disposal
of contaminated waste by persons or outside agencies properly
trained and certified to do so. 5. Contaminated/Infective Waste
All contaminated materials shall be placed only in an appropriate
container for disposal at the Police Department.
VII. HANDLING OF PERSONS AND EMPLOYEE CONDUCT:
A. Equal and Nondiscriminatory Treatment
Courtesy and civility toward the public are demanded at all times of all
department employees, and any conduct to the contrary will not be tolerated. Facilities, programs, and services shall be available to all
members of the public on an equitable basis regardless of known or
suspected HIV or HAV / HBV infection. Jokes, discrimination, and refusal
or omission of services will not be tolerated towards any member of the
public. Should a particular incident require the use of employee protection measures, such protection shall be used with courtesy and civility towards
all persons.
Employees of the department shall not discriminate nor treat unequally any
other employee known or suspected of being infected with HBV or HIV. If an infected employee receives medical approval to report to work, the
employee shall be treated without discrimination by all other employees.
ADM-05.11
The infected employee shall be employed so long as he or she is able to perform assigned job functions in accordance with department standards.
VIII. EMPLOYEE MANAGEMENT:
The Police Department shall maintain a safe working environment for all
employees. Adequate training, personal protective equipment, medical
precautions, and records shall be available to all employees.
A. Training and Education
The Police Department shall require employee training regarding HIV and
HAV / HBV facts as they relate to the working. No employee should be allowed to perform his or her duties before having received such training.
The Police Department should work with the City Personnel Division, and
other sources, to provide the needed training.
The training program should ensure that all employees:
1. Understand the modes of transmission of HBV and HIV.
2. Can recognize incidents when universal precautions should be
utilized.
3. Know the types of protective equipment appropriate for use in
specific instances.
4. Know and understand the limitations of protective clothing and equipment.
5. Are familiar with appropriate actions to take and persons to inform if
exposure occurs.
6. Are familiar with and understand all requirements for work practices
and department general orders.
7. Know where protective equipment is kept, its proper use, and how to
remove, handle, decontaminate, and dispose of contaminated clothing and equipment.
8. Know the corrective actions to be taken in the event of spills or
personal exposure to body fluids, the appropriate reporting
procedures, and the medical monitoring recommended.
Following the initial HAV / HBV and HIV training, employees should receive
refresher training at least annually thereafter.
ADM-05.12
B. Personal Protective Equipment
The Police Department shall provide all employees access to personal
protective equipment as may be necessary for protection from exposure to
body fluids. The equipment shall be provided in sufficient quantity so as to be available to all employees without having to share while working a single incident. The department shall pay all costs incurred for the acquisition,
cleaning, maintenance, disposal, and replacement of all equipment.
C. Post Exposure Evaluation and Follow-up Procedures In addition to any health-care or monitoring required by other rules,
regulations, or worker agreements, the Police Department shall offer,
without charge to an employee:
1. Voluntary HAV / HBV immunization. An employee who has received initial immunization shall be offered booster doses as may be
required/recommended by proper medical authorities.
2. Monitoring, at the request of the employee, for HAV / HBV and HIV antibodies following known or suspected exposure to blood or body fluids. The evaluation results shall be confidential.
It is recommended that monitoring be conducted following a known
or suspected exposure. Monitoring is particularly important if the exposure was to a person of unknown identity. Monitoring procedures shall be in accordance with the recommendations of
qualified medical personnel.
3. Counseling for an employee found, as a result of monitoring, to be seropositive for HAV / HBV or HIV.
D. Recordkeeping
The Police Department shall be responsible for the maintenance of incident and personnel reports pertaining to exposure, suspected exposure, training, and all other incidents dealing with HBV and HIV that are a concern to the
Division. Records should include:
1. Training records, indicating the dates of training sessions, the content of training sessions along with the names of all persons conducting the training, and the names of all persons receiving
training.
2. The conditions observed during routine, day-to-day operations for compliance with work practices and use of protective equipment. If non-compliance is noted, the conditions should be documented
along with corrective actions taken.
ADM-05.13
3. The conditions associated with each incident of exposure to body fluids, an evaluation of the conditions, and a description of any
corrective measures taken to prevent a recurrence or other similar
exposure.
Records pertaining to HAV / HBV vaccinations and post-exposure follow-up shall be retained for 30 years after termination of employment with the
department.
Samuel Hargadine
CHIEF OF POLICE
WARNING This directive is for departmental use only and does not apply in any criminal or civil
proceeding. The department policy should not be construed as a creation of a higher
legal standard of safety or care in an evidentiary sense with respect to third-party
claims. Violations of this directive will only form the basis for departmental
administrative sanctions.