***This could be you . . .***

*A janitor was stuck by a hypodermic needle left in a trash can.*

An employee found blood drops around his work area.

# 1. Applicability of this chapter

You are required to follow this chapter if you work with, or may be
exposed to, biohazards including blood and "other potentially infectious
materials" as a part of your job. JSC has adopted the recommendations
found in the Centers for Disease Control and Prevention and National
Institutes of Health "Universal Precautions" and "Biosafety in
Microbiological and Biomedical Laboratories" for controlling biohazards
in the workplace. If you don't work with blood or body fluids but find
them in your work area, follow paragraph 2 below. If you are a
supervisor, paragraph 20 lists your responsibilities for biohazards.

# 2. What to do if you discover blood or other potentially infectious body fluids

If you find blood or other potentially infectious body fluids around
your work area, you shall:

a.  Leave it alone. Without the proper training and equipment, you risk
    getting a bloodborne disease.

b.  Block off the area to prevent others from contacting it.

c.  Report it to Emergency Operations Center Security Dispatcher
    at (281) 483-4658 and to your facility manager. They will send
    janitorial personnel trained in bloodborne pathogens to clean it up.

d.  If the incident is an emergency, call x33333, JSC's emergency
    number.

# 3. Biohazards and bloodborne pathogens

The following definitions apply to this chapter:

a.  ***Biological hazards or biohazards*** are those infectious agents
    that present a risk of death, injury, or illness to employees.
    Bloodborne pathogens and other potentially infectious materials
    (subparagraphs b and c below) are considered biohazards.

b.  ***Bloodborne pathogens*** are 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),
    hepatitis C virus (HCV), and human immunodeficiency virus (HIV).

c.  ***Other potentially infectious materials*** is an OSHA definition
    that includes:

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1.  The following human body fluids: semen, vaginal secretions,
    cerebrospinal fluid, synovial fluid, pleural fluid, pericardial
    fluid, peritoneal fluid, amniotic fluid, saliva in dental
    procedures, any body fluid that is visibly contaminated with blood,
    and all body fluids in situations where it is difficult or
    impossible to differentiate between body fluids.

2.  Any unfixed tissue or organ (other than intact skin) from a human
    (living or dead).

3.  HIV-containing cell or tissue cultures, organ cultures.

4.  HIV- or HBV-containing culture medium or other solutions.

5.  Blood, organs, or other tissues from experimental animals infected
    with HIV or HBV.

# 4. OSHA requirements for bloodborne pathogens

If your job description includes possible exposure to blood or "other
potentially infectious materials," you shall follow the OSHA 29 CFR
1910.1030, "Bloodborne Pathogens."

# 5. How to determine whether you work in a job that exposes you to biohazards or bloodborne pathogens

a.  JSC Space and Life Sciences has a Biosafety Control Board that
    evaluates the use of any new potential biohazardous or pathogenic
    materials. The Biosafety Control Board periodically audits
    laboratories for safe handling of bloodborne pathogens and
    biological materials. Anyone, employees or visitors, who brings
    biohazard materials onto JSC or who plans to implement a process
    using biohazardous materials shall have approval from the Biosafety
    Control Board before use or implementation.

b.  The Clinic Services Branch evaluates all areas where civil service
    or contract workers could be exposed to bloodborne pathogens. Your
    management shall help in evaluating these areas.

# 6. Biosafety levels and precautions you must take for each

You shall never bring any biosafety level (BSL) 2 materials on site
without the prior approval of the Biosafety Control Board. BSL 3 or 4
materials are prohibited on site.

You must classify all biohazards or biological materials as Biohazard 1,
2, 3, or 4. You must also follow the requirements in the table below for
the biosafety level that matches the biohazard classification when
working with any biohazardous material in a laboratory or clinical
setting.

+-------+-------------+--------------+-----------------+-------------+
| BSL . | Involves    | Follow these | Use this safety | Use these   |
| . .   | these       | practices .  | equipment       | facilities  |
|       | agents . .  | . .          | (primary        | (secondary  |
|       | .           |              | barriers) . . . | barriers) . |
|       |             |              |                 | . .         |
+-------+-------------+--------------+-----------------+-------------+
| 1     | Not known   | Standard     | None required   | Open        |
|       | to cause    | micr         |                 | bench-top   |
|       | disease in  | o-biological |                 | sink        |
|       | healthy     | practices    |                 | required    |
|       | adults      |              |                 |             |
+-------+-------------+--------------+-----------------+-------------+
| 2     | Associated  | BSL 1        | Class I or II   | BSL-1 plus: |
|       | with human  | practice     | biosafety       |             |
|       | disease,    | plus:        | cabinets (BSCs) | Autoclave   |
|       | hazard =    |              | or other        | available   |
|       | auto-i      | Limited      | physical        |             |
|       | noculation, | access;      | containment     |             |
|       | ingestion,  | biohazard    | devices used    |             |
|       | mucous      | warning      | for             |             |
|       | membrane    | signs;       | manipulating    |             |
|       | exposure    | "sharps"     | any agents that |             |
|       |             | precautions; | cause splashes  |             |
|       |             | biosafety    | or aerosols of  |             |
|       |             | manual       | infectious      |             |
|       |             | defining any | materials       |             |
|       |             | needed waste |                 |             |
|       |             | dec          | PPE: laboratory |             |
|       |             | on­tamination | coats; gloves;  |             |
|       |             | or medical   | face protection |             |
|       |             | surveillance | as needed       |             |
|       |             | policies     |                 |             |
+-------+-------------+--------------+-----------------+-------------+
| 3     | Indigenous  | BSL-2        | Class I or II   | BSL-2 plus: |
|       | or exotic   | practice     | BSCs or other   |             |
|       | agents with | plus:        | physical        | Physical    |
|       | potential   |              | containment     | separation  |
|       | for aerosol | Controlled   | devices used    | from access |
|       | tr          | access;      | for             | corridors;  |
|       | ansmis­sion; | d            | manipulating    | se          |
|       | disease may | econtaminate | any agents      | lf-closing, |
|       | have        | all waste;   |                 | double-door |
|       | serious or  | d            | PPE: protective | access;     |
|       | lethal      | econtaminate | lab clothing;   | exhausted   |
|       | c           | lab clothing | gloves;         | air not     |
|       | onsequences | before       | respiratory     | re-         |
|       |             | laundering;  | protection as   | circulated; |
|       |             | baseline     | needed          | negative    |
|       |             | serum        |                 | airflow     |
|       |             |              |                 | into lab    |
+-------+-------------+--------------+-----------------+-------------+
| 4     | Dangerous   | BSL-3        | Conduct all     | BSL-3 plus: |
|       | or exotic   | practice     | procedures in   |             |
|       | agents that | plus:        | Class III BSCs  | Separate    |
|       | pose a high |              | or Class I or   | building or |
|       | risk of     | Change       | II BSCs with    | isolated    |
|       | life-       | clothing     | full-body,      | zone;       |
|       | threatening | before       | air-supplied,   | dedi­cated   |
|       | disease,    | entering;    | po              | supply and  |
|       | aerosol-    | shower on    | sitive-pressure | exhaust,    |
|       | trans­mitted | exit;        | personnel suit  | vacuum, and |
|       | lab         | d            |                 | dec         |
|       | infections; | econtaminate |                 | onditioning |
|       | or related  | all material |                 | systems;    |
|       | agents with | when exiting |                 | other       |
|       | unknown     | facility     |                 | r           |
|       | risk of     |              |                 | equirements |
|       | t           |              |                 | outlined in |
|       | ransmission |              |                 | the test    |
+-------+-------------+--------------+-----------------+-------------+

# 7. Exposure control plan

Any organization or company whose employees may be exposed to blood and
"other potentially infectious materials" needs to have a written
exposure control plan that is tailored to the work area and designed to
minimize worker exposure. The plan shall contain the items listed in 29
CFR 1910.1030(c) and include but not be limited to:

a.  Exposure determination and hazard analysis, which describe the
    occupation and tasks with exposure.

b.  Methods to comply with applicable requirements.

c.  Communicating hazards to exposed employees.

d.  Recordkeeping.

e.  The procedures to follow after an exposure to blood or other
    infectious materials.

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a.  Hepatitis B vaccination option.

You must update the written exposure control plan yearly.

# 8. Precautions to take when working with blood or other potentially infectious materials

If you work with any of the blood or body fluids listed above, you shall
observe these "universal precautions: "

a.  Treat all blood and body fluids as infectious. Urine, feces, saliva,
    breast milk, and vomit are not considered potentially infectious
    materials unless they are visibly contaminated with blood.

b.  Always wear appropriate PPE such as gloves, lab coats or aprons, and
    eye or face shields for the task at hand.

c.  Wash your hands with biocidal soap immediately after removing your
    PPE or coming in contact with blood or body fluids.

d.  Remove all PPE before leaving the work area and place in the
    appropriate container for storage, decontamination, or disposal.

e.  Don't eat, drink, smoke, apply cosmetics, or handle contact lenses
    in the work area.

f.  Don't store food and drink in refrigerators or freezers where blood
    or other infectious materials are stored.

g.  Minimize splashing and spraying blood or other infectious materials
    while handling them, while cleaning equipment, or during any other
    clean-up procedure.

h.  Don't pipet or suction with your mouth.

i.  Make sure all ventilation hoods and biological safety cabinets are
    inspected at least every year.

# 9. Precautions when using needles

If you use needles with blood or other infectious materials, you shall
observe these precautions:

a.  Don't shear, bend, or break used needles.

b.  Don't recap or re-sheath by hand.

c.  Don't remove used needles from disposable syringes.

d.  Dispose of used needles in an approved biohazard container.

# 10. Housekeeping precautions

Housekeeping is an important part of your protection, so you shall
observe these requirements:

a.  Disinfect all work surfaces with an appropriate biocide at the end
    of each work shift or when they are contaminated.

b.  Replace protective coverings, such as foil or plastic wrap used to
    protect equipment, at the end of the work shift or when they become
    contaminated.

c.  Disinfect all waste containers labeled biohazard on a regular
    schedule and clean them when they are visibly contaminated.

d.  Don't pick up broken glassware with your hands. Use tongs or a brush
    and dustpan. Dispose of broken glassware in a puncture-proof
    biohazard container so it won't injure other workers.

e.  Place all specimens in a closeable, leak-proof container and label
    the container before storing or transporting.

f.  Use a secondary container if the first container is likely to be
    damaged.

# 11. Disposal precautions

Disposal is an important part of protecting others, so you shall observe
these requirements:

a.  Place all infectious waste in closeable, leak-proof containers that
    are color-coded or labeled as described in paragraph 12 below.

b.  Keep infectious waste separate from other waste.

c.  Wear protective gloves when handling infectious waste.

d.  Make sure that infectious waste is picked up and transported by
    trained personnel only and that it is disposed of in a biological
    incinerator. In emergencies, first responders may take properly
    bagged waste to the JSC Clinic for disposal during working hours.

e.  Minimize handling laundry that is contaminated. Bag it at the site
    in a properly labeled container and take it to a laundry for
    cleaning.

# 12. Labeling requirements for blood and body fluids

Labels shall be fluorescent orange or orange-red and include the word
BIOHAZARD and the biohazard symbol in a contrasting color. Place this
warning sign on all containers of infectious waste, and on refrigerators
or freezers that contain infectious materials. You may use red bags or
containers in addition to labels for containers of infectious waste.

# 13. Protective clothing and equipment to use when working with blood and potentially infectious materials

You shall wear the following protective equipment:

a.  Gloves, latex or another type if you are allergic to latex

b.  Lab coat or apron and eye and face protection if splashing or
    spraying is possible

# 14. Hepatitis B virus vaccination

The JSC Clinic provides HBV vaccine to all on-site contractor and civil
service employees in the job classifications listed in the exposure
control plan for your area, subject to the following:

a.  The Occupational Health Officer shall concur before you get the
    vaccine.

b.  The vaccine shall be offered to you at no cost within 10 working
    days of being assigned duties that could expose you to blood or
    other potentially infectious materials. You may decline this vaccine
    when it is offered by signing a declination form, which is available
    at the JSC Clinic. If you later change your mind, you can still get
    the vaccine from the JSC Clinic, still free of charge.

# 15. Training to work safely with blood and body fluids

You must be trained within 10 working days of being assigned duties that
could expose you to blood or other potentially infectious materials and
yearly thereafter to handle safely blood and body fluids listed in the
"Universal Precautions" of the Centers for Disease Control and
Prevention. Your training shall include:

a.  A copy of 29 CFR 1910.1030 and an explanation of its contents.

b.  A general explanation of the epidemiology, symptoms, and modes of
    transmission of bloodborne diseases.

c.  An explanation of how to recognize activities that may involve
    exposure to blood and other potentially infectious material.

d.  An explanation of the use and limitations of practices that will
    prevent or reduce exposure, including appropriate engineering
    controls, work practices, and PPE.

e.  Information on the types, selection, proper use, location, removal,
    handling, decontamination, or disposal of PPE.

f.  Information on the HBV vaccine, including information on its
    effectiveness, safety, the benefits of being vaccinated, and that
    the vaccination will be offered to you free of charge.

g.  Information on the appropriate actions to take and persons to
    contact if you or someone else is exposed to blood or body fluids.

h.  An explanation of the procedure to follow if an exposure incident
    occurs, including how to report the incident and the medical
    follow-up that will occur.

i.  Information on the post-exposure evaluation and follow-up that will
    be provided for you after an exposure incident.

j.  An explanation of the signs, labels, and the color-coding system.

k.  An opportunity to ask questions of the person conducting the
    training session. Training is available through the Clinic Services
    Branch.

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a.  Information on the Centers for Disease Control Prevention's
    Communicable Hotline (1‑800-342-2437) to receive personal,
    confidential, and reliable information.

b.  See Chapter 4.1, "Program Description" for safety and health
    training, of this handbook for more information on training.

# 16. What to do if you are exposed to blood or other infectious materials

If you are exposed to blood or body fluids, get medical treatment
immediately. Getting proper treatment within 2 hours of exposure might
prevent you from contracting a bloodborne disease. If you are treated at
an outside medical facility, go to your site clinic as soon as possible
for a follow-up visit. Follow the table below:

+--------------------------+-------------------------------------------+
| If the exposure is . . . | Then . . .                                |
+--------------------------+-------------------------------------------+
| An emergency where you   | • Call x33333 at JSC and the Sonny Carter |
| need an ambulance        | Training Facility, x44444 at Ellington    |
|                          | Field, 911 at any off-site location, or   |
|                          | x5911 at White Sands Test Facility.       |
+--------------------------+-------------------------------------------+
| To the eye, mouth, other | • Flood the area with water for 15--20    |
| mucous membrane, or      | minutes or wash with soap.                |
| non-intact skin          |                                           |
|                          | • Go to the JSC Clinic or emergency room  |
|                          | if the Clinic is closed for post-exposure |
|                          | follow-up.                                |
+--------------------------+-------------------------------------------+
| To intact skin           | • Immediately and thoroughly wash the     |
|                          | affected area with biocidal soap.         |
|                          |                                           |
|                          | • Go to the JSC Clinic or emergency room  |
|                          | if the Clinic is closed for post-exposure |
|                          | follow-up.                                |
+--------------------------+-------------------------------------------+

# 17. Clinic actions for exposure

For JSC employees, the JSC Clinic will provide a confidential medical
evaluation to you if you have been exposed and will:

a.  Document the:

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1.  Route(s) of exposure.

2.  HBV, HCV, and HIV antibody status of the source individual, if
    known.

3.  The circumstances under which the exposure occurred.

4.  Any "first-aid" or "prophylactic" measures that you received.

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b.  Collect and test the source individual's blood to determine the
    presence of HIV, HCV, or HBV infection, if the source individual can
    be identified and permission is given. You will be informed of
    applicable laws and regulations about disclosing the identity and
    infectious status of the source individual.

c.  Collect blood from you as soon as possible after the exposure
    incident to determine your HBV, Hepatitis C, and HIV antibody
    status.

d.  Follow up on you, including the following:

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1.  Antibody or antigen testing

2.  Counseling

3.  Evaluation of reported illnesses

4.  Safe and effective post-exposure treatment under standard
    recommendations for medical practice

# 18. JSC medical records for bloodborne pathogens

The following govern JSC medical records for bloodborne pathogens:

a.  The JSC Clinic keeps all medical exposure records for the duration
    of your employment plus 30 years.

b.  These medical records are available to you and anyone with your
    written consent.

c.  You shall file an injury report (JSC Form 340) for any exposure. The
    Safety Office will send a copy to your supervisor or company.

# 19. For more information on biohazards and bloodborne pathogens

You can find more information on bloodborne pathogens in these documents
or contact the JSC Clinic:

a.  29 CFR 1910.1030

b.  "Universal Precautions" guidelines from the Centers for Disease
    Control and Prevention

c.  "Bio Safety in Microbiological and Bio medical Laboratories,"
    published by the Centers for Disease Control and Prevention and the
    National Institutes of Health

# 20. Responsibilities for bloodborne pathogen safety

As a ***supervisor***, you are responsible for:

a.  Controlling all exposures to bloodborne pathogens through a written
    exposure control plan designed to minimize worker exposure.

b.  Making sure your employees follow the requirements of this chapter
    and your exposure control plan.

c.  Making sure your employees are trained in protecting themselves from
    bloodborne pathogens.

d.  Providing adequate PPE.

e.  Offering to all employees the Hepatitis B vaccination and training
    within 10 working days of being assigned to a job in which they
    could be exposed.