Amend Section 5193, to read:
§ 5193. Bloodborne Pathogens.
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(c) Exposure Response, Prevention and Control.
(1) Exposure Control Plan.
(A) Each employer having an employee(s) with occupational exposure as defined by subsection (b) of this section shall establish, implement and maintain an effective Exposure Control Plan which is designed to eliminate or minimize employee exposure and which is also consistent with Section 3203.
(B) The Exposure Control Plan shall be in writing and shall contain at least the following elements:
1. The exposure determination required by subsection (c)(3);
2. The schedule and method of implementation for each of the applicable subsections: (d) Methods of Compliance, (e) HIV, HBV and HCV Research Laboratories and Production Facilities, (f) Hepatitis B Vaccination and Post-exposure Evaluation and Follow-up, (g) Communication of Hazards to Employees, and (h) Recordkeeping, of this standard;
3. The procedure for the evaluation of circumstances surrounding exposure incidents as required by subsection (f)(3)(A).
4. An effective procedure for gathering the information required by the Sharps Injury Log.
5. An effective procedure for periodic determination of the frequency of use of the types and brands of sharps involved in the exposure incidents documented on the Sharps Injury Log;
NOTE: Frequency of use may be approximated by any reasonable and effective method.
6. An effective procedure for identifying currently available engineering controls, and selecting such controls, where appropriate, for the procedures performed by employees in their respective work areas or departments;
7. An effective procedure for documenting patient safety determinations made pursuant to Exception 2. of subsection (d)(3)(A); and
8. An effective procedure for obtaining the active involvement of employees in reviewing and updating the exposure control plan with respect to the procedures performed by employees in their respective work areas or departments.
(C) Each employer shall ensure that a copy of the Exposure Control Plan is accessible to employees in accordance with Section 3204(e).
(D) The Exposure Control Plan shall be reviewed and updated at least annually and whenever necessary as follows:
1. To reflect new or modified tasks and procedures which affect occupational exposure;
2. a. To reflect changes in technology that eliminate or reduce exposure to bloodborne pathogens; and
b. If sharps are used in the employer’s place of employment, to reflect progress in implementing the use of needleless systems and sharps with engineered sharps injury protection;To document consideration and implementation of appropriate commercially available needleless systems and needle devices and sharps with engineered sharps injury protection;
3. To include new or revised employee positions with occupational exposure;
4. To review and evaluate the exposure incidents which occurred since the previous update; and
5. To review and respond to information indicating that the Exposure Control Plan is deficient in any area.
(E) Employees responsible for direct patient care. In addition to complying with subsections (c)(1)(B)6. and (c)(1)(B)8., the employer shall solicit input from non-managerial employees responsible for direct patient care who are potentially exposed to injuries from contaminated sharps in the identification, evaluation, and selection of effective engineering and work practice controls, and shall document the solicitation in the Exposure Control Plan.
(F) The Exposure Control Plan shall be made available to the Chief or NIOSH or their respective designee upon request for examination and copying.
(2) Sharps Injury Log.
The employer shall establish and maintain a Sharps Injury Log, which is a record of each exposure incident involving a sharp. The exposure incident shall be recorded on the log within 14 working days of the date the incident is reported to the employer.The information recorded shall include the following information, if known or reasonably available:
(A) Date and time of the exposure incident;
(B)Type and brand of sharp involved in the exposure incident;
(C)A description of the exposure incident which shall include:
1. Job classification of the exposed employee;
2. Department or work area where the exposure incident occurred;
3. The procedure that the exposed employee was performing at the time of the incident;
4. How the incident occurred;
5. The body part involved in the exposure incident;
6. If the sharp had engineered sharps injury protection, whether the protective mechanism was activated, and whether the injury occurred before the protective mechanism was activated, during activation of the mechanism or after activation of the mechanism, if applicable;
7. 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
8. The employee’s opinion about whether any engineering, administrative or work practice control could have prevented the injury.
(D) Each exposure incident shall be recorded on the Sharps Injury Log within 14 working days of the date the incident is reported to the employer.
(E) The information in the Sharps Injury Log shall be recorded and maintained in such a manner as to protect the confidentiality of the injured employee.
(3) Exposure Determination.
(A) Each employer who has an employee(s) with occupational exposure as defined by subsection (b) of this section shall prepare an exposure determination. This exposure determination shall contain the following:
1. A list of all job classifications in which all employees in those job classifications have occupational exposure;
2. A list of job classifications in which some employees have occupational exposure; and
3. A list of all tasks and procedures or groups of closely related task and procedures in which occupational exposure occurs and that are performed by employees in job classifications listed in accordance with the provisions of subsection (c)(3)(A)2. of this standard.
(B) This exposure determination shall be made without regard to the use of personal protective equipment.
(d) Methods of Compliance.
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(3) Engineering and Work Practice Controls-Specific Requirements.
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(B) Prohibited Practices.
1. Shearing or breaking of contaminated needles and other contaminated sharps is prohibited.
2. Contaminated sharps shall not be bent, recapped, or removed from devices.
Exception: Contaminated sharps may be bent, recapped or removed from devices if:
a. tThe employer can demonstrate that no alternative is feasible or that such action is required by a specific medical or dental procedure; and
b. The procedure is performed using a mechanical device or a one-handed technique, and the employer can demonstrate that no alternative is feasible or that such action is required by a specific medical or dental procedure.
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(E) Regulated Waste.
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3. Disposal of Other Regulated Waste. Regulated waste not consisting of sharps shall be disposed of in containers which are:
a. Closable;
b. Constructed to contain all contents and prevent leakage during handling, storage, transport, or shipping;
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(H) Cleaning and Decontamination of the Worksite.
1. General Requirements.
a. Employers shall ensure that the worksite is maintained in a clean and sanitary condition.
b. Employers shall determine and implement an appropriate written methods and schedules for cleaning and decontamination of the worksite.
c. The method of cleaning or decontamination used shall be effective and shall be appropriate for the:
i. Location within the facility;
ii. Type of surface or equipment to be treated;
iii. Type of soil or contamination present; and
iv. Tasks or procedures being performed in the area.
d. All equipment and environmental and work surfaces shall be cleaned and decontaminated after contact with blood or OPIM no later than at the end of the shift. Cleaning and decontamination of equipment and work surfaces is required more often as specified below.
2. Specific Requirements.
a. Contaminated Work Surfaces. Contaminated work surfaces shall be cleaned and decontaminated with an appropriate disinfectant immediately or as soon as feasible when:
i. Surfaces become overtly contaminated;
ii. There is a spill of blood or OPIM;
iii. Procedures are completed; and
iv. At the end of the work shift if the surface may have become contaminated since the last cleaning.
b. Receptacles. All bins, pails, cans, and similar receptacles intended for reuse which have a reasonable likelihood for becoming contaminated with blood or OPIM shall be inspected and decontaminated on a regularly scheduled basis and cleaned and decontaminated immediately or as soon as feasible upon visible contamination.
c. Protective Coverings. Protective coverings, such as plastic wrap, aluminum foil, or imperviously-backed absorbent paper used to cover equipment and environmental surfaces, shall be removed and replaced as soon as feasible when they become overtly contaminated or at the end of the workshift if they may have become contaminated during the shift.
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NOTE: Authority cited: Sections 142.3 and 144.7, Labor Code. Reference: Sections 142.3 and 144.7, Labor Code; Sections 117600 through 118360, Health and Safety Code.