Purpose:
To place linen into proper containers for transport to laundry.
To contain linen and prevent contamination to Student/Staff/Environment.

Equipment:
Appropriate bag – linen or plastic.
Procedure:
1. Place bag in easy-to-use position.
2. Linen removed from Student is placed into bag.
a. Dry clothes – Linen Bag
b. Visibly wet/soiled clothes and/or linens with (stool, urine, blood/body fluids) – plastic bag
3. Close bag (bags) securely – and take to Laundry.

Care needs to be taken NOT to aerosolize particles, as linen/clothes are being removed. Use a minimum of agitation, handle as little as possible. Use UNIVERSAL PRECAUTIONS when handling ALL soiled linen.

Standard:
1. Staff are advised to keep a change of clothing available in their car or locker.
2. Staff may wash their soiled clothes in an on-campus machine or at home.
3. When clothing is soiled with Blood/body fluids, Remove and place into a plastic bag.

Purpose:
To protect both personnel and student from infection.
Equipment:
Foam Soap (Provided in wall dispensers)
Water
Paper Towels

NOTE: ALL Employees and Students hands are to be washed:
a. Prior to and at End of work period.
b. Between direct Student contact (Student and/or Body Fluids)
c. After handling any contaminated articles or waste
d. Before and after handling food
e. Following each use of bathroom
f. When gloves are removed

Procedure:
1. Dispense paper towels first
2. Turn on faucet, adjust temperature and force of water. Stand well away from sink to avoid splashing.
3. Wet hands
4. Soap hands, work up lather using vigorous friction. Include the areas between the Fingers and around Nails. Wash for at least 20 seconds.
5. Rinse thoroughly. Hold hands DOWNWARD for water to fall from ends of Fingers.
6. Dry hands thoroughly with sufficient paper toweling
7. Use paper towels to turn off faucet, to maintain clean hands.
8. Discard paper towels in waste basket, plastic lined.

Purpose:
To protect Students/Personnel from infection.

Equipment:
• Lined waste basket in room.
• Disposable gowns and gloves – one (1) use only.
• Goggles – retained by person using

Found: Area designed by each Department

Procedure:
A. Gown:
1. Remove rings (if they could rip gloves), remove or move watch up arm.
2. Lap gown over at back to cover uniform and tie securely.
3. To remove, untie gown at waist
4. Remove gloves
5. Wash hands. If wearing goggles, remove at this time.
6. Unite gown at neck.
7. Remove gown by grasping either sleeve and pulling away from self. Roll outside to inside, discard in lined waste basket.

B. Goggles
1. Don goggles .
NOTE: Goggles may be reused by washing with soap and water and drying.

C. Gloves
1. Don gloves making sure cuff of gown is covered. To avoid contamination of arm and clothing.
2. Remove gloves by grasping cuff and inverting inside out. Discard in lined waste basket. Remove first.
NOTE: Gloves are put on LAST and removed FIRST.

NOTE: If the person taking care of the patient with an infection comes into direct contact with patient secretions/excretions causing gross contamination of gloves, gloves are to be changed BEFORE touching or contaminating other articles/areas of the room.
Unless there is gross contamination on gloves, gown – may be discarded in regular lined waste basket.

Date: _________ Received From Campus: __________________________

Found by: ___________________ Item(s) Found: _________________________

Did Penetration Occur to Employee? ____No ____Yes
If yes, by whom? _________________________________________________________

Was Treatment Received? ____No ____Yes
If yes, by whom? ________________________________________________________

_______________________________________________________________
What Treatment was Received?
________________________________________________________________

________________________________________________________________
Has Employee Received Hepatitis B Vaccine? ________ Yes ________ No

Any Other Medical Conditions or Considerations?
________________________________________________________________

________________________________________________________________

________________________________________________________________

Employee Signature: ____________________________

Supervisor Signature: _____________________________

Was Item Returned to Facility? ____ Yes _____ No

Date Returned: _________ To Whom?: ______________________________________

Returned By: _____________________________________________________________

This form shall remain on file.

Job tasks will be classified according to risks of exposure to Blood/body fluids, Mucous Membranes, Non-Intact Skin.
Employees engaged in the following activities are MANDATED to follow the minimum protective requirement(s).

Post Exposure Worksheet

Purpose: It is the policy of Hillcrest Educational Centers (HEC) to provide a safe and healthy work environment which includes proper management of exposure to potentially contaminated blood and/or body fluids. These procedures are meant to ensure that appropriate measures are taken to protect those at risk of exposure.

Background: OSHA estimates approximately 5.6 million workers in health care and other facilities are at risk of exposure to bloodborne pathogens such as the human immunodeficiency (HIV), hepatitis B (HBV) virus, hepatitis C (HCV) and other potentially infectious diseases. Those at risk include anyone whose job may require providing first-response medical care in which there is a reasonable expectation of contact with blood or other potentially infectious materials. Common exposure in settings like HEC may occur from human bites. Although they are rarely associated with the transmission of HIV or HBV infection they are associated with a significant risk for serious bacterial infection and require proper medical treatment. Prevention of exposures is critically important. Regular hand washing, appropriate use of gloves and training are steps that contribute to the prevention of complications from these exposures.
Vaccinations and Incident Reporting
HEC has a vaccination program through Occupational Health Services. This program is offered at no cost to all employees upon being hired and again to those who have an occupational exposure to bloodborne pathogens. In the event of employee exposure to bloodborne pathogens, post-exposure evaluation and follow-up will be provided at Occupational Health Services. Following any exposure incident, the affected employee should immediately report to the campus nurse on duty during normal business hours. After hours, employees are instructed to report to the Berkshire Medical Center Emergency Room. An ART form AND Post Exposure Work Sheet should be completed by the nurse, faxed to Employee Health Representative at HR, a copy should be given to the Program Manager and the original sent with the employee for further documentation by the treating physician.

Procedures after bite exposure (Student to Student or Student to Staff)
• Immediately wash the site for 5 minutes with soap and water or flush eyes with normal
saline or tap water for 15 minutes (remove and discard contact lenses) Mild bleeding should be allowed to continue
• If there is blood in the biter’s mouth it should be rinsed and spit with tap water several times
• Report the injury to a supervisor
• Contact or go to campus Nursing Department who will make an assessment and refer to pediatrician, Occupational Health Services or Emergency Department as necessary
• Initial assessment includes skin integrity (is the skin broken), documentation of the incident and those involved, and initial wound care
• If after hours, go to the Emergency Room for evaluation of a bite that has broken the skin
• Complete incident report form, ART Form and Post Exposure Work Sheet. Enter a progress note in the appropriate system.
• Obtain a medical history on the source patient (biter) and have blood specimens drawn within the first 8-10 hours after exposure (consent must be obtained): Rapid HIV and Hepatitis panel. (Previously drawn labs are acceptable if dated in the past 60 days)
• Employees referred to Occupational Health or ER will receive an assessment and treatment which may include but is not limited to tetanus update, antibiotics, and several blood tests as needed. Treatment options will be discussed on an individual basis.
• Report the results of blood testing of the source (biter) to Occupational Health as soon as available (within 24 hours if rapid HIV done). The status of the Employee should be reported to the campus at this time. If there are positive reports at any time, The Medical Directors of both HEC and Occupational Health will be notified immediately. Referral for appropriate counseling and treatment will be made.
• If exposure occurs when there is no nurse available to draw blood, a call should be placed to the campus Head Nurse to decide the course of action.

Procedures after body fluid exposure (Student to Student or Student to Staff)
In the event of an accidental exposure to blood or body fluids (e.g., needlestick, blood or body
fluid contamination to a cut or scrape, mucous membrane exposure)

• Immediately wash the area for 10 minutes with soap and water or flush eyes with normal
saline or tap water for 15 minutes (remove and discard contact lenses)or rinse mouth for several minutes
• Report the injury to a supervisor
• Contact or go to campus Nursing Department who will make an assessment and refer to pediatrician or Occupational Health Services as necessary
• Initial assessment includes skin integrity (is the skin broken), documentation of those involved, and initial wound care
• If after hours, go to the Emergency Room for evaluation
• Complete incident report form, ART Form and Post Exposure Work Sheet. Enter nursing note in appropriate system.
• Obtain a medical history on the source patient and have blood specimens drawn within the first 8-10 hours after exposure (consent must be obtained): Rapid HIV and Hepatitis panel. (Previously drawn labs are acceptable if dated in the past 60 days)
• Employees referred to Occupational Health or ER will receive an assessment and treatment based on the individual circumstances.
• Report the results of blood testing of the source to Occupational Health as soon as available (within 24 hours if rapid HIV done). The status of the Employee should be reported to the campus at this time. If there are positive reports at any time, The Medical Directors of both HEC and Occupational Health will be notified immediately. Referral for appropriate counseling and treatment will be made.
• If exposure occurs when there is no nurse available to draw blood, a call should be placed to the campus Head Nurse to decide the course of action.

Standard:
In order to provide for the safety of Employees and Students alike, Hilcrest provides these Infection Control Guidelines. ALL Employees will be responsible for having a working knowledge of the principles of infection control, modes of transmission of disease, and their role as Employee in the prevention of the spread of disease.

Introduction:
The concept of Universal Precautions focuses on the isolation of body substances such as Blood, Urine, Feces, Wound and Oral Secretions, Sputum, Semen, Vomitus, etc. In this way, the individual diagnosis of the student is not the determining factor in the handling of blood/body fluids.
CDC, OSHA, and the Massachusetts Department of Public Health state that we should consider all blood/body fluids as potentially infectious. By not relying on diagnosis for Universal Precautions we are better able to protect students and staff alike.
The most important parts of this concept are:
• INCREASED AND PROPER HAND WASHING BY STUDENTS AND STAFF
• THE USE OF GLOVES.

Certain Employees are at a higher risk of exposure to infectious materials than others. There are 3 categories of decreasing risk as shown below:

Category I: Tasks that involve exposure to blood/body fluids or tissue.
These are ALL procedures that involve an inherent potential for mucus membrane or skin contact with blood/body fluids or body substances. PROTECTIVE BARRIERS APPROPRIATE FOR THE TASK MUST BE WORN.

Category II: Tasks that involve no exposure to blood/body fluids or body substances, but may require performing unplanned Category I tasks.
These are procedures that during routine work, skin and mucus membrane contact with blood, body fluids or body substances doesn’t normally occur. However, the potential for exposure may occur. Appropriate barrier protection must be worn.

Category III: Tasks that involve no exposure to Blood, Body Fluids, or Body Substances.
These are tasks that during normal work routine, there is no exposure or potential for exposure to blood, body fluids, or body substances.

In order of decreasing intensity and/or potential for exposure, the following Employees are at risk:
Nurses
YDP’s
Teachers
Teachers Adies
Supervisors and Assistant Supervisors
Houskeeping
Maintenance
Food Service/Dietary
Administrative Personnel
Administrative/Campus Secretaries
Business Office

In-service training is provided at least yearly for ALL employees, and to ALL new employees, at time of hire. At least the following topics are covered:
Infection Control Policies and Procedures
Employee Health Practices
Risk of exposure to blood/body fluids or tissue(s)
Employee responsibility for reducing risk
Universal Precautions

Equipment is provided to safeguard Employee/Student contacts. Each Employee should know where to obtain supplies. These include:
Gloves – Vinyl or Latex of appropriate size.
Gowns – as necessary
Masks/Eye Protection – (Gobbles, or Glasses with Side Pieces)
Resuscitation Equipment
Plastic Bags – Plain or RED, as needed
Sharps Disposal Units – Appropriately placed
Cleaning Products – as needed.

Individual judgement is necessary in determining which type of barrier equipment will be needed. Some of the reasons for barrier use are listed below:
• Wear gloves when it is likely that hands will be in contact with: Body fluids such as Blood, Urine, Semen, Feces, Wound and Oral Secretions, Sputum, or Vomitus.
• Protect clothing ,a gown ,when: It is likely clothing will be soiled.
• Wear eye protection when: Eyes or mucous membranes may be splashed such as blood draws, irrigating wounds, etc.
• Follow Written Policy for handling of linens, trash, contaminated equipment.
• Used Needles, Syringes, Sharps are to be discharged in puncture proof containers which are provided. Do NOT recap needled after use.

• Wash hands often and carefully. ALWAYS wash hands after contact with: Blood, Body Fluids, Tissue(s), and after removing gloves.
• Mouth-to-Mouth resuscitation should be done with the use of a one-way mask which is provided.

In order to safely handle Blood, Body Fluids or Tissue(s) and ensure good care and treatment, the following Guidelines should be used:

Specimens:
All specimens of Blood/body fluids or Tissue are to be treated the same, and are to be considered potentially infectious. ALL persons handling specimens should take care in obtaining specimens or handling the container to prevent contamination of the container or self. If a container becomes soiled with Blood/body fluids or Tissue(s), while being obtained, cleanse the outside of the container with 70% alcohol (wear gloves), or place in a plastic bag for transport to the laboratory.

Wound Dressing:
ALL wound dressings are to be handled so as to confine and contain Blood/body fluids. The Inverted Glove technique may be used for small dressings. Gloves are to be worn when removing dressings. Care should be taken when removing large dressings, so as not to spill on self or patient. Place ALL dressings in an impervious bag, as soon as removed. Bags/gloves may be placed in regular trash for disposal.
EXCEPTION: Heavily soiled dressings are to be red-bagged, secured tightly, for removal and disposal.

Trash:
Trash is to be placed in appropriate plastic bags, secured tightly, for removal and disposal.

Sharps:
All sharps are to be placed in puncture-proof containers as provided. When containers are full, close securely, and arrange for pick-up as per Policy for Disposal. Keep container in Nurses Station until pick-up.

Linens:
Linens are to be handled in the following manner:
• Regular Linen – Placed into linen bag at site of use. Laundry is done by Students with Supervision or by Laundry personnel. Some laundry is done by direct care staff.
• Linen visibly soiled with Blood/body fluids – is to be placed into a plastic bag using gloves. Laundry will be done by Staff, Supervising the Student, or by a Laundry person.

PERSONAL CLOTHES:
Student’s personal clothing, soiled with blood/body fluids is placed into a plastic bag. Most clothing may be washed in a regular washing machine with detergent and bleach.

MOUTH-TO-MOUTH RESUSCITATION:
Disposable mouth-to-mouth resuscitation equipment is provided for use, when needed.

COMMUNICABLE DISEASE EXPOSURE:
Employees exposed within or outside the school, and susceptible to a communicable disease should notify the ICC, so approprate policy may be followed to prevent exposure to other Students and co-workers.

BLOOD/BODY FLUID SPILLS:
Large blood/body fluid Spills are to be treated carefully to avoid contamination of the Environment, Students, and Personnel. The blood or body fluids should be carefully wiped up with disposable paper towels, which should then be discarded into red plastic bags, and secured tightly. The contaminated area should then be wiped with a solution of 1:10 Bleach or other suitable sanitizer. Following this, Housekeeping will santize the area.

FOOD/DRINK:
Food or drink shall NOT be stored in Refrigerators, Freezers, Cabinets where Blood/body fluids are stored.

DISHES:
Dishes have not been found to transmit infections. Therefore, regular trays and dishes may be used for ALL staff and students.

BLOOD SPILLS AND CLEAN UP

Purpose:
To safely clean up and dispose of Blood/Body Fluid spills.

Equipment:
• Blood/Body Fluid Spill Kit ( Gloves, Goggles)
• Double Plastic Bags
• Disposable Paper Towels/Cloths for Clean-Up
• Dustpan and Brush
• Bleach Solution 1:10 Dilution or virex (Made Up as needed)
• Detergent/Germicide

Definition:
Blood/Body Fluid Spill – A spill will be defined as a large amount of blood spilled. If body fluids (as Gastric fluids, Fecal material, Urine) are obviously Blood tinged/contaminated, they will also be treated as a blood Spill. Drops of blood/body fluids may be wiped up with an alcohol wipe, or gauze, wearing gloves.

Procedures:
1. Mark/close off area of spill.
2. Obtain supplies needed and dress appropriately.
3. Prepare solution of detergent/germicide and a solution of bleach 1:10 or virex to decontaminate the area, after the spill is cleaned with the detergent.
4. Using care, clean up any broken glass using a dustpan and brush.
5. Using disposable paper towels/cloths, wipe up the Blood/Body spill. Place into red bag, secure tightly.
6. After Blood/body fluids have been wiped up, using a Clean paper towel/cloth, wipe area with bleach solution 1:10 or detergent/germicide.
7. Place used paper towels/cloths into red plastic bag, along with barrier gear, secure tightly, for disposal.
8. Arrange for transport and disposal.
9. Dustpan and brush are to be soaked in the 1:10 bleach solution or virex, rinsed and replaced.
10. Notify Housekeeping to sanitize the area.

Training: Blood Borne Pathogens Movie/ Training is done at new staff orientation and annually thereafter.

Information: This Infection Control Manual is available at all sites.
Record Keeping: Record keeping is done consistent with OSHA standards and regulations.

Method of Compliance: Policies and procedures are consistent with OSHA standrads and regulations.

Review of Plan: Annually on Date of Inception

Approved: This Plan is approved by the Infection Control Coordinator and the Leadership of Hillcrest Educational Centers, Inc.

O.S.H.A.

This standard is written to address OSHA recommended policies/procedures to be used by Hillcrest for the care and safety of students and employees. In order to accomplish this goal, Departments where exposure to blood/body fluids is a possible part of their work experience will have written policies/procedures addressing these issues.
Body Fluids include: blood, semen, vaginal secretions, other blood contaminated body fluids, saliva in dental procedure.
Also, Hillcrest has a standard appropriate Employee Health Policy for pre-employment screening for: Hepatitis B Vaccines, Follow-Up Blood/Body Exposures, as well as Exposures to Communicable Disease.

These standards are addressed in the following policies and documents:

Infection Control Manual
Infection Control Procedures
Universal Precautions/Procedures
Employee Health

I. Employees considered at risk of Blood Borne Pathogen Exposure include the following:

A. ALL Nursing Staff
Youth Development Professionals (YDP’s)
Teachers
Teacher’s Aides
Assistant Supervisors
Supervisors

B. Environment of Care Services
Housekeeping
Maintenance

EXCEPTIONS:
Training/Staff Development
Campus/Administrative Secretary
Administrative Office Workers

II. Universal Precautions:
A. Barriers/Handwashing
B. Specimen Handling
C. Wound Dressings
D. Trash (Medical Waste Handling)
E. Sharps
F. Linen Handling
G. Exposures to Communicable Diseases
H. Exposures to Blood-Borne Pathogens
I. Blood/Body Fluid Spills
J. Safe-Work Practices

III. Barriers:
When a specific barrier is indicated ALL persons performing the task will wear specific barrier-appropriate barriers for use as identified/listed for procedures:
a. Protective Clothing – Needs to prevent blood/infectious materials from passing through and contaminating personal clothing or skin. This clothing need not be impervious.
b. Gloves – Work where there is a chance of contact with ANY blood/body fluids that may transmit a blood/borne pathogen.
c. Hands – Washed using CDC recommended methods whenever gloves are removed.
d. Eye Protection – Provided to ALL persons where there is a chance of blood/body fluid splashing.
e. One-Way Resuscitation: Masks provided for resuscitation.

(ALL persons involved in care involving blood/body fluid exposure are to be aware of where to find barriers, how to use them, when to use them, and how to dispose of them).

IV. Housekeeping
ALL persons involved in health care are responsible for keeping his/her area clean and safe to work in. Food and/or drink is NOT kept or eaten where contamination can/could occur. Spills are cleaned up as they occur, to ensure no cross-contamination or exposure to others.
The Housekeeping Department is responsible for ALL general cleaning. The Department has written Policies/Procedures, schedules, and appropriates products for maintaining cleanliness, safety of the campus.

V. Linen Handling:
Students may be responsible for their own laundry, or are assisted by direct care staff.
Hillcrest campuses may employ full-time Laundry personnel.
Gloves are to be used, if there is any possibility of body fluid contamination
OR
Linen grossly contaminated with blood, potential infectious material(s).

VI. Regulated (Medical) Waste:
Heavily soiled waste (where environment could become contaminated by leakage) is placed in a red biohazard bag and transported by housekeeping for disposal.
ALL sharps are placed into rigid containers which are provided to the campuses, and are conveniently placed for easy use. Containers are NOT to be overfilled, closed securely at site, .
Needles are NOT recapped, or broken, prior to discarding.
Slightly soiled bandages, bandaids, alcohol wipes, sanitary napkins are NOT considered to be regulated (Medical) waste. These may be placed in regular trash receptacles.

VII. Employee Health
There is a written plan for Employee Health. This Plan includes:
• Pre-Employment Evaluation/Physical
• Essential functioning testing
• Vaccines – HBV

Follow-Up Exposures to:

o Hepatitis B
o HIV/AIDS
o TB
o Communicable Disease(s)

All employees are required to report any signs and/or symptoms of communicable disease to a campus nurse. Signs and symptoms include but are not limited to:
Fever, vomiting, diarrhea, rash, fatigue, sore throat, and/or skin lesions.
The nurse will then take action consistent with policy on suspected or confirmed communicable disease.

VIII. Education:

There is an ongoing education program for all employees. All mandated programs are available and are to be attended on a Yearly Basis.

IX. Medical Records:
ALL Medical Records, Vaccine Records, Exposure Follow-Up, are located in the Employee Health Record.

X. Copies of OSHA Blood Borne Pathogen Standard –
are available in the following campus areas:
Human Resources Department
Infection Control Manuals
Nurses Stations