Safeguards are taken for the health and safety of patients, students, graduate assistants, and faculty/staff. These are:

1. Each student athletic trainer is required to have received a Hepatitis B Vaccine or signed a waiver prior to entry into the program
2. Modalities are checked and serviced periodically for potential problems.
3. No student is allowed to use a modality without specific instructions from a clinical instructor and the student having shown competence with the modality.
4. Students are required to be Standard First Aid & CPR certified before admission into the program and must gain recertification each year. Each student will also be AED certified if the materials needed are available for this type of certification.
5. Five year students must successfully pass two practicums in athletic training classes and attend the preseason in-service program prior to performing athletic training activities in the athletic training room.
6. OSHA guidelines are followed very closely. All student stating they have read the guidelines and universal precautions and understand and will adhere to them must sign a consent form. Also, a training session on the OSHA guidelines and universal precautions is required each year of all athletic training students.
7. The local health department is retained to dispose of medical waste and sharp objects.
8. Appropriate emergency procedures are discussed and demonstrated with each new athletic training student.
9. Each athletic training student must take part in a yearly in-service on the appropriate techniques of emergency procedures.
10. All emergency and potentially important phone numbers are posted at specific locations should an emergency situation arise.

Bloodborne Pathogens Exposure Control Plan
In accordance with the Occupational Safety Health Administration (OSHA) Bloodborne Pathogens Standard, 29 CFR 1910.1030, the following Exposure Control Plan has been developed:

1. Exposure Determination

OSHA requires employers to perform an exposure determination concerning which employees may incur occupational exposure to blood and other potentially infectious materials. The exposure determination is made without regard to the use of personal protective equipment (i.e., employees are considered to be exposed even if they wear protective equipment). This exposure determination affects all full-time athletic trainers on staff, graduate assistants, and student athletic trainers at The University of West Alabama working directly with University athletes or athletes participating on the University campus as part of a program sponsored by or hosted by The University of West Alabama.
The job classification and associated tasks for these categories are as follows:
A. Athletic Training Staff members will be expected to provide emergency treatment for life-threatening emergencies, including administering mouth-to-mouth resuscitation and controlling bleeding occurring due to participation in athletics. Also, the staff member may be involved in assisting team physicians with suturing, draining blisters, applying band-aids, and shaving calluses.
B. Graduate Assistants and Student Athletic Trainers will often be required to perform the same taks when the situation requires.

2. Implementation Schedule and Methodology

OSHA also requires that this plan include a schedule and method of implementation for the various requirements of the standard. The following complies with this requirement.

A. Compliance Methods

Universal Precautions will be observed at this facility in order to present contact with blood, blood products, or other potentially infectious materials. All blood, blood product, or other potentially infectious material will be considered infectious regardless of the perceived status of the source or source individual.
Engineering and work practice controls will be used to eliminate or minimize exposure to employees at this facility. Where occupational exposure remains after institution of these controls, personal protective equipment shall be used (refer to the Policies & Procedures Manual: All staff, graduate assistants, and student athletic trainers will use personal protective equipment in dealing with any potentially infectious material). At this facility, sharps containers, waste disposable bags, and clearly marked biohazardous waste containers will be used as engineering controls.
The above controls will be examined and maintained on a regular basis, with attention given to the contents of the engineering controls to insure removal once the containers reach ½ to ¾ of capacity. The effectiveness of the controls shall be reviewed on a semiannual basis by an individual appointed by the Head or Assistant Athletic Trainers.
Hand washing facilities are also available to the employees who incur exposure to blood or other potentially infectious materials. OSHA requires that these facilities be readily accessible after incurring exposure. At this facility, there are two hand-washing facilities located in the athletic training room, in each athletic locker room, in each coach’s locker room, and in each of the public restrooms. There are no available facilities at game/practice sites. As an alternative, a 10% bleach and water solution and isopropyl alcohol are stored in each athletic trainer’s kit on the site. If this alternative method is used, the hands are to be washed with soap and running water as soon as feasible following any exposure.
After proper removal and disposal of personal protective gloves or other personal protective equipment, employees shall wash their hands and any other potential contaminated skin area immediately or soon as feasible with soap and water.
If employees incur exposure to their skin or mucous membranes, then those areas shall be washed or flushed with water as appropriated or as soon as feasible following contact.

B. Needles

Contaminated needles and other contaminated sharps objects will not be bent, recapped, removed, sheared, or purposely broken. Following usage needles or other contaminated sharps objects will be disposed of in a clearly marked biohazardous, sharps container. OSHA allows for one exception to the rule governing the disposal of needles, if the procedure requires that the contaminated needles be recapped or removed and no alternative is feasible, and the action is required by the medical procedure. If such action is required, then the recapping or removal of the needle must be done by the use of a mechanical device or a one-handed technique. At this facility recapping or removal is only permitted while assisting one of the team physicians in a procedure necessitating this act.

C. Containers for Reusable Sharps

Contaminated sharps that are not reusable are to be placed immediately, or as soon as possible after use, in appropriated sharps containers. At this facility, the sharps containers are puncture resistant, labeled with a biohazard label, and are leak proof. The sharps container is located in the cabinet above the first aid area of the main athletic training island. An individual appointed by the Head Athletic Trainer has the responsibility for disposal of the sharps container when it becomes ¾ full. The container need only be checked as necessitated by its use.

D. Work Area Restrictions

In work areas where there is reasonable likelihood of exposure to blood and other potentially infectious materials, employees are not to eat, drink, apply cosmetics or lip balm, or handle contact lenses. Food and beverages are not to be kept or placed on treatment tables, taping decks, or countertops when blood or other potentially infectious materials are likely to be present. Mouth pitpettng or suctioning of blood or other potentially infectious materials is prohibited. All procedures will be conducted in a manner that will minimize splashing, spraying, splattering, and generation of droplets of blood or other potentially infectious materials.

E. Specimens

Specimens of blood or other potentially infectious materials, such as urine, will be placed in a container that prevents leakage during the collection, handling, processing, storage, and transport of the specimens.
The container used for this purpose will be labeled or color-coded in accordance with the requirements of the OSHA standards. It should be noted that this standard provides for an exemption for specimens from the labeling/color-coding requirements of the standard, provided the facility uses Universal Precautions in the handling of all specimens and the containers are recognizable as container specimens. This exception applies only while the specimens remain in the facility.
If outside contamination of the primary container occurs, the primary container shall be placed within a secondary container that prevents leakage during the handling, processing, storage, transport, and/or shipping of the specimen.

F. Contaminated Equipment

Equipment that has become contaminated with blood or other potentially infectious materials should be examined before servicing or shipping and shall be decontaminated as necessary unless the decontamination of the equipment is not feasible.

G. Personal Protective Equipment

All personal protective equipment used at the facility will be provided without cost to employees. Personal protective equipment will be chosen based on the anticipated exposure to blood or other potentially infectious materials. The protective equipment will be considered appropriate only if it does not permit blood or other potentially infectious materials to pass through or reach employees’ clothing, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time that the protective equipment will be used. The protective equipment necessary for the athletic training room primarily consists of latex gloves. These gloves will be stored on the main athletic training room island, in the first aid cabinet of the taping room, and in all athletic training kits used by the staff, graduate assistants and students, and in all individual fanny packs. These gloves will be available at all times and at no cost to the staff, graduate assistants, or students.
There is also other protective equipment made available to everyone at no cost to the staff, graduate assistants, and students. They are listed below:

Personal Protective equipment

• One-way Pocket Mask
• Protective eyewear
• Examination Gloves
• Face Shield
  
  

All personal protective equipment will be cleaned, laundered, and disposed of by the employer at no cost to the employees. The employer at no cost to the employees will make all repairs and replacements.
All garments that are penetrated with blood shall be removed immediately or as soon as feasible. All protective equipment will be removed before leaving the work area.
Gloves shall be worn where it is reasonably anticipate that employees will have hand contact with blood, other potentially infectious materials, non-intact skin, and mucous membranes. Gloves will be used for the following procedures:

• Applying bandages
• Applying wound closures
• Draining blisters
• Shaving calluses
• Cleaning open wounds
• Handling urine specimens
• Cleaning evaluation tables
• Cleaning spills of potentially infected materials
• Evaluating oral/dental injuries or conditions
• Applying direct pressure to open wounds
• Handling/changing wound dressings
   

Disposable gloves used at the facility are not to be washed or decontaminated for reuse. They are to be replaced as soon as practical when they become contaminated or as soon as feasible when or if they are torn, punctured, or when their ability to function as a barrier is compromised. Utility gloves may be decontaminated for reuse provided that the integrity of the glove is not compromised. Utility gloves will be discarded if they are cracked, peeling, torn, punctured, or exhibit other signs of deterioration or when their ability to function as a barrier is compromised.
The facility will be cleaned and decontaminated daily when the training room is used by athletes. Decontamination will also take place after any blood or other potentially infectious material has been exposed in the athletic training room. Decontamination will be accomplished by using a 10% bleach and water solution available in the cabinet under each sink counter and in all athletic trainers’ kits.
Any broken glassware that may be contaminated will not be picked up direct with the hands. Cardboard sheets should be used to corner and lift any broken pieces. All broken glass or material should be placed in a sharps container for disposal.

H. Regulated Waste Disposal

All contaminated sharps shall be discarded as soon as feasible in sharps containers located in the facility. Sharps containers are located in the areas listed above.
Regulated waste other than sharps shall be placed in appropriate containers with color-coded waste bags. Such containers are located in the Homer athletic training room, Pruitt athletic training room, taping room, baseball field and softball field.
There containers are supervised by the designated person(s), and are disposed of by the Sumter County Health Department.

I. Laundry Procedures

Laundry contaminated with blood or other potentially infectious materials will be handled as little as possible. Such laundry will be placed in appropriately marked bags where it is used. This laundry will not be sorted or rinsed in the area of use. It will then be removed by the individual responsible for laundry using personal protective equipment, and washed separately with bleach.
All employees who handle contaminated laundry will use personal protective equipment to prevent contact with blood or other potentially infectious materials.

J. HIV/HBV Exposure

Post exposure Evaluation and Follow-Up
When an employee incurs an exposure incident, it should be reported to the Head or Assistant Athletic Trainer. All employees who incur an exposure will be offered post exposure evaluation and follow-up in accordance with the OSHA standard. This follow-up will include the following:

1. Written documentation of the route of exposure and the circumstances related to the incident as soon as feasible following the exposure. This is to be returned to the Head or Assistant Athletic Trainer.
2. If possible, the identification of the source individual and, if possible, the status of the source individual. The blood of the source individual will be tested after consent is obtained for the HIV/HBV infection.
3. Results of the testing of the source individual will be made available to the exposed employees with the exposed employee informed about the applicable laws and regulation concerning disclosure of the identity and infection of the source individual.
4. The employee will be offered the option of having their blood collected for testing of the employee’s HIV/HBV serological status. The blood sample will be preserved for up to 90 days to allow the employee to decide if the blood should be tested for HIV serological status. However, if the employee decides before that time that testing will or will not be conducted then the appropriate action can be taken and the blood sample discarded.
5. The employee will be offered post-exposure prophylaxis in accordance with the current recommendations of the U.S. Public Health Service.
6. The employee will be referred to appropriate counseling concerning precautions to take during the period after the exposure incident. The employee will also be given information on what potential illness to be alert for and to report any related experiences to appropriate personnel.
7. The Head Athletic Trainer will be designated to assure that the policy outlined above is effectively carried out as well as to maintain records related to this policy.
   
   

K. Interaction with Health Care Professionals

A written option shall be obtained from the health care professional that evaluates employees of this facility. Written opinions will be obtained in the following instances:

1. When the employee is sent to obtain the Hepatitis B vaccine.
2. Whenever the employee is sent to a health care professional following an exposure incident.

Health care professionals shall be instructed to limit their opinions to:

1. Whether the Hepatitis B vaccine is indicated and if the employee has received the vaccine, or for evaluation following an incident.
2. That the employee has been informed of the results of the evaluation.
3. That the employee has been told about any medical conditions resulting from exposure to blood or other potentially infectious materials. (Note: The written opinion to the employer is not to reference any personal medical information).

L. Training

Training for all employees will be conducted before initial assignment to tasks where occupational exposure may occur. Training for employees will include an explanation of the following:

1. The OSHA Standard for Bloodborne Pathogens
2. Epidemiology and symptomatology of bloodborne disease
3. Modes of transmission of bloodborne pathogens
4. The exposure plan (i.e., points of the plan, lines of responsibility, how the plan will be implemented, etc.)
5. Procedures that might cause exposure to blood or other potentially infectious material at this facility
6. Control methods to be used at the facility to control exposure to blood or other potentially infectious materials.
7. Personal protective equipment available at this facility.
8. Who should be contacted concerning exposure to blood or other potentially infectious materials.
9. Post-exposure evaluation and follow-up.
10. Signs and labels used at this facility.
11. Hepatitis B vaccine program at the facility.

M. Record Keeping

All record required by the OSHA standard will be maintained by an employee appointed by the Head Athletic Trainer. All provisions required by the standard will be implemented by August 1, 1998. The athletic training staff will be responsible for conducting the training to the graduate assistants and student athletic trainers during preseason orientation. All employees will receive annual refresher training within one year of the employee’s previous training. The OSHA Standard for Bloodborne Pathogens and the outline for the training material will be kept in the office of the Head Athletic Trainer and in the policies manual at the Athletic Training Room Desk by the main entrance.

N. Athletic Health Care Responsibilities

The following information was taken from the 1999/00 NCAA Sports Medicine Handbook, Twelfth Edition, 1999, Pages 32-33.

The following recommendations are designed to further minimize risk of bloodborne pathogen transmission in the context of athletics events and to provide treatment guidelines for care givers. These are sometimes referred to as “universal precautions”, but some additions and modifications must be made as relevant to the athletic arena.

1. Pre-event preparation includes proper care for existing wounds, abrasions, cuts or weeping wounds that may serve as a source of bleeding or as a port of entry for bloodborne pathogens. These wounds should be covered with an occlusive dressing that will withstand the demands of competition. Likewise, care providers with healing wounds or dermatitis should have these areas adequately covered to prevent transmission to or from a participant. Student-athletes may be advised to were more protective equipment on high-risk areas, such as elbows and hands.
2. The necessary equipment and/or supplies important for compliance with universal precautions should be available to care givers. These supplies include appropriate gloves, disinfectant bleach, antiseptics, designated receptacles for soiled equipment and uniforms, bandages and/or dressing, and a container for appropriate disposal of needles, syringes or scalpels.
3. When a student-athlete is bleeding, the bleeding must be stopped and the open wound covered with a dressing sturdy enough to withstand the demands of activity before the student-athlete may continue participation in practice or competition. Current NCAA policy mandates the immediate, aggressive treatment of open wounds or skin lesions that are deemed potential risks for transmission of disease. Participants with active bleeding should be removed from the event as soon as is practical. Return to play is determined by appropriate medical staff personnel. Any participant whose uniform is saturated with blood, regardless of the source, must have that uniform evaluated by appropriate medical personnel from potential infectivity and changed if necessary before return to participation.
4. During an event, early recognition of uncontrolled bleeding is the responsibility of officials, student-athletes, coaches, and medical personnel. In particular, student-athletes should be aware of their responsibility to report a bleeding wound to the proper medical personnel.
5. Personnel managing an acute blood exposure must follow the guidelines for universal precaution. Sterile latex gloves should be worn with direct contact with blood. Gloves should be changed after treating each individual participant and after glove removal, hands should be washed.
6. Any surfaces contaminated with spilled blood should be cleaned in accordance with the following procedures: With gloves on, the spill should be contained in as small an area as possible. After the blood is removed, the surface area of concern should be cleaned with an appropriate decontaminate.
7. Proper disposal procedures should be practiced to prevent injuries caused by needles, scalpels or other sharp instruments or devices.
8. After each practice or game, any equipment or uniforms soiled with blood should be handled and laundered in accordance with hygienic methods normally used for treatment of any soiled equipment or clothing before subsequent use. This includes provisions for bagging the soiled items in a manner to prevent secondary, contamination of other items or personnel.
9. Finally, all personnel involved with sports should be trained in basic first aid and infection control, including the preventative measures outlined previously.