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UNIVERSAL PRECAUTIONS G-110 (AIDS) FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: HANDLING INMATES WITH BODY FLUID NO: G-110 PRECAUTIONS FILE: UNIVERSAL PRECAUTIONS EFFECTIVE DATE: 12-18-89 REVISED: 12-25-94, 05-01-98, 08-01-01, 03-01-03 AUTHORITY: Sheriff M. Mims APPROVED BY: Captain J. Flores REFERENCE: Penal Code Sections 1524.1, 4018.1 and 7500, et seq Health and Safety Code Section 121050 through 121070; Management Directive 2600; Departmental Policy Sections 1008 and 1016. PURPOSE: The purpose of this policy is to reduce the risk of infection and exposure to communicable diseases by educating personnel in the proper hygienic and precautionary measures advocated by current medical research. POLICY: It is the policy of the Fresno County Sheriffs Department Detention Bureau to treat all human blood and body fluids as if they are known to be infectious. It is the policy of the Fresno County Sheriffs Department Detention Bureau to supply all employees with the necessary equipment and supplies to follow accepted universal bodily fluids precautions. PROCEDURES: I. DEFINITIONS A. AIDS - Acquired Immune Deficiency Syndrome. A disease of the immune system caused by HIV, and characterized by failure of the body's immune system to protect against a multitude of opportunistic infections and certain cancers. B. EXPOSURE — Exposure is the condition of being subjected to a fluid or substance capable of transmitting an infectious agent in a manner that may have a harmful effect. An exposure to a communicable disease may exist when one or more of the following occur: Page 1 of 9 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: HANDLING INMATES WITH BODY FLUID NO: G-110 PRECAUTIONS FILE: UNIVERSAL PRECAUTIONS • Blood and/or body fluid in the eyes, nose, or mouth • Blood and/or body fluid exposed to an open wound • Needle stick or puncture wound (including human bite) • Mouth-to-mouth resuscitation An exposure is NOT just blood or body fluid on or near the skin or clothing, the product has to somehow get inside the body. If the fluid is merely on the skin, near it, or around it, it is NOT considered to be an exposure. C. GASSING - Gassing is defined as intentionally placing or throwing, or causing to be thrown, upon the person of another, any mixture of human excrement and/or other bodily fluids or substances. D. HIV - Human Immunodeficiency Virus. HIV is the virus that causes AIDS, attacking the body's immune system and reducing its ability to fight disease. E. UNIVERSAL PRECAUTIONS - Guidelines established bythe Centersfor Disease Control that focus on the risk of exposure to blood and body fluids rather than on a diagnosed disease. Universal precautions means that all blood and other potentially infectious body fluids are treated as if they are infected. II. MANAGEMENT OF INMATES WITH COMMUNICABLE DISEASES A. All arrestees are pre-screened by medical staff prior to acceptance into the facility. However, if an inmate discloses to an officer that they have a communicable disease, the officer shall ensure medical staff is aware of the inmate's claim. B. Inmates with communicable diseases should be cautioned not to disclose their diagnosis to fellow inmates for their own protection. C. Pending examination and testing, medical staff may recommend thatthe inmate be placed into isolation. Such inmates may also be isolated to protect them from potential physical harm from other inmates. 1. Inmates with symptomatic communicable diseases may be managed separately from the general population in regard to visits, transportation and other routine activities, depending on the inmate's condition/diagnosis. Page 2 of 9 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: HANDLING INMATES WITH BODY FLUID NO: G-110 PRECAUTIONS FILE: UNIVERSAL PRECAUTIONS 2. Normal precautions shall be taken to protect both the inmate and staff members. D. If medical staff finds the inmate to have NO evidence of a communicable disease, the inmate shall be placed (or remain) in general population. E. All inmates with communicable diseases will be educated and provided with information regarding the transmission of communicable diseases and risk-reduction strategies. The inmates will be advised of appropriate support services by the Human Services System (HSS) Communicable Disease Outreach staff. III. ISOLATION PROCEDURES - BODY FLUID PRECAUTION A. Cleaning the cell 1. Inmates shall be responsible for the sweeping and general cleaning of their cell. 2. Inmates shall be given a plastic bag for their trash. The trash shall be collected twice daily after meals. a. Officers shall hold open a large, regular plastic bag. b. Inmates shall drop their trash bag into the open bag. C. Officers shall then tie the outer bag and dispose of it with the regular trash. B. Feeding If enteric isolation is ordered, the inmate shall be fed using styrofoam trays and disposable utensils. After use, the inmate shall place the tray, utensils and all leftover food in their plastic trash bag. C. Laundry Inmates shall be given a special water soluble laundry bag,which can be obtained from either the Clothing Room or the Medical Services Unit. 1. Inmates shall place all soiled clothing into the water-soluble bag. 2. Officers shall hold open a large red plastic bag. 3. Inmates shall place the water-soluble bag inside the bag the officer is holding. Page 3 of 9 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: HANDLING INMATES WITH BODY FLUID NO: G-110 PRECAUTIONS FILE: UNIVERSAL PRECAUTIONS 4. Officers shall then tie the bag closed and forward it directly to the Clothing Room. 5. The Clothing Officers shall place the red bag in a clothing cart to be transported to the South Annex Jail for processing. The red bag shall be opened without touching the water-soluble bag; drop the water-soluble bag into the washer. Hot water will dissolve the bag. 6. Contaminated personal clothing will be treated in the same manner, but will be washed in the Main Jail Clothing Room. D. Showers Inmates shall be allowed to use the shower according to the normal cell schedule. No special cleaning of the shower area is required. E. Phone Inmates shall be allowed to use the telephone and visiting phones per the normal cell schedule. However, the inmate shall be given a germicidal hand wipe (which may be obtained from Medical Services)to wipe the visiting telephone receiver after its use. F. Isolation cells are to be scrubbed down using an approved EPA germicide or a 1.100 solution of chlorine bleach (1/4 cup bleach per one gallon of water) immediately upon the release or transfer of an inmate from the isolation area. The person cleaning the cell shall be provided with disposable gloves and eye protection. All soiled cleaning materials and gloves shall be placed in a plastic bag and the end securely tied. G. Isolation inmates shall be allowed to attend all regular activities unless contraindicated by written medical orders. IV. PROTECTION AGAINST POSSIBLE EXPOSURE A. Immunizations are recommended for all personnel involved in public contact as a preventive measure. 1. Tetanus Toxoid (every ten (10) years) 2. Tuberculin Skin Test (yearly) 3. Mumps and Rubella Vaccine (advisable if not received as a child/one-time dose) Page 4 of 9 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: HANDLING INMATES WITH BODY FLUID NO: G-110 PRECAUTIONS FILE: UNIVERSAL PRECAUTIONS 4. Measles Vaccine 5. Hepatitis B Vaccine (Recombivax/Hepavax) B. All open wounds or breaks in the skin shall be thoroughly covered with a bandage which repels liquid. C. Protective apparel (face and body covering) shall be made available in the security stations and maintained in such a manner so as to be accessible to all staff members as needed. Protective apparel may include, but not be limited to: disposable gloves, gown/plastic apron, face masks and/or eye protection. D. Disposable (latex or vinyl) gloves shall be worn when there is a possibility of contact with blood and/or bodily fluids. Care should be taken to avoid touching other items (i.e., pens, books and personal items in general) while wearing the disposable gloves in a potentially contaminated area. After use, gloves shall be removed and disposed of properly. Wash hands immediately, or as soon as possible following the removal of potentially contaminated gloves. Antibacterial soap and warm water or an approved disinfectant shall be used to wash one's hands, paying particular attention to the fingernails. If access to soap and water is limited, germicide towelettes or alcohol may be used until soap and water is available. E. Care needs to be exercised when removing any contaminated article of clothing so that it does not contaminate other articles. Use extra caution when removing gloves to prevent contamination to the skin. Carefully remove the article (remove gloves by pulling them off from the cuff). Turn the contaminated side inside out, place in a plastic bag, tie the end, and dispose of in the trash. V. PRECAUTIONS TO BE USED WHEN HANDLING INMATES A. Basic precautions 1. Consider and treat all contact with body fluids as potentially infectious and take precautions to prevent unnecessary exposure. Treat all drug paraphernalia as if it were contaminated. Page 5 of 9 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: HANDLING INMATES WITH BODY FLUID NO: G-110 PRECAUTIONS FILE: UNIVERSAL PRECAUTIONS 2. Wear gloves whenever there is the possibility of contact with a bodily fluid. 3. All sharps and items that cut or punture (i.e., knives, razors, broken glass and needles) shall be treated cautiously to avoid cutting, stabbing, or puncturing one's self or any other person. If the item is not evidence, touching it with the hands shall be avoided. Rather, use a device (i.e., a broom and a dustpan) to clean up debris. If the material must be hand held, protective gloves must be worn. Never blindly place hands in an area where there may be sharp objects that could cut or puncture the skin. B. Inmate disturbances; Aggressive or violent inmates 1. In circumstances which are not considered life threatening,develop a plan of action and utilize protective apparel. Note: It is suggested and preferred that staff members wear protective apparel in ALL situations when dealing with the possibility of exposure. 2. In cases where an inmate is combative or threatening to staff and blood is present, protective apparel WILL be worn. C. Responses to homicides, suicides and resuscitations Staff members shall, at a minimum, wear disposable gloves. In the event of the need for emergency resuscitation, all staff members are encouraged to utilize eye protection and the mouth-to-mask resuscitators provided by the Department. VI. EXPOSURE TO BODILY FLUIDS - TREATMENT AND CARE A. Prompt intervention following an exposure to blood and/or body fluids will effectively prevent transmission of communicable diseases. Immediately wash any skin that becomes contaminated with blood or bodily fluids with a germicidal/antibacterial hand wipe. A follow-up wash with soap and water should be used in conjunction with the germicide. Page 6 of 9 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: HANDLING INMATES WITH BODY FLUID NO: G-110 PRECAUTIONS FILE: UNIVERSAL PRECAUTIONS B. Any wound inflicted from a human bite, needle stick, or other sharp object should be thoroughly washed with soap and water. Do NOT "milk" the wound. Milking may cause localized tissue trauma, thus opening up more blood vessels to organisms. Seek preventive medical attention as soon as possible. C. Immediately flush eyes with an irrigating solution (e.g., Dacriose, saline, or water) if a splash to eyes occurs. D. Preventive treatment is provided for any exposure defined as invasive contact made with blood and/or body fluids through- 1. Open wound (fresh wound, not yet covered by a scab) 2. Puncture wound, needle stick, or human bite 3. Splash to eyes, nose and/or mouth 4. Unprotected mouth to mouth resuscitation An exposure is NOT just blood or body fluid on or near the skin or clothing; the product has to somehow get inside the body. If the fluid is merely on the skin, near it, or around it, it is NOT considered to be an exposure. E. Preventive treatment for HIV must be provided within the first two (2) hours after the exposure. (Recent information indicates that treatment may be effective up to 24 hours following exposure but is MOST effective in the 2-hour period. Health officials still recommend that HIV treatment begin within 2 hours, but if treatment is definitely indicated, it should not be withheld if it can be given in the first 24 hours.) During normal business hours, contact the HSS/Community Health Communicable Disease Division immediately at 445-3569. After business hours, weekends, holidays or any time Communicable Disease Investigative staff is not immediately available, contact FSO Dispatch at488-3111 and ask for the Emergency Response Team (ERT) member on-call. If treatment is not readily available, go to the hospital emergency room. F. The exposed employee should consider themselves to be infectious to Page 7 of 9 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: HANDLING INMATES WITH BODY FLUID NO: G-110 PRECAUTIONS FILE: UNIVERSAL PRECAUTIONS others, until appropriate testing proves otherwise, and should protect sexual partners, accordingly. VI I. DECONTAMINATION OF EQUIPMENT A. Contaminated equipment (e.g., flashlight, radio, etc.) shall be decontaminated as soon as possible. 1. Porous surfaces (i.e., nylon) shall be brushed and scrubbed with a detergent and hot water, laundered and allowed to dry. 2. Non-porous surfaces (i.e., plastic and metal)shall be brushed and scrubbed with detergent and hot water, sprayed with a bleach solution, rinsed, and allowed to dry. Delicate equipment (i.e., radios) should be brushed and scrubbed very carefully using a minimal amount of EPA approved germicide. 3. While cleaning equipment, pay close attention to handles, controls, radios, corners and other tight spots. B. Contaminated clothing shall be removed as soon as feasible and rinsed in cold water to prevent the setting of bloodstains. Care needs to be exercised that the piece of clothing does not contaminate other articles before it is laundered or dry cleaned. 1. Utilize disposable gloves to protect hands when cleaning contaminated clothing. 2. Remove as much of the soil as reasonably possible by scraping dry, crusted contaminants with a disposable or easily washable item (e.g., a stick or ruler). 3. Wipe or wash wet contaminants with a rag or paper towel which can be thrown away. 4. Clothing should be double bagged until ready to be laundered. a. Clothing may be cleaned in any washing machine (including home washers). b. The dry cleaning process will dilute out the contaminants as Page 8 of 9 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: HANDLING INMATES WITH BODY FLUID NO: G-110 PRECAUTIONS FILE: UNIVERSAL PRECAUTIONS well as lift the dirt from the fabric. Wet clothing should be sun-dried prior to dry cleaning. Inform the dry cleaner of the potential contamination. C. Contaminated leather shall be brushed and scrubbed with detergent and hot water. If the contaminant soaked through the leather, the item shall be discarded. D. Walls, floors or other objects shall be scrubbed down using an approved EPA germicide or a 1:100 solution of chlorine bleach (1/4 cup bleach per one gallon of water). Ensure that the person cleaning the area is provided with disposable gloves and eye protection. All soiled cleaning materials and gloves shall be placed in a plastic bag and the end securely tied. Vill. AIDS EDUCATION FOR INMATES A. Education for inmates may be provided by the HSS/Community Health Communicable Disease Outreach program,which includes the basic HIV information, the effect on the immune system, transmission, risk reduction techniques and issues surrounding testing for antibodies to the virus. B. Human Services System (HSS) may also be involved in the education of inmates by providing informational videos for the inmates to view in their housing area on a regular basis. IX. EMPLOYEE'S RESPONSIBILITY TO REPORT EXPOSURE In order to provide appropriate and timely treatment should exposure occur, all employees shall verbally report the exposure to their immediate supervisor and complete a written report as soon as possible following the exposure. Referto Policy and Procedure Section G-115/HIV REPORTING AND TESTING REQUIREMENTS for more complete instructions concerning reporting and testing. Page 9 of 9