OSHA Inspection: U. S. DRUG ENFORCEMENT ADMINISTRATION

Issued

Sep 13, 1991

Abate by

Oct 21, 1991

General-duty citation text

Executive order 12196 Section 1-201(a):   The employer did not furnish
employment and a place of employment which were free from recognized hazard s
that were causing or likely to cause death or serious physical harm to
employees in that employee(s) were exposed to the hazard of becoming in-
fected with Hepatitis B virus (HBV) and/or Human Immunodeficiency Virus
(HIV) through possible direct contact with blood or other body fluids.
(a)    On or about 6/11/91, JNSU Unit, JFK
International Arrival Building
Employees with the job title of Special Agent
were potentially exposed to blood or body
fluids while performing con-trolled hazardous
substances investiga-tion and evidence pro-
cessing.  The employer did not implement their
Infection Control Program  in  this Unit.
The hazards of such exposure include, but are
not limited to, the onset of clinical symptoms
of acute Hepatitis B, anorexia, abdominal pain,
jaundice and the potential for becoming a
chronic carrier of the Hepatitis B and/or Human
Immunodeficiency Virus.
ABATEMENT NOTES:
Among other methods, one feasible abatement method to reduce this hazard, i s
to establish and enforce adequate procedures regarding exposure to and
handling of blood and body fluids,  such as those stipulated by the Centers
for Disease Control (CDC).  Guidelines for prevention of transmission of
human Immunodeficiency Virus and Hepatitis B Virus to health care and
puiblic Safety workers, a response to P.L. 100-607 the Health Omnibus
Programs exterior Act of 1988.
TRAINING AND EDUCATION
Training and Education of employee(s) such as, but not
limited to special agents.
Such training and education shall be at the time of initial
employment and at least annually thereafter.  The training
materials used shall be appropriate in content and vocabul-
ary to educational level, literacy, and language background
of the employees being trained.
The Training and Education Program shall contain, at a
minimum, the following elements:
(i)    A general explanation of the modes of
transmission of bloodborne pathogens;
(ii)   An explanation of the employer's Infec-
tion Control Program;
(iii)  An explanation of the appropriate
methods for recognizing tasks and other
activities that may involve exposure
to blood or body fluids and other
potentially infectious materials;
(iv)   An explanation of the use and
limitations of work practices that will
prevent or reduce employee exposure,
including appropriate engineering
controls, work practices, and personal
protective equipment;
(v)    An explanation of the basis for selec-
tion of personal protective equipment;
(vi)   Information of the Hepatitis B
vaccination, including information on
its efficacy, safety and the benefits of
being vaccinated;
(vii)  Information on the appropriate actions
to be taken and the person to contact
in an emergency;
(viii) An explanation of the procedure to
follow if an exposure incident occurs,
including the method of reporting the
incident and the medical follow-up that
will be made available;
(ix)   An explanation of the signs and labels
and/or color coding used in the
workplace; and
(x)    A copy of the Center for Disease Control
(CDC) Guidelines.
Law-Enforcement Considerations
1.   Searches and evidence handling
Criminal justice personnel have potential risks of acquiring HBV
or HIV infection through exposures which occur during searches and
evidence handling.  Penetrating injuries are known to occur, and
puncture wounds or needle sticks in particular pose a hazard during
searches of persons vehicles, or cells, and during evidence handling.
The following precautionary measures will help to reduce the risk
of infection:
.  An officer should use great caution in searching the clothing
of suspects.  Individual discretion, based on the circumstance s
at hand, should determine if a suspect or prisoner should empt y
his own pockets or if the officer should use his own skills in
determining the contents of a suspect's clothing.
.  A safe distance should always be maintained between the office r
and the suspect.
.  Wear protective gloves if exposure to blood is likely to be
encountered.
.  Wear protective gloves for all body cavity searches.
.  If cotton gloves are to be worn when working with evidence of
potential latent fingerprint value at the crime scene, they ca n
be worn over protective disposable gloves when exposure to
blood may occur.
.  Always carry a flashlight, even during daylight shifts, to
search hidden areas.  Whenever possible, use long-handled
mirrors and flashlights to seach such areas(e.g., under car
seats).
.  If searching a purse, carefully empty contents directly from
purse by turning it upside down over a table.
.  Use puncture-proof containers to store sharp instruments and
clearly marked plastic bags to store other possibly con-
taminated items.
.  To avoid tearing gloves, use evidence tape instead of metal
staples to seal evidence.
.  Local procedures for evidence handling should be followed.  In
general, items should be air dried before sealing in plastic.
Not all types of gloves are suitable for conducting searches.  Vinyl
or latex rubber gloves provide little protection against sharp in-
struments, and they are not puncture-proof.  There is a direct trade-
off between level of protection and manipulability.  In other words,
the thicker the gloves, the more protection they provide, but the less
effective they are in locating objects.  Thus, there is no single type
of thickness of glove appropriate for protection in all situations.
Officers should select the type and thickness of glove which provides
the best balance of protection and search efficiency.
Officers and crime scene technicians may confornt unusual hazards,
especially when the crime scene involves violent behavior, such as a
homicide where large amounts of blood is present.  Protective gloves
should be available and worn in this setting.  In addition, for very
large spills, consideration should be given to other protective
clothing, such as overalls, aprons, boots, or protective shoe covers.
They should be changed if torn or soiled, and always removed prior to
leaving the scene.  While wearing gloves, avoid handling personal
items, such as combs and pens, that could become soiled or con-
taminated.
Face masks and eye protection or a face shield are required for
laboratory and evidence technicians whose jobs which entail potential
exposures to blood via a splash to the face, mouth, nose, or eyes.
Airborne particles of dried blood may be generated when a stain is
scraped.  It is recommended that protective masks and eyewear or face
shields be worn by laboratory or evidence technicians when removing
the blood stain for laboratory analyses.
While processing the crime scene, personnel should be alert for the
presence of sharp objects such as hypodermic needles, knives, razors,
broken glass, nails, or other sharp objects.
WRITTEN INFECTION CONTROL PROGRAM
The employer shall design and implement a written Infection Control
Program to minimize or eliminate employee exposure.  This Infection
Control Program shall be reviewed and updated as necessary to reflect
significant changes in tasks or procedures.  This program shall con-
tain, at a minimum, the following:
(i)    A determination of the exposure potential of all
employees;
(ii)   The schedule and method of implementation of the
Infection Control Program.
(iii)  All the items related to the identification,
evaluation, and control of bloodborne pathogens and
exposure to blood and body fluids contained in the
employer's Infection Control Training and Information
Program must be incorporated in the establishment's
overall written Inefction Control Program.
The written Infection Control Program shall be made avail-
able to all employees during the training program and at all
other times.
HEPATITIS B VACCINATION
The facility's infection control policy regarding Hepatitis
B vaccinations shall address all circumstances warranting
such vaccinations and shall identify employees of substant-
ial risk of directly contacting blood and body fluids.
All such employees shall be offered Hepatitis B vaccinations
in amounts and at times prescribed by standard medical
practice.
FOLLOW-UP PROCEDURES AFTER POSSIBLE EXPOSURE TO HIV/HBV:
(i)    If a special agent has a percutaneous
(needle-stick or cut) or mucous membrane
(splash to the eye, nasal mucosa, or
mouth) exposure to blood or body fluids
or has a cutaneous exposure to blood
or body fluids when the worker's skin
is chapped, abraded, or otherwise non-
intact, the source person  shall be
informed of the incident and tested for
HIV and HBV infections, after consent is
obtained.
(ii)   If the person(s) consent is refused or if the source person
tests positive, the special agent shall be evaluated clinically
by HIV antibody testing as soon as possible and advised to
report and seek medical evaluation of any acute febrile illness
that occurs within 12 weeks after exposure.  HIV seronegative
workers shall be retested 6 weeks post-exposure and on a per-
iodic basis thereafter (12 weeks and 6 months after exposure).
(iii)  Follow-up procedures shall be taken for
special agents exposed or potentially
exposed to HBV.  The type of procedures
depends on the immunization status of
the worker (i.e., whether HBV vaccina-
tion has been received and antibody
response is adequate) and the HBV
serologic status of the source patient.
The CDC Immunization Practices Advisory
Committee has published its re-
commendations regarding HBV post expo-
sure prophylaxis in table format in the
June 5, 1985, Morbidity and Mortality
Weekly Report.
(iv)   If an employee refuses to submit to the
procedures in (ii) or (iii) above, when
such procedures are medically indicated,
no adverse action can be taken on that
ground alone since the procedures are
designed for the benefit of the exposed
employee.

Issued

Aug 22, 1991

Abate by

Dec 27, 1991

Issued

Aug 22, 1991

Abate by

Dec 27, 1991

Issued

Aug 22, 1991

Abate by

Dec 27, 1991

Issued

Aug 22, 1991

Abate by

Dec 27, 1991