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Part 1, Chapter 1: Manual Exhibit 1-1-C

Example - Indian Health Manual Appendix/Exhibit Format

Manual Appendix/Exhibit 3-22-B
Page 1 of 1


(Please note:  This Hepatitis B Exposure Control Plan is an example of information contained in an Indian Health Manual appendix/exhibit and does not apply to Indian Health Service (IHS) employees, nor those assigned to the Indian Self-Determination and Education Assistance Act, Public Law (P.L.) 93-638, 25 United States Code 450 et seq., facilities.)

  1. Purpose.  The purpose of the Hepatitis B Exposure Control Plan is to eliminate or minimize employee occupational exposure to blood or body fluids.
  2. Background.  The Hepatitis B virus (HBV) has long been known to cause serious disease in susceptible individuals.  The agent that causes the Acquired Immune Deficiency Syndrome (AIDS), the human immunodeficiency virus (HIV), has been discovered only relatively recently.

    These and other blood-borne pathogens present occupational risks to health care providers.  In September 1986, several unions representing hospital and health care employees petitioned the Occupational Safety and Health Administration (OSHA) to take action to reduce the risk of exposure.  The petition was denied; however, in October 30, 1986, the Departments of Labor and Health and Human Services published a Joint Advisory Notice entitled, "Protection Against Occupational Exposure to Hepatitis B Virus and Human Immunodeficiency Virus."   On November 27,1987, OSHA announced its intent to initiate rulemaking to reduce occupational exposure to HBV and HIV.  After a comment period, OSHA published a Notice of Proposed Rulemaking on May 30, 1989.

  3. Hepatitis B Vaccination and Post-Exposure Evaluation/Follow-Up.  The Hepatitis B Vaccine and vaccination series will be available to all employees who have occupational exposure, including post-exposure evaluation and follow-up to all employees.
  4. Hepatitis B Vaccination.  Hepatitis B vaccination is made available to the employee after his or her attendance at a bloodborne pathogen training and information session.  The vaccine is made available to all employees with occupational exposure unless the employee has previously received the complete hepatitis B vaccination series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicated for medical reasons, or the individual declines.  The vaccine will be provided according to current recommendations of the U.S. Public Health Service.  There is no current recommendation for booster doses.  Pre-screening before receiving the hepatitis B vaccination is not routinely performed.

    All employees who decline to accept hepatitis B vaccination will be required to sign a Hepatitis B Vaccine Declination form.  If an employee decides to accept the vaccination at a later date, the hepatitis B vaccination will be made available at that time.  Declination forms are kept on file.

  5. Post-exposure Evaluation and Follow-up.  Following a report of an exposure incident, an employee will be given a confidential medical evaluation.  For all exposure incidents, the route(s) of exposure and the circumstances under which the exposure incident occurred (to include details of the use or non-use of engineering controls or work practice controls) are documented.  The source individual is identified and documented, unless identification is not feasible or prohibited by state or local law.  After consent is obtained, the source individual's blood is tested for HBV and HIV status.  If the exposed employee gives consent, a baseline blood sample is collected immediately following the incident with subsequent periodic samples taken at a later date.  Results of the source individual's testing will be made available to the exposed employee and the employee will be informed of laws/regulations regarding the privacy rights of the source individual.  The results of the source individual's blood test and employee's blood test are confidential and will be known only to the exposure Nurse/Physician and the exposed employee.  Counseling and other features of post exposure evaluation will be offered whether or not the employee elects to have baseline HIV/HBV serological testing.