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© 2015 Health Carousel LLC

Safety Handbook

Version 5/20/2015

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Printed: May 2015

Safety Handbook

© 2015 Health Carousel LLC

Version 5/20/2015

Confidentiality Notice: This handbook including all attachments is for the sole use of the intended recipient andmay contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution isprohibited unless specifically authorized by Health Carousel, LLC.

3Contents

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© 2015 Health Carousel LLC Version 5/20/2015

Table of Contents0

Part I Introduction 4

Part II Safety Orientation and Periodic Safety Meetings 4

Part III Safe Work Environment 4

Part IV Work Related Incidents, Injuries or Accidents 5

Part V Workers Compensation Insurance 7

Part VI Occupational Exposure to Disease 7

Part VII Other Work Place Incidents 7

Part VIII What To Do In Case of An Auto Accident with a Rental Car 8

Part IX General Safety Rules 8

Part X Work Safety Rules 9

Part XI Work Habits 10

Part XII Work Area 11

Part XIII Smoking 11

Part XIV Workplace Violence 12

Part XV Fire Safety 12

Part XVI Lifting 13

Part XVII Carrying 13

Part XVIII Pushing 14

Part XIX Pulling 14

Part XX Chemicals and Hazardous Materials 14

Part XXI Material Safety Data Sheets 15

Part XXII Chemicals 17

Part XXIII Bloodborne Pathogens and Infection Control Plan 18

Part XXIV Needlestick Policy 18

Part XXV Compliance Methods 23

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© 2015 Health Carousel LLCVersion 5/20/2015

1 Introduction

The personal safety of Health Carousel Contract Professionals while on assignment is a toppriority for Health Carousel, and we require that our Contract Professionals make it their toppriority as well. At Health Carousel , we believe that ALL work site hazards can be preventedor corrected if everyone accepts their responsibility for safety. We also feel that preventingaccidents is a shared responsibility between Health Carousel, its clients and our HealthcareProfessionals. We must all work together to insure a safe work site and the elimination ofaccidents.

During your assignment, you are expected to utilize safe practices. You must report to workrested and ready to give your full attention to each assignment. Follow the work site safetypractices and don't take short cuts. If an accident occurs, report it immediately to your worksite supervisor and your Recruiter / Account Manager. Be sure to record it on your timesheet / record.

If you are injured while working at a client facility, we all are hurt. Please do your part andwork safely. Use this manual as a ready-reference. You must refer to it as yourassignments and work duties change.

2 Safety Orientation and Periodic Safety Meetings

Prior to commencing employment with us, all Contract Professionals are required tocomplete appropriate safety training. Health Carousel Contract Professionals are required tocomplete Core Mandatory safety training including Environmental Safety, HazardousChemicals, Infection Control, Fire Safety, HIPAA, and Age Specific Competencies anddemonstrate that you understand the fundamental rules for workplace safety for healthcareprofessionals. Contract Professionals are required to participate in periodic safety training, atleast annually. As part of Health Carousel's safety training for Contract Professionals areencouraged to ask questions to ensure proper understanding of safety rules and practices. You will also be required complete any safety training programs for traveling ContractProfessionals which may be required by each individual healthcare facility.

3 Safe Work Environment

Health Carousel Contract Professionals will be instructed to complete a safety orientation attheir assigned facility, to use safe practices at their work site, to report unsafe workingconditions, to use Personal Protective Equipment (PPE) as appropriate, to follow the safetyrules and procedures for the specific facility to which they are assigned, to refuse to work in aunit or with equipment for which s/he is not adequately trained or qualified, and to becomefamiliar with evacuation procedures for the facility.

Health Carousel Contract Professionals should not work in any unit for which they are notqualified; nor should they perform tasks or use equipment for which they have not beenproperly trained. While on assignment, Health Carousel Contract Professionals shouldrefuse to work in unsafe working conditions and should promptly report unsafe workenvironment to Health Carousel. If you are ever in doubt about how to do a job or task safely,it is your duty to ask a qualified person for assistance. Unsafe conditions must be reportedimmediately.

Work Related Incidents, Injuries or Accidents 5


4 Work Related Incidents, Injuries or Accidents

If You Are Injured at the Worksite . . .It is critical that you notify Health Carousel about any significant incidents that occur while youare on an assignment. Any on-the-job injuries, exposures to disease, illnesses that may beattributable to the work place or any other significant incidents must be reported to yoursupervisor at the facility and to Health Carousel’s Risk Management Officer immediately afterthe event.

Tom Herbort, Health Carousel Risk Management Officer Phone 800-927-5918, Ext: 9856Email: [email protected]

If you are injured on the job or involved in a workplace accident, you must:

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1. Assess the seriousness of your injury and obtain appropriate medical treatment. Ifyou incur an injury, seek immediate treatment per protocol. For example, in case of aneedle stick or exposure, immediately wash the exposed area with soap and water orflush exposed mucous membranes in water.

2. Notify your health facility supervisor and your Health Carousel Representative orHealth Carousel Risk Management Officer as soon as possible within 24 hours. It iscritical that you notify the Health Carousel about any significant incidents that occurwhile you are on an assignment. Any worksite injuries, exposures to disease,illnesses that may be attributable to the work place or any other significant incidentsmust be reported to your supervisor at the facility and to the Health Carousel's RiskManagement Officer immediately after the event. Failure to report an incident in atimely manner may affect Workers’ Compensation eligibility and is also grounds fordisciplinary action. To report a workers compensation claim, please contact our RiskManager, at the Health Carousel corporate office, who can direct you to theappropriate workers compensation office for the state in which you are working.

3. Complete an accident investigation report, even if your injury is minor and medicalassistance is not needed. If a company representative is not available, please leave avoice mail and your call will be returned. When completing incident report forms, werequest that you use the report form from the facility to document importantinformation about the workplace incident and complete our incident report formseparately. Please attach a copy of the facility’s form to the Health Carousel form andfax a legible copy to your Health Carousel Representative within 24 hours of theincident. A witness, preferably the shift supervisor, or someone who was present atthe time of the incident and saw what happened should sign the incident report.

4. You must submit to a drug screen if you are injured on the job. Health Carouselrequires Contract Professionals to take a drug screen as a routine part of everyworkplace incident. If you seek medical treatment, please have the hospital’s labadminister the drug test, if possible. However, if you do not seek medical treatment,or cannot take the drug test at the hospital, you still need to take the drug test. Pleasecontact your Health Carousel Recruiter for proper contact information to take the testat least within 24 hours of the incident.

5. Please fill out any state required injury reports when applicable and forward them toHealth Carousel.

6. Please submit a medical release form prior to returning to work. You may return towork upon certification by the physician. Prior to the return to work, you must provideHealth Carousel with a statement from the physician certifying your ability to return towork, including the return date as well as any applicable restrictions.

Failure to comply with the above within 24 hours of the accident may result in delaysand/or problems in processing your claim.

Workers Compensation Insurance 7


5 Workers Compensation Insurance

As long as a work injury is properly documented, reasonable necessary follow-up medicalattention will be paid for by the appropriate workers’ compensation insurance, even after youleave the assignment. If you anticipate that further treatment may be required, be sure tocheck with the Health Carousel Risk Management Officer to obtain the name, address andpolicy number of the workers’ compensation insurer to give to future medical providers. Mostinsurance carriers need to hear from you before you seek follow-up treatment in order to giveprior approval for payment or physician selection.

6 Occupational Exposure to Disease

If you find yourself in a situation with a likelihood of exposure to a contagious disease (e.g.,tuberculosis) or a blood borne pathogen (e.g., hepatitis C or HIV), immediately report this toyour facility supervisor, and follow up with a report to Health Carousel’s Risk ManagementOfficer.

Before you start your assignment involving patient care or patient interaction, you will need toprovide documentation of your hepatitis B vaccination series or a waiver of vaccination. Whileon assignment, any required vaccination for hepatitis B will be provided to you throughreimbursement of expense by Health Carousel. You are strongly encouraged to take thissignificant preventative step if you have not already done so. There has been an increasedemphasis on education in recent years about the prevention of health professionals’occupational exposure to disease, particularly those illnesses that are communicable byblood borne pathogens. Health Carousel is committed to fulfilling our obligation to reduce therisk of exposure through vaccination, education and follow-up of any incident. If you become illand have reason to believe the illness is work-related, it is important that you immediatelynotify your facility supervisor and Health Carousel’s Risk Management Officer in the samemanner that you would in the event of injury.

7 Other Work Place Incidents

If you are involved in an incident in which there may be an allegation of negligence or violationof rules or procedures, it is essential that you notify your facility supervisor and HealthCarousel Risk Management Officer immediately. A delay in reporting the matter could resultin an insurance company’s rejection of any claim that may result.

As with work injuries, reporting any involvement in a potential professional liability situationnecessitates the collection of information. Before you call your Health CarouselRepresentative, record, in writing, as many of the following questions as possible:

What was the date and time of the incident?

Where in the facility did the incident occur?

What were you doing at the time of the incident? How did it occur?

Who were the witnesses to the incident (patients, doctors, etc.)?

What was the nature of the incident?

Did the incident result in injury?

Have there been any threats of legal action? By whom?

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8 What To Do In Case of An Auto Accident with a Rental Car

Auto accidents are an unfortunate, but possible occurrence in a person’s driving experience. Health Carousel and our rental car partners realize that, for all persons involved, the stressand trauma associated with an accident can be significant. Should you be involved in an autoaccident while driving a rental vehicle, there are some important steps you need to follow:

Steps to Follow When an Accident Occurs:

1. Call the local police - 911 in most areas.

2. Once the police arrive, ask them to complete and provide you with a copy of the policereport and accident report

3. Complete and turn in the accident report usually found on the back of the rental jacket

4. Call the location where you picked up your rental vehicle (the number will be listed onthe rental agreement)

5. You will be asked for your rental agreement number, which is at the top of the rentalagreement

6. If the car is not in driving condition, arrangements will be made with the local rentallocation for a replacement vehicle

7. Call the roadside assistance hotline for your rental car company for emergencies,accidents, and car breakdown

Please remember: In the event of an accident, the Accident Report in the rental jacket mustbe completed immediately after the accident has been reported to the Police. You will beadvised whether you should continue driving the car. If the car is not drivable, then promptlycontact your rental car company to ensure proper handling of your need for a replacement.

9 General Safety Rules

Health Carousel safety rules are the minimum standards for safe working conditions. Yourclient facility supervisor will answer any specific safety questions you may have about yourspecific assignment.

Work Safety Rules 9


10 Work Safety Rules

Use of alcohol or drugs during work hours is strictly prohibited

All Contract Professionals are required to use proper body mechanics to perform any lifting

Operate only the equipment that you have been authorized or directed to operate by yourassigned healthcare facility supervisor and for which you have received adequate training. Report all faulty equipment to your assigned healthcare facility supervisor

Report all unsafe conditions to your assigned healthcare facility supervisor

Use proper hand-washing techniques

Follow Universal Precautions at all times. Wear proper protective equipment.

Follow all fall precautions

Follow proper procedures to dispose of hypodermic needles. No recapping of needles!

Dress appropriately

There is a mandatory safety meeting held annually. It includes fire safety, universalprecautions, needle stick precautions, body mechanics, infection control training, and agerelated competencies

Follow all facility policies and procedures

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11 Work Habits

Know and follow all safety regulations pertaining to your assignment.

Before starting any task, make sure you know exactly what is to be done and how to do itsafely.

Be sure you perform your tasks in a manner that protects you and others.

Let your supervisor know if you feel you do not have adequate safety protection/knowledgein any work activity.

Never operate a piece of equipment unless you have been trained and are authorized.

Use your personal protective equipment whenever it is required. Some work assignmentsat Health Carousel require Associates to use various forms of Personal ProtectiveEquipment (PPE) such as gloves, safety goggles or glasses, etc. Personal protectiveequipment will not prevent an accident from happening but it does provide a barrier topersonal injury. When personal protective equipment is required by the work assignment,the Client Facility is required to provide it to you for your use while on the assignment.

Make sure all tools and equipment are in proper working order. Do not "fix" or repairanything yourself unless you are requested by your site supervisor, trained and authorizedto do so.

Report unsafe equipment to your supervisor immediately. Do not take chances! Notify anappropriate Health Carousel representative of any safety problems you encounter while atthe work site.

Never do anything that is unsafe in order to get the job done. If a job is unsafe, report it toyour supervisor.

Working under the influence of alcohol or illegal drugs or using them at work is prohibited.

Absolutely NO horseplay is ever permitted. Keep your mind on your work. Do not distractothers or allow your attention to wander from the task at hand.

Walk, do not run. Stay alert and pay attention to where you are walking. Walk aroundobstructions not over or on them.

Do not bring firearms or explosives onto company property.

Work Area 11


12 Work Area

Work areas must be kept clean and orderly at all times. Keeping the worksite clean iseveryone's responsibility. Good housekeeping is fundamental to a safe workplace.

Keep walkways, aisles, and stairs clear of tripping and falling hazards.

Always practice good housekeeping. Keep your work area clean. Properly dispose of trashin a timely manner.

Watch where you place power cords and hoses. Do not place power cords, cables, orhoses in walkways or where they are exposed to be run over.

Materials, supplies and equipment must be stored properly. All chemicals and solventsmust be kept in safety containers with proper labels.

If there are unlabeled chemicals in your work area, do not assume that you know what theyare. Address the matter with your supervisor and request a label.

Fluid on the floor should be removed as soon as possible, if this falls within your jobdescription and if you know what the fluid is. Otherwise, ask someone to guard the hazardand notify your supervisor of the condition immediately.

13 Smoking

Smoking is permitted in designated "Smoking Areas" at designated break times only.Smoking areas should be clearly marked throughout the work site. If they are not marked,ask your supervisor about their location. Smoking is prohibited in ALL other areas.

In "Smoking Areas", you must use the provided and approved ashtrays.

Smoking in unauthorized areas is a serious offense. Since careless smoking causes mostfires, you must strictly adhere to the smoking regulations to protect the safety of yourself,others and the company.

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14 Workplace Violence

The Health Carousel intends to provide a safe and secure workplace for our ContractProfessionals, applicants, clients, patients of clients, visitors, and others with whom we dobusiness. Health Carousel does not tolerate workplace violence, and such actions aregrounds for dismissal.

Workplace violence includes any physical attack that happens on the job, at a client site orat a Health Carousel office. If you are threatened at work, walk away and report the incidentto your Health Carousel recruiter. Engaging in violence or physically retaliating to verbaltaunts are grounds for dismissal.

Health Carousel has a "zero tolerance" guideline for possession of any type of weapon,firearm, explosive or ammunition. Health Carousel expressly forbids the possession offirearms on company or client property, including but not limited to all client facilities,vehicles and equipment, whether leased or owned by Health Carousel or its client. Inaddition, firearms in vehicles owned by anyone working with or at Health Carousel andparked on Health Carousel or client property are strictly forbidden.

Possession of firearms on Health Carousel or client property may be cause for disciplinaryaction including immediate termination of employment. To enforce this guideline, HealthCarousel reserves the right and conveys this right to our clients, to inspection of anyoneemployed at Health Carousel and their personal effects with or without cause, includingpersonal vehicles while on company or client premises. Refusal to allow inspection will besubject to the same disciplinary action as being found in possession of firearms.

15 Fire Safety

Know, and strictly follow, the smoking rules in your work area.

Know where the fire safety equipment is in your work area. This may include hoses,blankets, alarms or extinguishers.

Learn the evacuation routes and gathering sites for each assignment facility.

If you discover a fire, tell another person immediately. Call or have them call 911 and asupervisor.

If the fire is small (such as a wastebasket fire) and there is minimal smoke, you may try toput it out with a fire extinguisher.

If the fire grows or there is thick smoke, do not continue to fight the fire. Warn otherAssociates in the area to evacuate.

To extinguish a clothing fire on yourself, drop to the ground and roll to cause a smotheringeffect. For another person, use a blanket, or other means if available, to smother the fire.

Never load or stack materials or equipment that blocks access to fire safety equipment.

Never tamper with or move fire equipment except for actual use.

Report any equipment defects immediately to your supervisor.

Lifting 13


16 Lifting

Before you attempt to lift any object, plan and test the lift.

Check the object's weight. Squat down and try lifting just a corner.

If you do not feel comfortable about the lift, the object requires awkward handling or if is tooheavy, DON'T LIFT IT!

Ask someone close to help you or request a mechanical lifting device.

Once you have decided that you can lift an object, you MUST follow some basic steps inmaking a proper lift:

First, position your feet: preferably one foot alongside of the object to be lifted and the otherfoot slightly behind the first and about shoulder width apart. This will provide the balanceyou need for a correct lift.

Tighten the muscles in your stomach by pulling your stomach in and straightening yourback (spine).

Remember a straight back does not mean a vertical back. You can still keep your backstraight even if required to lift at an angle.

Bend your hips and knees and draw the object close to your body. Bending your knees willaid in keeping your back straight and bending your hips will allow you to keep the load closeto you.

Grasp the object by opposite corners and position your body so its weight is centered overyour feet.

Start the lift by pushing against your heels, and then slowly straighten your legs.Remember to use smooth movements and avoid jerking.

Once the object has been lifted, keep the load close to your body and if required, turn yourwhole body as a unit, including your feet. Don't Twist!

If more than one person is required to lift an object, designate one person to act as theleader. Have that person direct the movements out loud so you can coordinate yourmovements. Lift at the same time. Use your legs to lift, not your back.

17 Carrying

Keep your back as straight as possible and keep the object close to your body.

Move slowly, with small steps; Move your feet to change direction. Do not twist!

Put your object down by bending your hips and knees, keeping your back straight and theload close to your body.

If more than one person carries an object, designate one person to act as the leader. Havethat person direct the movements out loud so you can coordinate your movements. Keepthe load level when carrying. Move smoothly together and unload at the same time.

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18 Pushing

Stand close to the object to be moved.

Crouch down with your feet shoulder width apart.

Bend your elbows and put your hands on the load at chest height.

Lean forward and if possible; put your chest and hands against the object.

Keep your back straight, crouch and push with your legs.

19 Pulling

Place your feet shoulder width apart with one foot behind the other. Stay close to the objectto be pulled. Allow enough room between you and the object so that it will not hit your feet.

Grasp the object firmly, as close to its center of gravity as possible.

Crouch, leaning away from the object and counterbalance the weight of your body againstthe resistance of the load.

Pull by straightening your legs. Keep your back straight.

Step backward while continuing to crouch. Let your legs do all the work.

When possible, pushing is preferred over pulling.

20 Chemicals and Hazardous Materials

In 1970, Congress passed the Occupational Safety and Health Act. Over the yearsamendments have been added that expanded the original requirements of the Act. TheHazardous Communication (HAZCOM) regulations require all employers to advise theirContract Professionals of the presence of any hazardous materials being used in theworkplace. With a client base that changes daily, it is not possible for Health Carousel tomake you aware of the hazardous materials in use at every client facility. Additionally,because we have no control over the client company's internal operations, we are often notadvised when hazardous materials are in use. Nor do we know individual Safety/EmergencyPlan provisions of each company. We do not want our Contract Healthcare Professionals toreact to emergencies in a way that could cause increased injuries or make the situationworse. Health Carousel therefore wishes to advise you in a general manner what you, ourContract Professional, can do to insure the greatest measure of personal safety on the job.

Material Safety Data Sheets 15


21 Material Safety Data Sheets

Health Carousel clients are required to maintain and make available to our ContractProfessionals Material Safety Data Sheets (MSDS) on every chemical in the work area. It isimportant to know how to read a Material Safety Data Sheet because this document explainssafety information about chemicals in the work environment. While each manufacturer mayformat the information as they see fit, each MSDS must have the following information:

Product name - material/trade name, product number and common names

Product content - if the product is a mixture, the chemical components are generallyidentified

Physical and chemical characteristics - what the product should look like and in somecases the consistency. This section should also give the vapor pressure, boiling pointand flash point.

Physical hazards - this is the potential for fire, explosion or reactivity.

Health hazards – This is one of the most important sections for you to review. Thissection will explain the signs and symptoms of exposure and any medical conditionswhich may be aggravated by working around or with this chemical. First aidsuggestions are commonly found in this area as well.

Safety considerations - this section will discuss routes of entry. That means how thischemical is most likely to enter your body (i.e. breathing, contact with skin,swallowing). This section will usually discuss the suggested or in some casesrequired PPE when handling or working around this chemical.

Emergency contact information - this information will give you direction for contactingthe manufacturer or in some rare cases the distributor.

Any client that uses chemicals in the workplace is required to have an "Associate Right toKnow Station" were the MSDS are stored. Knowing where the MSDS are located and how toread one, gives you the critical keys to protecting yourself from any potential exposure at theclient site. Ask your work site supervisor where you can location their material safety datasheets if you should need them.

Since Health Carousel works with many client companies utilizing different chemicalsubstances, it is our belief your personal safety is best insured by following the establishedsafety procedures at your assigned work site. If you do not understand the procedures or theMSDS information, ask your supervisor. If your supervisor is unable to provide you withsufficient information to answer your question(s), ask your Health Carousel Representative.We will be happy to obtain the information you requested.

So many of the materials you use every day at work and at home contain chemicals thatcould be hazardous to your health. More and more chemicals are being introduced into thework environment each year. Even common items like rubber cement are flammable and canbe hazardous if improperly used. With this in mind, it is important that you take charge of yourown safety and know what chemical are in your work area - even if you are not directlyworking with them.

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Health Carousel Associates are required to utilize all protective equipment required bygeneral safety rules and material safety data sheets in the performance of their workassignments. If you are exposed to or contaminated by an unknown substance, contact yourClient Supervisor immediately!

Chemicals 17


22 Chemicals

Identifying labels and applicable precautionary measures are required on all chemicals andhazardous materials. The label will advise you if this chemical presents a hazard.

Look for common identifications such as: DANGER, WARNING or CAUTION. If you seethese words on a chemical in your area, it is a good idea to check the MSDS to be sure youare knowledgeable of the hazards and safety measures needed in your work area. Manylabels use the NFPA identification which is a combination of colors and numbers identifyinghazard. The higher the number, on a scale of 0 to 4, the greater the hazard. The colorsidentify the following:

Blue - Health Hazards

Red - Fire Hazards

Yellow - Reactivity Hazards, this may relate to interaction with other chemicals OR toexposure to heat.

White - Special or Other hazards important to note.

Labels MUST be present on all chemicals at the time you are using them. DO NOT removeor alter a label on any chemical container. If you are unclear how to read a label or cannot findthe MSDS for that chemical, ask your supervisor. Do not use a chemical that has noidentifying label. If you need work with a chemical and must use a temporary container, besure to label the container. If labels are not available, you must be in possession of thecontainer at all times and must properly dispose of the unused chemical and the containerwhen you are done with it.

Associates using or handling chemicals must practice daily hygiene in order to prevent skindermatitis. Good proper hygiene, proper PPE and good housekeeping are the three mostimportant protective barriers against chemical hazards and are everyone's responsibility.

When working with chemicals, Good Hygiene includes but is not limited to:

Washing your hands before and after using the restroom.

Washing your hands before and after eating, drinking or smoking.

Bathing and wearing freshly laundered clothes every day.

Avoiding hand to face contact before washing your hands.

Washing or sanitizing your respirator (if required) before putting it on - each time.

In some cases, clients will advise that they will launder your work clothes. HealthCarousel requests that you do not take your work boots home. These instructions aregiven to prevent chemical contamination of your home. They must be followedcarefully.

If you have questions about any chemical, ask your work site supervisor.

Do not use an unlabeled chemical if you are not ABSOLUTELY SURE what is in thecontainer.

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23 Bloodborne Pathogens and Infection Control Plan

Bloodborne Pathogens can cause illness or disease when you come in contact with blood orother body fluids. These diseases include, but are not limited to HIV/AIDS, Hepatitis B (HBV),Hepatitis C (HCV), and Tuberculosis. If you come in contact with blood or body fluids, notifyyour Client Supervisor immediately. DO NOT attempt to clean up blood or body fluids,contaminated equipment, or other surfaces. Workers with risk of on-the-job exposure needto be aware of Universal Precautions.

24 Needlestick Policy

The following procedures apply to all Health Carousel affiliated organizations’ healthcareprofessionals who have had significant contact from a contaminated needle or who have hadcontamination to an open wound or mucous membrane. These procedures apply to anycontamination received at a Health Carousel contracted facility. However, if the exposureoccurs outside the contracted facility and your assignment through the Health Carousel, it isrecommended that the healthcare professional seek medical care from the nearestemergency room or health care facility.

Significant Contact Definition

a. Contaminated needle with puncture of skin surfaceb. Any wound secondary to a contaminated objectc. Contamination of any open wound or mucous membrane by saliva, blood or any body fluid.

Insignificant Contact Definition

a. Exposure of unbroken skin by blood or saliva or other body fluids.

Procedure

a. Cleanse wound thoroughly with soap and water, or appropriate substance for tissuecleaning.

b. Report incident to appropriate exposure management personnel at the contracted facility.Complete all appropriate reports required by the facility within the required time. Send acopy of the facility specific incident report(s) to your Health Carousel recruiter.

c. Contact your recruiter within 24 hours or the beginning of the next regular business day.Complete all appropriate reports and interviews required by the Health Carousel within therequired time.

d. Obtain patient’s (source of exposure) permission for blood sample to be drawn forHepatitis B Surface Antigen (HBsAg), Hepatitis C Antibody (Anti-HCV), and Antibody toHuman Immunodeficiency virus (Anti- HIV). Samples should be submitted to a lab usingappropriate paperwork and usual process for the facility. Be certain you understand howthis information can be retrieved.

Needlestick Policy 19


e. The healthcare professional should have her/his blood drawn at the facility as soon aspossible for HBsAg, Antibody to Hepatitis B Surface Antigen (Anti-HBs), Hepatitis CAntibody, and Anti-HIV. If the healthcare professional has had a documentedseroconversion following a Hepatitis B vaccination series, the HBsAg and Anti-HBs are notneeded.

f. The primary purpose of the initial visit is to document the incident and offer prophylactictherapy for HIV exposure.

g. If health care providers at the facility have questions about appropriate care, they can callthe national HIV Post-Exposure Prophylaxis Hot-Line for Clinicians at 1-888-HIV-4911,which is open 24 hours per day.

h. If the source is Anti-HIV negative, further follow up is at the discretion of the healthcareprofessional and the healthcare professional’s physician. If the patient to whom thehealthcare professional was exposed is shown to be Anti-HIV positive, repeat healthcareprofessional testing at 6 weeks, 3, 6, and 12 months from initial exposure isrecommended. If these are done in the Health Carousel contracted facility, there will be nocharge for the follow-up testing as the Health Carousel will reimburse the facility for testsrecommended herein. At such time that the Health Carousel healthcare professional nolonger works at the contracted facility where the contamination took place, the healthcareprofessional must obtain approval from their Health Carousel recruiter prior to engaging inany remaining follow-up testing.

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i. Any healthcare professional who seroconverts her/his Anti-HIV will be referred by theDirector of Clinical Support for appropriate follow-up care unless the state in which thecontracted facility is located mandates the results of the Anti-HIV test remain confidential;only the healthcare professional, her/his physician and the contracted facility director willknow the test results. The healthcare professional’s physician or the contracted facilitydirector may inform others of the healthcare professional’s Anti-HIV test result only aftercounseling and obtaining written permission from the healthcare professional.

j. If the patient to whom the healthcare professional was exposed is shown to be HBsAgnegative, no further Hepatitis B testing or therapy is needed. If the patient to whom thehealthcare professional was exposed is shown to be HBsAg positive but the healthcareprofessional is also HBsAg positive or the healthcare professional is Anti-HBs positive(either from prior disease or as a result of a Hepatitis B vaccination series), no furtherHepatitis B testing or therapy is needed. If the patient to whom the healthcare professionalwas exposed is shown to be HBsAg positive and the healthcare professional is bothHBsAg negative and Anti-HBs negative, the healthcare professional should receive onedose of Hepatitis B Immune Globulin (.06 ml/kg intramuscularly) as soon as possible within72 hours after exposure, and begin a Hepatitis B vaccination series within seven days. Ifthe healthcare professional has already received Hepatitis B vaccination but has a negativeAnti HBs test result, the healthcare professional should receive HBIG and one dose ofHepatitis B vaccine.

k. In accidental exposure to blood from a patient with Hepatitis C, the healthcare professionalshould have a HCV-PCR in 2-3 weeks post-exposure. The healthcare professional shouldalso follow-up for Hepatitis C serology at 6 weeks, 6 months, and 1 year.

l. Prophylaxis has been utilized by needlestick recipients in an attempt to decrease their riskof development of HIV infection. Before the healthcare professional utilizes this form oftherapy, several points should be considered:

This risk of transmission of HIV per episode of percutaneous exposure to HIV-infectedblood is, on the average, approximately 0.4%.

1. Anti-HIV seroconversion in a needlestick recipient has been documented despite use ofprophylaxis.

2. Drugs used for HIV prophylaxis have multiple possible side effects. Please contact yourphysician prior to discontinuing any prophylaxis medications to ensure it is indeed themedication responsible for the symptoms.

m. If the healthcare professional voluntarily elects to seek independent evaluation for anyincidence related to a needlestick outside the confines of the Health Carousel contractedfacility, unless otherwise noted herein, these costs will be the responsibility of thehealthcare professional.

Guidelines for Needlestick and Body Fluid Exposures for Health Carousel Healthcare Professionals

It is recommended that you receive treatment within 2 hours of a needlestick or body fluid

Needlestick Policy 21


exposure. You are encouraged to seek counseling at the Health Carousel contracted facilityso that your degree of exposure can be assessed and to assure appropriate data is collectedon the source patient. With this necessary counseling, you will be in a better position tomanage both your exposure and the related costs.

Risks

1. HIV: If you sustain an injury with a needle or other sharp object that has been exposed to apatient’s body fluids, or if you splash a patient’s body fluid onto broken skin or mucousmembranes, you may be at risk to contract infection with human immunodeficiency virus(HIV), the causative agent of AIDS.

a. If this occurs, treatment is available that can substantially reduce the risk of acquiringHIV infection. The U. S. Centers for Disease Control and Prevention recommends thatfor maximum protection, you should receive treatment within two hours of exposure.

2. HBV: Healthcare personnel who have received hepatitis B vaccine and developed immunityto the virus are at virtually no risk for infection. For a susceptible person, the risk from asingle needlestick or cut exposure to HBV-infected blood ranges from 6-30% and dependson the hepatitis B e antigen status of the individual.

3. HCV: The average risk for infection after a needlestick or cut exposure to HCV-infectedblood is approximately 1.8%. The risk following a blood exposure to the eye, nose or mouthis believed to be very small; however, HCV infection has been reported from blood splashto the eye.

Reporting

1. The following are guidelines for what to do if you sustain a needlestick injury or body-fluidexposure.

a) If the exposure occurs during working hours, care should be obtained from the HealthCarousel contracted facility. Report the exposure to the department responsible formanaging exposures. Prompt reporting is essential because, in some cases,postexposure treatment may be recommended and it should start as soon as possible.

b) If the exposure occurs during non-working hours, it is recommended that the healthcareprofessional seek medical care from the nearest emergency room or health care facility.Again, prompt reporting is essential because, in some cases, postexposure treatment maybe recommended and it should start as soon as possible.

Treatment

1. Options vary and new treatments may emerge. As such, postexposure treatmentsshould be discussed with the healthcare professional’s medical provider(s).

The procedures and guidelines provided herein are subject to revision and modification by the

Safety Handbook22


Health Carousel Executive Committee and supersedes previous needlestick policies. TheHealth Carousel strives to keep all recommendations current based on regulatory instructionand/or expert findings within the medical community. However, due to the dynamic nature oftreatments and healthcare in general, recipients of this document must understand that theseare recommendations only, based on authoritative advise at a specific point in time. Thisdocument in no way attempts to take the place of professional, licensed medical advice; it isimperative that anyone affected by incidences described within this publication seekimmediate professional medical treatment.

Compliance Methods 23


25 Compliance Methods

All Contract Professionals are required to use Universal Precautions to prevent contact withblood or other potentially infectious materials. Universal precautions are infection controlguidelines designed to protect workers from exposure to diseases spread by blood andcertain body fluids. Universal precautions stress that all bodily fluids should be assumed to bedangerous to contact. Measures must be taken for protection against exposure to blood andcertain body fluids. These measures consist of:

Personal Protective Equipment (PPE) – PPE shall be provided for Health CarouselContract Professional use by the assigned facility at its own cost. PPE includesgloves, gowns, shoe covers, goggles, glasses with side shields, masks, andresuscitation bags. The purpose of PPE is to prevent blood and body fluids fromreaching the workers' skin, mucous membranes, or personal clothing. It must createan effective barrier between the exposed worker and any blood or other body fluids.Check PPE for damage before putting it on. Remove PPE carefully and in such amanner to prevent the spread of contamination. Disposable equipment must bedisposed of properly after its first use and may not be re-used.

Engineering Controls - Engineering controls refer to methods of guarding orremoving hazards from the workplace. For example, syringes and needles are to bedisposed of in puncture-proof hard plastic containers.

Work Practice Controls - Practical techniques that reduce the likelihood of exposureby changing the way a task is performed like using a broom to pick up glass withblood on it rather than picking the glass up by hand. All contaminated areas should bedisinfected as soon as feasible after a spill of any potentially infectious material. Soiled laundry items should be laundered without delay to decrease the risk ofaccidental infection.

Good Hygiene - Contract Professionals are required to utilize good hygiene duringtheir work assignment. Wash your hands with an antibacterial soap immediatelyafter coming in contact with or potentially coming in contact with bodily fluids. If at allpossible, DO NOT handle used needles sharps or contaminated reusable sharps.Flush exposed eyes, nose, or mouth quickly and thoroughly with water. Keep opencuts, rashes and other broken skin covered at all times.

Work Area Restrictions – In areas where there is a likelihood of exposure to blood orother potentially infectious materials, Contract Professionals are restricted fromeating, drinking, applying cosmetics or lip balm, or handling contact lenses. At alltimes, work procedures should be conducted as to reduce or eliminate splashing,spraying, splattering, or generating droplets of blood or other potentially infectiousmaterials.

Hepatitis B Vaccination – Before you start your assignment, you will need to providedocumentation of your hepatitis B vaccination series or a waiver of vaccination. Whileon assignment, any required vaccination for hepatitis B will be provided to youthrough reimbursement of expense by Health Carousel.

Safety Handbook24


Post –Exposure Evaluation and Follow-Up – When an Contract Professionalincurs an exposure incident, s/he may have a post-exposure medical evaluation andfollow-up as needed at no cost to the Contract Professional. The ContractProfessional is required to report the incident to his/her worksite supervisor and toHealth Carousel in written form as soon as feasible.

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