GUIDE

Bodily Fluids Exposure
December 2005

2005-0043

Together. John’s. CAPP and the contributors do not guarantee its accuracy. and elemental sulphur throughout Canada.ca Website: www. While it is believed that the information contained herein is reliable under the conditions and subject to the limitations set out. natural gas liquids. Newfoundland Canada A1C 1B6 Tel (709) 724-4200 Fax (709) 724-4225 Email: communication@capp. Review by July 2008 Disclaimer This publication was prepared for the Canadian Association of Petroleum Producers (CAPP) by industry representatives and Lost Time Solutions. The use of this report or any information contained will be at the user’s sole risk. S.ca . CAPP also has 125 associate members that provide a wide range of services that support the upstream crude oil and natural gas industry. CAPP or its contributors. oil sands.The Canadian Association of Petroleum Producers (CAPP) represents 150 companies that explore for. develop and produce natural gas. 235 Water Street St. 2100. Alberta Canada T2P 3N9 Tel (403) 267-1100 Fax (403) 261-4622 403. 350 – 7th Ave. crude oil. regardless of any fault or negligence of the contributors.capp. Calgary. these members and associate members are an important part of a $90-billion-a-year national industry that affects the livelihoods of more than half a million Canadians.W. CAPP member companies produce more than 98 per cent of Canada’s natural gas and crude oil.

Bodily Fluid Exposure Page i . December 2005 CAPP Guide . This may also include the cleanup/disposal of contaminated equipment/supplies that may occur as a result of the above-mentioned activities.Overview • • • • To provide a resource to assist member companies to develop their own code of practice and safe work practices for management of bodily fluids (BF) To limit occupational exposure to BF through the use of Universal Precautions and by appropriate waste management disposal To decrease the risk of occupationally acquired infection from BF This guide is not intended as a safe operating procedure nor does it relieve employers of the responsibility to develop their own site-specific safe operating procedures Project Scope Applies to all business activities and personnel where first aid and/or life support practices as well as cleanup/disposal of spilled body fluids is an expected role.

..................4 5.....3 3 4 Regulatory Requirements................................3 Contaminated Laundry........4 Personal Protective Equipment...............................................................................5 5.........................................................................................4 5............................... Eye Protection ..................................................7 Program Evaluation...........1 5.................................................2 Employee........................................3 6 7 8 Post Exposure Management .......................7 July 2005 CAPP Guide .........................................4 5..6 6......................................................................3 Control.....2 2 2........................................5 Disposal Practices ..........................5 5......................1 Employer ............................................................Contents Overview ..........5 5.........................................................................................3 Work Practices .............................................3...........................................................................................................................2 Responsibilities ..............................................2 Record Keeping...........2 Contractor.i 1 Program Layout...................................................................................2.3 Identification ................................................4 5..........................3....................................................................................................................2 Masks........................................................................................................................................................................................i Project Scope.......4 5................................................1 1........................................................................................................3................................................................................2 2...........1 7............................2................................................3 Assessment....................................................................5 Post Exposure Reporting.................................................................1 Training Content....................................1............7 5 Engineering Controls ......................1 4......1 Gloves ............1 Sharps Use and Disposal......................................................2 4...........................................................................................................1 1..........................................1 2..6 Post Exposure Follow-up ..3.................................................................................................................................................................2 Risk Management............1.......................Bodily Fluid Exposure Page ii ........4 Incident Management..............................1 Housekeeping .......................................1 Post Exposure Testing.......................................................2 Care and Maintenance of Equipment............................................................................................................................................................................................................2 5.....2 Bodily Fluid Waste Disposal..........................................................................5 5.........................................3 4.......................

practices and personal protective equipment. provincial and territorial regulations/ recommendations pertaining to BF handling in their specific area of operations Refer to Appendix “A” for examples of regulations Training Content Training is an integral component of risk management and the following should be considered when implementing a training program. immunization considerations.1 Regulatory Requirements • • 1. the contents or summary of training sessions. • • • • The training content is considered a CAPP recommendation as a due diligence obligation for all employees. students and contractors Training should be provided by a qualified agency that meets local regulatory requirements Contractors will comply with these standards and train employees as part of their contractual obligations Training should include a general explanation of epidemiology and symptoms of blood borne diseases.Bodily Fluids Exposure Page 1 . the name and qualifications of the individual conducting the sessions. and the names and job titles of all persons attending the training session The training record will be maintained according to regulatory and/or specific company requirements • • December 2005 CAPP Guide . waste management and disposal and information on post-exposure protocol and follow-up Employer will maintain records of all training sessions. appropriate engineering controls. transmission modes.1 Program Layout 1.2 Companies should be aware of federal.

Ensuring that appropriate protective equipment is supplied. As a result. provincial or territorial regulations specific to content. training records and equipment maintenance records. requirements for documentation and record keeping will vary according to operating site location.1 Employer The employer is responsible for: • • • • • • • • • 2. available and maintained commensurate with the potential risks Ensuring that employees are aware of the need and procedures for obtaining immediate first aid/medical attention and for reporting incidents of exposure to blood and body fluids Investigating exposure incidents with follow-up to prevent similar incidents from occurring Providing for the care and maintenance of equipment Program Evaluation Record Keeping Employee The employee is responsible for: • • • • • • Identifying the risks associated with the potential for exposure to BF Knowing how to access immediate first aid and medical attention Knowing and implementing procedures for reporting exposure incidents Applying appropriate clean-up and disposal procedure as per safe work practices Participating in all training programs Practicing universal precautions.Bodily Fluids Exposure Page 2 . (those who have first aid responsibilities as a designated part of their job) Scheduling and delivery of BF Training Program.2 Responsibilities 2. retention and confidentiality of personal health care records.3 Contractor The contractor is responsible for: • Implementing a guideline that is aligned with applicable regulations. December 2005 CAPP Guide . 3 Record Keeping Employers must comply with federal.e. including the use of personal protective equipment 2.2 Offering all employees the opportunity to participate in the BF Program Identifying employees who are required to be included in the BF Program i.

Exposure types include: − Contact with mucous membranes such as a splash in the eye.2 Assessment First Aid administration procedures which may include: • • • • Suppression and containment of bleeding Artificial Respiration (AR mouth to mouth) Cardiopulmonary Resuscitation (CPR) Automatic External Defibrillators (AED) 4. open dermatitis or eczema − Contact from a needle stick.Bodily Fluids Exposure Page 3 . hepatitis B virus (HBV). personal protective equipment and disposal practices December 2005 CAPP Guide .4 Risk Management 4. • • • Universal precautions are designed to prevent transmission of human immunodeficiency virus (HIV). laceration or puncture − Exposure with contaminated material that can occur during procedure administration and / or waste disposal 4. chapped or abraded skin. mouth and/or nose − Contact with non-intact skin.1 Identification • • Identify all procedures where workplace exposure to BF is anticipated.3 Control Prevention is a key component to any program in order to minimize or eliminate risks to the company or its employees. hepatitis C virus (HCV) and other bloodborne pathogens Universal precautions treat all blood and body fluids as potentially infectious Engineering controls should include work practices.

or as soon as feasible. etc. Equipment must be cleaned and maintained according to manufacturer instructions 5. such as brush and dustpans. or breached gloves shall be disposed of in the specified manner Gloves must be changed after contact with each individual (remove gloves pulling from top and turning inside out) Hands must be washed immediately after gloves are removed • • • • December 2005 CAPP Guide .Bodily Fluids Exposure Page 4 . other potentially infectious materials. used.2.1 Work Practices 5.1. storage and cleaning along with documentation must be in place. torn. tongs.) 5.5 Engineering Controls 5. inspection. and non-intact skin. It shall be cleaned up using mechanical means.1 Housekeeping • • • • • All equipment and working surfaces shall be cleaned and decontaminated after contact with blood.) used for picking up contaminated or potentially contaminated materials shall be properly disinfected or disposed of after use A quality assurance program that includes regular maintenance. or other potentially infectious materials Appropriate disinfectants shall be used for cleaning All receptacles which are intended for reuse shall be inspected and decontaminated on a regularly scheduled basis. or when their ability to function as a barrier is compromised Contaminated.1. or forceps. mucous membranes.2 Personal Protective Equipment Personal protective equipment should be placed in areas where exposure to BF is anticipated (First Aid stations. vehicles etc. body fluids. and when touching contaminated items or surfaces Gloves shall be replaced when contaminated.2 Care and Maintenance of Equipment • 5. Supplies must be inspected and changed on a regular basis. or punctured. Cleanup materials (brush. forceps. upon visible contamination Broken glassware shall not be picked up directly with the hands.1 Gloves • Disposable impermeable gloves must be worn for all procedures where it can be reasonably anticipated that there will be contact with blood.

such as goggles or glasses with side shields.4 Incident Management Incident with loss of blood/body fluid: • • • Close off the area to prevent traffic moving through Put on personal protective equipment (minimum is disposable gloves) Clean area/work surfaces and/or equipment then disinfect with the recommended disinfectant December 2005 CAPP Guide .2. leak-proof sharps container Store. or droplets of blood or other potentially infectious materials may be generated and eye. splatter. The container will be maintained upright throughout use 5. Eye Protection • Disposable surgical masks.3 Contaminated Laundry • • • 5.3.3.2 Masks. should be worn whenever splash.3 Disposal Practices 5.3.2 Bodily Fluid Waste Disposal Using appropriate Personal Protection Equipment (PPE): • • • • Place all contaminated products in double garbage bags clearly marked with either a bio-hazard label or in a bio-hazard disposal bag Handle garbage as little as possible Place all sharps in a bio-hazardous labeled.3. in combination with eye protection. transport and dispose of wastes according to federal. nose.1 Sharps Use and Disposal • Containers for contaminated sharps shall be easily accessible to personnel and located as close as possible to the immediate area where sharps are used. provincial. spray.5.Bodily Fluids Exposure Page 5 . bagged or containerized at the location where used and shall not be sorted or rinsed Should be transported in a highly visible labeled bag and cleaned by professional service provider using approved method of disinfection 5. or mouth contamination may be anticipated 5. and local regulations Should be handled as little as possible with a minimum of shaking Should be tagged.

needle − Body surface exposed − Condition of the skin: Is the skin intact or broken? (i.Bodily Fluids Exposure Page 6 .pdf for post-exposure guidelines Post Exposure Reporting Employee • • Report exposure immediately to Supervisor Complete an incident investigation report form ensuring the following information is captured: − Incident description − Specific equipment involved i.e.gc.ca//publicat/ccdr-rmtc/95pdf/cdr2119e.hc-sc.phac-aspc. gloves. needle prick.1 Post exposure follow-up will be initiated as soon as possible after the exposure has occurred Refer to http://www.ca/ for post-exposure testing schedule Refer to http://www.e.e.6 Post Exposure Management For workers exposed to blood and body fluids • • • 6. etc) − Eye(s) − Nose − Mouth − Personal protection used (i. cut(s).gc. disposal surgical mask etc. gown.) − Initial treatment − Disposition Supervisor • Report exposure immediately to a qualified health professional Qualified Health Professional • Implement follow up protocol which shall have post exposure testing and post exposure follow-up December 2005 CAPP Guide .

7 Post Exposure Testing To be performed by qualified health professional • • • • • • • Review completed incident investigation report Obtain consent from source individual and exposed individual(s) for blood testing Document if no signed consent is received Collect all employee’s blood as soon as feasible after consent is obtained Provide results of source individual’s tests to the exposed individual(s). the exposed individual will be given a confidential health evaluation and followup Supportive psychological counseling by a qualified professional may be required Schedule of follow-up blood testing will be dependent upon initial exposure results and shall follow local.Bodily Fluids Exposure Page 7 . provincial and/or federal requirements Keep records for each individual with occupational exposure as per company. Anti-HBC − Hepatitis C screen – Anti HCV − HIV testing Frequency of the above tests will be determined by local. local. provincial and/or federal requirements Review results and develop subsequent treatment plan. this may include consultation with an infection control specialist File confidential documentation in exposed individual’s health record Immediately following a report of an exposure incident.1 Post Exposure Follow-up • • • • • 8 Program Evaluation • • • • Review of overall program content Effectiveness of education and training ensuring all components are covered Data analysis to review frequency trends Safe work practices established December 2005 CAPP Guide . provincial and federal regulations Assess each exposure to determine prevention strategies • • • 7. with the appropriate signed consents Inform the exposed individual about confidentiality laws in order to protect the source individual’s privacy rights Laboratory testing should include but not be limited to: − Hepatitis B screen – HbsAg.

mb.ca/labour/ Ontario: Ontario Occupational Health and Safety Act HIV/AIDS in the Workplace http://www.htm December 2005 CAPP Guide .gov.ab.ca Saskatchewan: Saskatchewan Labour Health and Safety Protecting Emergency Response Workers from Infectious Diseases http://www.com Manitoba: Workplace Safety and Health Division Managing Exposure to Human Blood/Body Fluids Work Safe Bulletin http://www.ca Quebec: Act Respecting Occupational Health and Safety Regulation respecting the Quality of the Work Environment http://www.Bodily Fluids Exposure Page 8 .labour.worksafebc.ca/safety/infectious-diseases/introduction.ccohs. Canada Occupational Safety and Health Regulations Alberta: Alberta Human Resources and Employment Statutes and Regulations Workplace Health & Safety Bulletins AIDS and the Workplace Universal Precautions for Workers Who May Be Exposed to HIV Alberta First Aid Regulations http://www.gov.Appendix A Canada: Resources Canada Labour Code.on.ca British Columbia: Worker’s Compensation Board of British Columbia HIV/AIDS AND HEPATITIS B AND C Preventing Exposure at Work http://www.sk.gov.ipc.

nt.ns.yk. Responsibilities.htm Northwest Territories Safety Act.html Nova Scotia: Nova Scotia Offshore Petroleum Occupational Health and Safety Requirements – Draft Element 1 – Rights. Prince Edward Island: Occupational Health and Safety Act http://www. Newfoundland: Occupational Health and Safety Act http://www.ca/labour/ New Brunswick: Occupational Health and Safety Act General Regulation http://www.nf.ca/ Nunavut: The Nunavut Act states that all laws of the Northwest Territories will apply in Nunavut.pe.gov.nb.php3 Yukon Occupational Health and Safety Act http://www.gov. General Safety Regulations http://www. and Regulatory Mechanisms Part 4 – Occupational Health and Safety Policy.gov.ca/acts/acts/o-00-2.ca/ December 2005 CAPP Guide .Bodily Fluids Exposure Page 9 . some will access the Occupational and Safety Act for that province. Program and Management System http://www.gov.gov.ca/hss/index.ca/index.The following websites will take you to the province’s government site.cnsopb.

Any contaminated object that can penetrate the skin. pants. through an event such as a needle stick. Hepatitis B Virus Hepatitis C Virus Human Immunodeficiency Virus HBV HCV HIV Personal Protection Specialized disposable clothing or equipment worn by an Equipment individual for protection against a hazard. A situation in which mucous membranes or the skin barrier is pierced. Includes all bodily fluids in situations where it is difficult or impossible to differentiate between bodily fluids. Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV). uniforms. synovial fluid. shirts. vaginal secretions. who in the course of his/her daily duties has been exposed to potentially. Describes the presence or the reasonably anticipated presence of BF on an item or surface.Bodily Fluids Exposure Page 10 . Exposure Refers to an event which. Controls (e. broken capillary tubes. Pathogenic microorganisms present in humans.g. December 2005 CAPP Guide . and exposed ends of dental wires.. cut. and abrasion. amniotic fluid and pus. scalpels. broken glass. pleural fluid. These pathogens include. and products made from human blood. Any bodily fluids visibly contaminated with blood. during the course of an individual’s duties. Means human blood.g. infected BF. General work clothes (e. self sheathing needles). human bite. cerebrospinal fluid. seminal secretions. but are not limited to. but are not limited to. and blouses) not intended to function as protection against a hazard are not considered to be Personal Protective Equipment. exposes individual to potentially infectious BF.. saliva.Appendix B Bodily Fluid (BF) Glossary Includes. that isolate or remove the blood-borne pathogen hazard from the workplace. including. human blood components. Hepatitis B Virus (HBV). Blood Bloodborne Pathogens Broken Skin Contaminated Contaminated Sharps Engineering Controls Exposed Individual An individual. but not limited to: needles. sharps disposal containers.

Universal Precautions Work Practice Controls December 2005 CAPP Guide . An approach to infection control. HCV. prohibiting the recapping of needles).g..Bodily Fluids Exposure Page 11 . and other blood-borne pathogens. whose blood or other potentially infectious materials may be a source of occupational exposure to other individuals. Controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e. HIV. all blood and bodily fluids are treated as if known to be infectious for HBV. According to the concept of Universal Precautions.Source Individual Any individual. living or dead.

1997 www. Preventing Exposure at Work WorkSafe 1998 www.show_document?p_table=STANDARDS&p_ id=10051 Last Update: 2001-01-18 8. Canadian Communicable Disease Report Supplement Vol.ca/oshanswers/prevention/ppe/universa. Bloodborne Pathogen Exposure Standard.worksafebc. Safety Bulletin BH003.osha.S.ab. Occupational Safety and Health Administration. AIDS and the Workplace. 2000 Last Update: March 2003 December 2005 CAPP Guide . U. Draft 2000 9. May 1997 Last Modified: 2005-09-21 7.calgaryhealthregion. Health Canada. First Aid Regulation. (AR48/2000). Canadian Center for Occupational Health and Safety.Appendix C Bibliography 1. Alberta Workplace Health & Safety Bulletins.htm 3. Quality Management Plan for Compliance with First Aid Regulation. Workplace Health and Safety. 2000 Refer to: www.ca/hre/whs/publications/pdf/bh003. Blood and Body Fluid – Post Exposure Guidelines.gov/pls/oshaweb/owadisp. Department of Labor. http://www.pdf 2000 2. Calgary Regional Health Authority. 2000 www3.calgaryhealthregion.Bodily Fluids Exposure Page 12 .html Last Updated: 2002-04-02 6. 23S3.ccohs. Alberta Occupational Health and Safety.gov. British Columbia Worker’s Compensation Board.pao. Universal Precautions for Workers Who May Be Exposed to HIV.ca/policydb/ShowPolicy?policy_id=1465 5.gov.ab. Standards – 29 CFR Bloodborne Pathogens 1910 – 1030.pdf 4. 1996. Administrative Manual 1998 Refer to: www.ca/directives/ohs/first-aid.ca/policydb/ShowPolicy?policy_id=1478 www.com/publications/health_and_safety_information/by_topic/assets/pdf/hi v_aids. Blood and Body Fluid Post Exposure Management Standard. Universal Precautions. HIV / AIDS and Hepatitis B and C. PanCanadian Petroleum Ltd.. An Integrated Protocol to Manage Health Care Workers Exposed to Bloodborne Pathogens.

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