Identification

In accordance with the OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030, the following exposure control plan has been developed for

Introduction 

In 1992, the Occupational Safety and Health Administration (OSHA) enacted the Bloodborne Pathogens Standard codified as 29 CFR 1910. 1030. The purpose of the standard is to protect workers from anticipated exposures to bloodborne pathogens including Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV). 

The OSHA Bloodborne Pathogens Standard was modified in 2001 to include the Needlestick Safety and Prevention Act which includes new examples in the definition of engineering controls, requires exposure control plans reflect changes in technology that eliminate or reduce exposure to bloodborne pathogens, requires employers to consider safer needle devices when they conduct their annual review of their exposure control plan and requires employers to solicit input from non-managerial employees responsible for direct patient care in the identification, evaluation and selection of engineering and work practice controls. It also requires the employer to document this input in the exposure control plan and requires employers to establish and maintain a log of percutaneous injuries from contaminated sharps.

The Exposure Control Plan (ECP) is designed to minimize occupational exposure by identifying potentially exposed employees, routinely employing Universal Precautions and instituting engineering and work practice controls. 

Review and Update of the Exposure Control Plan 

This Exposure Control Plan will be reviewed and updated by the responsible supervisor, PI, or Dept Head at least annually, and when necessary to reflect new or modified tasks and procedures that affect occupational exposure, and to reflect new or revised employee positions that affect occupational exposure. The review and update of the plan will also: (1) Reflect changes in technology that eliminate or reduce exposure bloodborne pathogens; and (2) Documents annually consideration and implementation of appropriate commercially available and effective safer medical devices designed to eliminate or minimize occupational exposure.

Scope and Application

This Exposure Control Plan applies to all employees at risk of occupational exposure to bloodborne pathogens. Workers at risk are identified based on their Job Classifications or the Tasks and Procedures associated with the work they perform. Therefore, it is important that an accurate Exposure Determination be conducted to identify all individuals covered by this plan. 

Exposure Determination 

OSHA requires employers to determine (perform an exposure determination concerning) which employees may incur occupational exposure to blood or other potentially infectious materials (OPIM). The exposure determination is made without regard to the use of personal protective equipment (e.g., employees are considered to have potential exposure even if they wear PPE). This exposure determination contains the following:

Please indicate (check) all the materials to which employees may have reasonably anticipated contact.

List all employees, their job classifications and the associated tasks in which occupational exposure to bloodborne pathogens may occur. 

List the tasks, procedures and activities or groups of closely related tasks and procedures, which are associated with occupational exposure to blood or other potentially infectious materials. Please be sure to include all activities both primary and ancillary to your project in which occupational exposure may occur. In those activities or tasks, which only some employees may be assigned, please specify which employees (by name, title, or job classification) will be involved in each activity.

Method of Implementation

Engineering, work practice controls, and personal protective equipment, as outlined in this Exposure Control Plan will be used to eliminate or reduce employee exposure to Bloodborne Pathogens hazards. 

The Exposure Control Plan will be reviewed and updated at least annually, and when necessary to reflect new or modified tasks and procedures, and to reflect new or revised employee positions that affect occupational exposure. The review will also document the consideration and implementation of changes in technology and safer needle devices that reduce or eliminate exposure.

The Principal Investigator or supervisor is responsible for the overall implementation, developing site-specific procedures and specific policies, and the annual review and update of the Plan. 

The Department of Environmental Health and Safety is available to assist with development of the exposure control plan, employee training and other consultative roles as related to the OSHA standard. 

A copy of this plan will be accessible in the work place to all employees at risk for occupational exposure.

Compliance Methods

Universal/Standard Precautions 

Universal or what is now often referred to as Standard Precautions is a simple approach to infection control and will be used with all blood or other potentially infectious materials (OPIM). Universal Precautions were developed by the Centers for Disease Control to help prevent the transmission of bloodborne diseases in the work place. Under Standard Precautions, all human blood, human body fluids, secretions and excretions, and other potentially infectious materials (OPIM) are considered infectious for HIV, HBV, HCV and other bloodborne diseases. Therefore, all human blood and OPIM are treated as though they are infectious and precautions are taken accordingly.

Engineering Controls

Engineering controls are physical or mechanical means of isolating or removing bloodborne hazards from the work area. Engineering and work practice controls are used to eliminate or minimize exposure to employees. Where occupational exposure remains after institution of these controls, personal protective equipment will be used. 

The following engineering controls are used: 

• Handwashing facilities with appropriate hand cleaners and disposable towels are readily available in the work area, such as the laboratory, procedure room, or patient care area. Where it is not feasible to have handwashing facilities readily accessible, disinfectant hand cleaners (containing at least 60% alcohol) will be provided.
• Sharps containers are available where sharps are used. Appropriate containers are puncture resistant, labeled with a biohazard label or color coded, and leak proof on the sides and bottom. Sharps containers are located as close to the point of use as possible, preferably at eye level. Sharps containers may not be allowed to overfill.

• Re-usable Sharps Containers will not be opened, emptied, or cleaned manually; or in any other manner that would expose employees to the risk of percutaneous injury.  
• A guide for the proper selection and use of sharps containers can be found at the following website:

https://stacks.cdc.gov/view/cdc/6386/cdc_6386_DS1.pdf (PDF)

• Sharps safety devices will be used to the extent feasible, appropriate, commercially available and effective to reduce employee exposure to blood or OPIM for withdrawing body fluids, accessing a vein or artery or administering medications or other fluids. Sharps with Engineered Sharps Injury Protections (SESIPs) encompasses a broad array of devices including: syringes with guards or sliding sheaths that shield the attached needle after use, needles that retract into the syringe after use, needless IV medication connection systems, and plastic capillary tubes. A list of safety devices with manufactures and specific products can be found at the following web site:  

http://www.tdict.org/

• Biological Safety Cabinets (Class II) will in appropriate situations (i.e. labs) to provide worker protection during aerosol generating procedures with human blood and OPIM including human cells, tissue cultures, and blood products and blood components. Class II Biological Safety Cabinets, while providing laminar airflow to protect research material, are designed with inward flow to protect personnel, and filtered exhaust air for environmental protection as well.

• Infectious Waste is discarded into biohazard containers, lined with a red plastic bag. If the waste could puncture the bags, it must first be placed in a sharps container. 
• Mechanical Pipettes must be used; mouth pipetting is prohibited. 
• Containers for blood or OPIM: Specimens of blood or other potentially infectious material will be placed in a container that prevents leakage during collection, handling, processing, storage, transport and shipping. 

• The container for storage, transport, or shipping shall be labeled with the Biohazard warning symbol in fluorescent orange or orange-red, and closed prior to being stored, transported, or shipped. 
• If outside contamination of the primary container may have occurred, the primary container will be placed within a second container that prevents leakage during handling, processing, storage, transport, or shipping and is labeled with the Biohazard warning symbol in fluorescent orange or orange-red. 
• If the specimen could puncture the primary container, the primary container will be placed within a second container that is puncture-resistant in addition to the above characteristics. 

• Autoclaves are available in some labs, clinics or units for decontamination. Proper use of equipment is essential to ensure sterilization. 
• Transportation:  Transportation refers to the packaging and shipping of materials by air, land or sea. Transfer refers to the process of exchanging these materials between facilities. When transporting blood or OPIM off site, all federal, state and local regulations for packaging transportation must followed. Please contact the Biosafety Office at 852-6670 for further information. 
• Contaminated Equipment will be decontaminated prior to servicing or shipping. Equipment that cannot be decontaminated will be labeled with a biohazard label. When using centrifuges, balanced tubes will be used and procedures immediately implemented to cleanup the equipment if an accidental spill occurs.
• Plastic or Mylar Coated Capillary tubes will be used instead of glass capillary tubes.
  
  

Needle Stick and Sharps Safety 

The supervisor or PI who has employees with direct patient contact must consider and, where appropriate, use effective engineering controls, including safer sharps devices or needleless systems for withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids, in order to reduce the risk of injury from needlesticks and from other sharp medical instruments. This includes:

• Establish a program for evaluating safer sharps devices designed to eliminate or minimize occupational exposure. This program should include an identification process, an evaluation process and a selection process. 
• Review the sharps that are being used on an annual basis. 

Note: An appropriate safer sharps device includes only devices whose use, based on reasonable judgment in individual cases, will not jeopardize patient or employee safety or be medically contraindicated.

The PI or supervisor must identify all sharp devices that have available products with safer engineering features and determine which products are to be evaluated.

In departments that have direct patient care, the PI or responsible supervisor alone cannot evaluate and select the safer sharps devices; supervisors must choose non-managerial employees who perform tasks using the sharps also to be involved in this process. 

The following non-managerial employees will participate in the evaluation process

• The PI or supervisor should encourage each evaluator to comment on evaluation forms. The Centers for Disease Control and Prevention (CDC) have sample screening and evaluation forms available HERE.
• The PI or supervisor will be responsible for the completed sharps evaluation forms. 
• Note: If there is no safer option for a particular sharps device used where there is exposure to blood or OPIM, you are not required to use something other than the device that is normally used. This information must be documented. During your annual review of devices, you must inquire about new or prospective safer options.

Once the evaluation process is complete and the safer sharp device has been chosen, the PI or supervisor must implement use of the safer sharps devices as soon as possible.

Note: The selection and implementation process cannot be postponed in order to use up supplies of non-safer sharps. Additionally, when the safer sharps are in place, supplies of the non-safer sharps may not be used.

The review and update of the Exposure Control Plan must reflect innovations in procedure and technological developments that eliminate or reduce exposure to bloodborne pathogens. This includes, but is not limited to, newly available sharps devices designed to reduce the risk of percutaneous exposure to bloodborne pathogens.

The following web sites provide additional information on the Needlestick Safety Act, Needlestick injury prevention and available Sharps Safety Devices.

• How to Prevent Needle Stick Injury

• For a list of safety-engineered sharp devices and other products designed to prevent occupational exposures to bloodborne pathogens: Sharps Safety Device List

The PI or supervisor is responsible for ensuring engineering controls are maintained or replaced as necessary to ensure their effectiveness

• Check that there is an adequate stock of supplies (e.g. sharps containers, red bags, gloves)
• Check the fill level of sharps containers and replace filled containers with new ones
• Check the fill level of infectious waste containers and appropriately close or seal containers when no more than ¾ full. 
• Ensure controls are adequate for existing and new work tasks and infectious materials.
• Ensure controls are readily accessible to affected employees.
• Implement alternative controls if necessary (e.g. provide antiseptic towelettes or waterless antiseptic agents if no handwashing facility is available, provide secondary container if outside of primary is soiled or for transport).
  
  

Work Practice and Administrative Controls

Work Practice controls are behavioral means of reducing an individual’s exposure potential by following established rules, procedures, or guidelines associated with a particular work task. Safe work practices used in conjunction with engineering controls and PPE may substantially decrease an individual’s risk of incurring an exposure to blood or OPIM. 

All employees must adhere to the following work practice controls:

• Observe Universal/Standard Precautions at all times. (See section 3. A. above)
• Washing Hands with soap and water for at least fifteen (15) seconds is required immediately after any exposure, and as soon as possible after removal of gloves or other personal protective equipment. If employees incur exposure to skin, those areas will be washed with soap and water. Exposures to eyes or mucous membranes require flushing with water. 
• Antiseptic towelettes or other waterless hand cleaners/disinfectants may be used if handwashing facilities are not feasible for a particular situation. If these temporary alternatives are used, wash hands with soap and running water as soon as feasible. 
• Needles and Sharps will not be bent, recapped, removed, sheared or purposely broken. Needles and other sharps will be discarded into approved sharps containers. Recapping is permitted only if no other means are feasible and a mechanical device or one-handed technique is used. 
• Personal Protective Equipment will be removed immediately upon leaving the work area. Lab coats, used as PPE, must not be worn outside the work area. Items visibly contaminated or likely to be contaminated with blood, OPIM, or infectious agents are to be discarded in infectious waste containers. Items that meet the definition of Regulated waste (see Section 3, Waste Disposal) are to be disposed in infectious waste containers. 
• Eating, Drinking, applying cosmetics, and handling contact lenses are prohibited in work areas where there is a possibility of occupational exposure. Food and beverages will not be stored in refrigerators, freezers, counters or bench tops where blood or OPIM are present. 
• Mouth Pipetting or suctioning is prohibited. 
• All procedures involving blood or OPIM will be conducted in a manner minimizing spraying, splashing or generation of droplets.
• Post BIOHAZARD signs or labels at entrances to work areas, refrigerators, freezes, fume hoods, biosafety cabinets, etc. where blood or OPIM is used or stored
• Needleless Systems or Sharps with engineered sharps injury protectors must be considered and used to the extent feasible for the collection of bodily fluids or withdrawal of body fluids, accessing a vein or artery, or administering medications or other fluids.

Personal Protective Equipment

Personal Protective Equipment (PPE) is specialized clothing or equipment worn by a worker for protection against a hazard. When there is a risk of occupational exposure to Bloodborne Pathogens, PPE is an effective means of protection when the proper type is used and its integrity maintained. PPE such as, but not limited to gloves, gowns,  aprons, surgical caps, foot covers, lab coats, face shields, masks, and respirators will be provided to employees as appropriate.

All personal protective equipment (PPE) used will be provided, at no cost to the employees. 

PPE is chosen based on the anticipated exposure. The PPE will be considered appropriate only if it does not permit blood or OPIM to pass through or reach the employee’s clothing, skin, eyes, mouth, or mucous membranes under normal conditions of use and for the duration of time the PPE will be used. 

 At a minimum, individuals working with BBP will wear a lab coat & gloves while handling or processing blood or OPIM. Tasks or procedures that may produce aerosols, if not performed in a biosafety cabinet, require the use of appropriate face protection: a surgical mask with safety glasses or glasses with either side shields, or chin length face shield.  

Employees exhibiting dermatitis, allergy or sensitivity to normally provided gloves will be provided with hypoallergenic, powder-free gloves or gloves of an alternative, equally protective material. 

The Principal Investigator, or supervisor is responsible for ensuring that PPE in appropriate sizes is readily accessible to all employees and  will ensure there is an adequate stock of supplies and PPE. 

The supervisor or PI must ensure that all employees are trained in the proper selection, use, limitations, donning and doffing, cleaning or disposal of PPE that is appropriate for the tasks they will perform.  

All employees must adhere to the following precautions when wearing PPE:

• Contaminated PPE will be removed as soon as possible. 
• All PPE must be removed prior to leaving the work area, whether contaminated or not. This is especially important for gloves, since they are generally assumed to be contaminated. When disposable gloves are removed, they must be discarded in Biohazard containers. 
• Gloves are worn when employees may have hand contact with blood, OPIM, mucous membranes or non-intact skin, or contaminated items or surfaces. 
• Gloves must be replaced as soon as possible if they are torn, punctured, or when their ability to function as a barrier is compromised. 
• Gloves must not be worn to transport blood or OPIM outside the work area, as a means to prevent skin contact. Instead, the primary container is placed in a clean secondary container for transport, making gloves unnecessary.
• Disposable gloves may only be used once. Gloves will be discarded when removed. They are not to be washed or decontaminated for re-use. 
• Utility gloves may be decontaminated for re-use if the integrity of the glove is not compromised. However, they must be discarded if they are torn or punctured. 
• Lab coats and other washable PPE must be laundered either by a laundry service or on-site, by machine using regular settings and detergent and bleach. These items and other contaminated garments must not be sent home with the employee for cleaning. 
• Street clothes are not considered PPE. Scrubs are usually worn in a manner similar to street clothes; therefore, street clothes and scrubs should be covered by appropriate gowns, aprons or lab coats when splashes to the skin or clothes are reasonably anticipated.

Housekeeping 

Proper and routine cleaning and decontamination of work areas is an integral part of preventing environmental transmission of bloodborne pathogens. 

The Principal Investigator or supervisor will ensure work areas will be maintained in a clean and sanitary condition. A written schedule for cleaning and methods of decontamination based on the location, type of surface to be cleaned, type of soil present, and the tasks or procedures done in the area will be implemented. 

Work Surfaces

Work surfaces and equipment will be cleaned and decontaminated at the completion of procedures, as soon as possible after contact with blood or OPIM, and at the end of the work shift if they may have been contaminated during the shift.

Appropriate Disinfectant

Cleaning of contaminated work surfaces after completion of procedures is required to ensure that employees are not unwittingly exposed to blood or OPIM remaining on a surface. Appropriate disinfectants include a diluted bleach solution and EPA registered tuberculocides (List B), and products registered against HIV/HBV (List D). OSHA Instruction CPL 2-2.69 (Nov. 19, 2001) does not include 70% alcohol among “appropriate disinfectants” and thus, it may not be used as the sole disinfectant. 

Under this standard, OSHA has interpreted that, to decontaminate contaminated work surfaces, either an EPA-registered hospital tuberculocidal disinfectant or an EPA-registered hospital disinfectant labeled as effective against human immunodeficiency virus (HIV) and hepatitis B virus (HBV) is appropriate. Hospital disinfectants with such HIV and HBV claims can be used, provided surfaces are not contaminated with agents or concentration of agents for which higher level (i.e., intermediate-level) disinfection is recommended. In addition, as with all disinfectants, effectiveness is governed by strict adherence to the label instructions for intended use of the product.

The lists of the EPA Registered products are available from the EPA Website 

NOTE: The EPA lists contain the primary registrants’ products only. The same formulation is frequently repackaged and renamed and distributed by other companies. These renamed products will not appear on the list, but their EPA Registration number must appear on the label. 

The following is just a sample of some commercially available disinfectants, and is not meant to be a comprehensive list. Please consult the university stock room and other vendors for these and other “appropriate disinfectants”. 

• Bleach (Clorox) Solution (5.25% available chlorine in a 1/10 or 1/100 dilution in water)
• CiDecon Detergent Disinfectant (Decon Laboratories, Inc.)
• BDD Backdown (Decon Laboratories) 
• Cavicide (Metex Research Corp.)
• Process NPD (Steris Corp.)
• Sani-Cloth (PDI)
• Dispatch Hospital Cleaner Disinfectant (Caltech Industries)
• Amphyl (Reckitt Benckiser)
• Envirocide (Metex Research Corp.)

Any of the above mentioned products are considered effective when used according to the manufacturer’s instructions provided the surfaces have not become contaminated with agents or volumes of concentrated agents for which a higher level of disinfection is recommended. 

Spills

Spills must be cleaned up immediately. Use personal protective equipment (PPE) appropriate to prevent BBP or OPIM from coming in contact with your hands, mucous membranes, non-intact skin or penetrating protective clothing. For most spills, a lab coat or disposable gown and gloves should be sufficient. 

Clean up and absorb liquid material with paper towels or other absorbent materials to prevent spill from spreading. Use tongs or similar device to pick up broken glassware or sharps and dispose in sharps container. Discard paper towels used to soak up spill in biohazard container, and any broken glass in a sharps container. Most organic material must be cleaned before disinfecting the area. 

Disinfect spill area by first laying absorbent material over spill area, and then gently adding a 10% bleach solution or other “appropriate disinfectant” and allowing it soak for the required contact time (15-20 min. for bleach or see manufactures recommended contact time). Wash your Hands. After contact time has elapsed, wipe area with water or cleaning solution if indicated. Wash your hands. If you have a question about a biohazard spill, call DEHS at 502.852.6670. If this is an emergency call DPS at 502.852.6111.

The following table is a schedule of cleaning and decontamination based upon the location within the facility, type of surface to be cleaned (e.g. hard-surface versus carpeting) and type of soil present (e.g. gross contamination versus minor spattering) and tasks and procedures being performed (e.g. lab analyses versus blood collection). At a minimum, work surfaces and equipment that come in contact with Blood or OPIM will be cleaned and disinfected at the completion of procedures and immediately, or as soon as possible after a spill. 

All employees must adhere to the following practices of housekeeping and infection control: 

• Protective coverings such as imperviously backed absorbent paper, plastic wrap or aluminum foil used to cover equipment and environmental surfaces will be removed and replaced as soon as feasible after contamination.
• Inspect regularly all bins, pails, cans and similar receptacles intended for reuse that may become contaminated. Receptacles will be cleaned and decontaminated immediately or as soon as feasible upon visible contamination. 
• Broken glassware that may be contaminated must never be picked up by hand. Mechanical means such as forceps, tongs, or dustpan and broom must be used. Tools used in cleanup must be properly disinfected or discarded. The broken glass must be placed in a sharps container. 

Regulated Waste Disposal 

Regulated waste is defined by OSHA as liquid or semi-liquid blood or OPIM; contaminated items that would release blood or OPIM in a liquid or semi-liquid state if compressed; items that are caked with dried blood or OPIM capable of releasing these materials during handling; contaminated sharps; all needles and syringes regardless of their use; and pathological and microbiological wastes. All employees will adhere to the following when disposing Regulated Waste:

• Immediately after use, sharps will be disposed of in closable, puncture resistant containers that are leak proof on sides and bottom, and labeled or color-coded (see Section 6 for label requirements). 
• Sharps containers will be replaced routinely and not allowed to overfill. 
• Reusable sharps containers will not be opened, emptied, or cleaned manually in a manner that would expose employees to the risk of percutaneous injury. Employees may NOT place their hands into containers whose contents include reusable sharps. 
• All regulated waste must be segregated, packaged and discarded in accordance with the policies outlined in the University of Louisville Disposal Guide for Infectious Medical Waste. It is the responsibility of the department, or laboratory generating regulated waste to comply with these guidelines, and provide the appropriate packaging material (i.e. sharps containers and orange/red Biohazard bags). A copy of the UofL guidelines for disposal of Infectious Waste is included in Appendix B. 

Contaminated Laundry 

The department, PI or supervisor is responsible for providing laundry services for contaminated lab coats, other contaminated re-usable garments and any other contaminated non-disposable laundry items. Laundry service is provided by (name of vendor) _____________________________.

• Laundry contaminated with blood or OPIM will be handled as little as possible. Such laundry will be placed in appropriately marked bags (red bags) at the location where it is used. 
• All employees who handle contaminated laundry will use appropriate personal protective equipment (gloves). 
• Disposable articles may be used when feasible to reduce the generation of contaminated laundry. 
• Laundry items should not be rinsed prior to being placed in laundry bags.
• Should employee owned clothing be contaminated, laundry services will also be provided. Home laundering of personal protective equipment or contaminated clothing is not permitted.

Labels and Signs 

The PI or supervisor is responsible for ensuring labels and signs are available and posted as necessary to ensure adequate information is provided to workers and visitors entering the work area. 

• Labels shall be affixed to containers of regulated waste, sharps containers, refrigerators, freezers, or other containers used to store, transport, or ship blood or OPIM. 
• Red bags or containers may be substituted for labels as appropriate. 
• Contaminated equipment will be labeled indicating contaminated surfaces and areas.   
• The required labels will include the International Biohazard Symbol and BIOHAZARD written under the symbol.       
• The labels will be fluorescent orange or orange-red with the letters and symbols in a contrasting color (Black). 
• Labels will be affixed as close as feasible to the container, in a way that prevents their loss or unintentional removal. 

Hepatitis B Vaccination Program 

The Principal Investigator, or responsible supervisor, must ensure all employees identified as having occupational exposure to blood or OPIM are offered the Hepatitis B vaccine, at no cost to the employee, within 10 working days of assignment to a job with potential exposure.

• The PI or supervisor will have the employee complete the Hepatitis B Vaccine Offer Form, and will maintain a copy of the form. The form requires the employee to choose one of three options: 

• Option A: the employee elects to receive the vaccine at this time, at no cost to them.
• Option B: is the OSHA declination statement, indicating the employee declines the vaccine at this time, but may elect to receive the vaccine at no charge if they continue to have occupational exposure. 
• Option C: the employee has been previously vaccinated or is unsure of vaccine status.

Accepting the Hepatitis B Vaccine and Titer Check 

Supervisors must ensure that employees choosing to receive the hepatitis B vaccine or titer check, report to the Health Services Office within the 10 working day period. 

• Employees opting to receive the vaccine or titer check are to report to the Belknap or HSC Health Services Office within 10 working days. Employees will be provided with additional information about the vaccine, and will be provided the vaccine after a medical evaluation and signing a consent form. The vaccine will be provided in accordance with current US Public Health Service Centers for Disease Control Guidelines current at the time. Currently, the vaccine is given in a three dose series, followed by a titer check. A booster dose is not recommended at this time. 

Vaccine records, titer checks and all medical records will be maintained in the Health Services Office. 

The vaccine is not mandatory, but is strongly encouraged, 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. 

All employees are strongly encouraged to be vaccinated against Hepatitis B virus if their work may expose them to blood or OPIM including human cells, tissue cultures, blood products and blood components.

Vaccines are provided on a walk-in basis. The Hepatitis B vaccination is made available through either the: