VI - HEPATITIS B. VACCINATION, POST-EXPOSURE
EVALUATION AND FOLLOW-UP

           The County recognizes that even with good adherence to all exposure prevention practices, exposure incidents can occur.   As a result, we have implemented a Hepatitis B Vaccination Program, as well as set up procedures for post-exposure evaluation and follow-up should exposure to bloodborne pathogens occur.

           A.   Vaccination Program:

                      1.   To protect employees as much as possible from the possibility of Hepatitis B infection, a vaccination program has been implemented.   This program is available, at no cost, to all employees who have probable occupational exposure to bloodborne pathogens.   The vaccination program consists of a series of three inoculations over a six-month period.   As part of their bloodborne pathogens training, employees receive information regarding Hepatitis vaccination, including its safety and effectiveness.

                      2.   The Risk Manager, Clinical Services Director and/or Clinic Manager are responsible for setting up and operating the vaccination program. Department Heads are responsible for ensuring that employees within their Department who have probable occupational exposure to Bloodborne pathogens have received the Hepatitis vaccination within ten (10) working days of initial assignment. Vaccinations are performed under the supervision of a licensed physician or other health care professional.   Employees who decline to take part in the vaccination program must sign the "Vaccination Declination Form" attached hereto as Exhibit "F."

                      3.   Any unvaccinated employee involved in an exposure incident shall be entitled to receive, at no cost, the Hepatitis B vaccination series.   This shall be made available as soon as possible but in no event later than twenty-four hours after the exposure incident.

                      4.   To ensure that all employees are aware of the vaccination program, it is thoroughly discussed in our bloodborne pathogens training.

           B.   Post-Exposure Investigation, Evaluation and Follow-up:

                      1.   If an employee is involved in an incident where exposure to bloodborne pathogens may have occurred, the following steps shall be immediately taken:

                                  a.   The employee must immediately notify his/her department head or designated employee;

                                  b.   The department head or designated employee shall immediately notify the Clinical Services Director, Clinic Manager or Risk Manager;

                                  c.   The employee must immediately complete the incident report (attached as Exhibit "G") and forward to Risk Management;           

                                  d.   An investigation into the circumstances surrounding the exposure incident shall be conducted; and

                                  e.   The exposed employee shall receive medical consultation and treatment (if required) as expeditiously as possible.

                      2.   If an employee is involved in an incident resulting in an injury from a sharp (object that penetrates the skin or any other part of the body, including, but not limited to: needle devices, lancets, broken glass and broken capillary tubes), these additional steps shall be taken:

                                  a.   The exposed employee's supervisor shall complete, within fourteen days from the date the incident is reported to the employer, the Sharps Injury Log (attached hereto as Exhibit "H").   The Sharps Injury Log provides the following information:

• Date and time of exposure incident;
• Type and brand of sharp involved;
• Job classification of the exposed employee;
• Department where exposure occurred;
• Procedure being performed by the employee;
• How the incident occurred;
• The body part involved;
• Whether the sharp had engineered sharps injury protection;
• Whether the protective mechanism was activated;
• Whether the injury occurred before the protective mechanism was activated, during activation or after activation;
• If the sharp had no engineered sharps injury protection, the injured employee's opinion as to whether and how such a mechanism could have prevented the injury; and
• The employee's opinion about whether any other engineering, administrative or work practice control could have prevented the injury.

                      3.   The Risk Manager, Clinical Services Director and/or Clinic Manager investigate every exposure incident that occurs in our facility.   This investigation shall be initiated within 24 hours after the incident occurs utilizing the Incident Report (Bloodborne Pathogens) attached as Exhibit "F".

                      4.   In order to make sure employees receive the best and most timely treatment if an exposure to bloodborne pathogens occurs, the County has set up a comprehensive post-exposure evaluation and follow-up process.   The "checklist" attached as Exhibit "I" will be used to verify that all steps in the process have been completed.   The Clinical Services Director and/or Clinic Manager or his/her designee shall oversee this process.

                      5.   After the Incident Report (Bloodborne Pathogens) is evaluated, written recommendations are made for avoiding similar incidents in the future.

                      6.   The County recognizes that the information involved in this process must remain confidential and will do everything possible to protect the privacy of the people involved.

                      7.   The post-exposure process is as follows:

                                  a.   The exposed employee shall provide the County with the following confidential information:

                                             i) Documentation regarding the routes of exposure and circumstances under which the exposure incident occurred; and

                                             ii) Identification of the source individual (unless infeasible or prohibited by law).

                                  b.   If possible, the County shall test the source individual's blood to determine HBV, HCV and HIV infectivity.   This information will be made available to the exposed employee, if it is obtained.   At that time, the employee will be made aware of any applicable laws and regulations concerning disclosure of the identity and infectious status of a source individual.   The exposed employee shall receive information related to the significance of the source individual's laboratory results and its implications.

                                  c.   The County shall collect and test the blood of the exposed employee for HBV, HCV and HIV status within 48 hours of being notified of the exposure.

                                  d.   If the employee consents to baseline blood collection, but does not give consent at that time for HIV serologic testing, the sample shall be preserved for at least 90 days.   If within 90 days the employee elects to have the baseline sample tested, such testing shall be done as soon as feasible.

                                  e.   Concurrent to steps a, b, and c, and after consultation and assessment of the employee’s risk exposure, an appointment will be made for the employee with a qualified healthcare professional to discuss the employee's medical status.   If it is determined that post exposure prophylaxis is recommended, employees will meet with the County’s Health Officer as soon as possible.   Employees have the option to consult with his/her private physician.   The post exposure checklist shall be utilized. The Health Officer or Clinical Services Director and/or Clinic Manager will be available to consult with the healthcare professional on an as needed basis.

            C.   Information provided to the Healthcare Professional:

                        To assist the healthcare professional, a number of documents will be forwarded including the following:

                        1.   Copy of the Bloodborne Pathogens Standard.

                        2.   A description of the exposure incident;                        

                        3.   A description of the exposed employee's duties as they relate to the exposure incident;

                        4.   The exposed employee's relevant medical records; and

                        5.   Results of the source individual's blood testing, if available; and

                        6.   Other pertinent information.

            D.   Healthcare Professional Written Opinion:

                        After the consultation, the healthcare professional shall provide the Clinical Services Director and/or Clinic Manager with a written opinion evaluating the exposed employee's situation.   A copy of this opinion shall be given to the exposed employee.

                        The written opinion shall contain only the following information:                        

                        1.   Confirmation that the employee has been informed of the results of the evaluation; and

                        2.   Confirmation that the employee has been told about any medical conditions resulting from the exposure incident which requires further evaluation or treatment.

                        All other findings or diagnoses will remain confidential and will not be included in the written report.    

            E.   Medical Recordkeeping:

                        The Clinical Services Director and/or Clinic Manager are responsible for setting up and maintaining these medical records, which contains the following information:

                        1.   Name of the employee;

                        2.   A copy of the employee's Hepatitis B Vaccination status;

                        3.   Dates of any vaccinations;

                        4.   Medical records relative to the employee's ability to receive vaccination;

                        5.   Copies of the results of the examinations, medical testing and ongoing follow-up procedures which take place as a result of an employee's exposure to bloodborne pathogens;

                        6.   A copy of the information provided to the consulting healthcare professional as a result of any exposure to bloodborne pathogens;

                        7.   A copy of any information provided to the healthcare professional; and

                        8.   The employee’s Social Security Number.

            As with all information in these areas, the County will keep the information in these medical records confidential.   We will not disclose or report this information to anyone without the employee's written consent (except as required by law).   Medical records shall be retained for the duration of employment plus 30 years.

 

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Copyright © 2001 County of Inyo
Last Updated: October 8, 2005 December 8, 2006