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By W. Cobryn. The Johns Hopkins University. 2018.

Fire Department Exposure Control Plan Policy The (Facility Name) is committed to providing a safe and healthful work environment for our entire staff buy 10mg torsemide overnight delivery. January 2007 A-37 International Association Infectious Diseases of Fire Fighters Appendices Model Exposure Control Plan (Continued) The following is a list of job classifications in which some employees at our establishment have occupational exposure buy discount torsemide 20 mg online. Methods of Implementation & Control Standard Precautions All employees will utilize standard precautions purchase 20mg torsemide fast delivery. All employees have an opportunity to review this plan at any time during their work shifts by contacting (Name of responsible person or department). Engineering Controls and Work Practices Engineering controls and work practice controls will be used to prevent or minimize exposure to bloodborne pathogens. A-38 January 2007 Infectious Diseases International Association Appendices of Fire Fighters Model Exposure Control Plan (Continued) Sharps disposal containers are inspected and maintained or replaced by (Name of responsible person or department) every (list frequency) or whenever necessary to prevent overfilling. We evaluate new procedures or new products regularly by (Describe the process, literature reviewed, supplier info, products considered). Both front line workers and management officials are involved in this process (Describe how employees will be involved). January 2007 A-39 International Association Infectious Diseases of Fire Fighters Appendices Model Exposure Control Plan (Continued) • Utility gloves may be decontaminated for reuse if their integrity is not compromised; discard utility gloves if they show signs of cracking, peeling, tearing, puncturing or deterioration. Housekeeping Regulated medical waste is placed in containers which are resealable, constructed to contain all contents and prevent leakage, appropriately labeled or color-coded (see Labels section), and closed prior to removal to prevent spillage or protrusion of contents during handling. Sharps disposal containers are available at (must be easily accessible and as close as feasible to the immediate area where sharps are used). A-40 January 2007 Infectious Diseases International Association Appendices of Fire Fighters Model Exposure Control Plan (Continued) Laundry The following contaminated articles will be laundered by this company: ________________________ ________________________ ________________________ ________________________ Laundering will be performed by (Name of responsible person or department) at (time and/or location). The following laundering requirements must be met: • Handle contaminated laundry as little as possible, with minimal agitation • Place wet contaminated laundry in leak-proof, labeled or color-coded containers before transport. January 2007 A-41 International Association Infectious Diseases of Fire Fighters Appendices Model Exposure Control Plan (Continued) Hepatitis B Vaccination (Name of responsible person or department) will provide training to employees on Hepatitis B vaccinations, addressing the safety, benefits, efficacy, methods of administration and availability. Vaccination is encouraged unless 1) documentation exists indicating the employee has previously received the series, 2) antibody testing reveals the employee is immune, or 3) medical evaluation shows that vaccination is contraindicated. Vaccination will be provided by (List health care professional who is responsible for this part of the plan) at (location). Following the medical evaluation, a copy of the health care professional’s Written Opinion will be obtained and provided to the employee. It will be limited to whether the employee requires the Hepatitis vaccine and whether the vaccine was administered. Post-Exposure Evaluation & Follow-Up Should an exposure incident occur, contact (Name of responsible person) at the following number: ___________________________________. An immediately available confidential medical evaluation and follow-up will be conducted by (Licensed health care professional). Following the initial first aid (clean the wound, flush eyes or other mucous membranes, etc. Procedures for Evaluating the Circumstances Surrounding an Exposure Incident (Name of responsible person or department) will review the circumstances of all exposure incidents to determine: • Engineering controls in use at the time • Work practices followed • A description of the device being used (including type and brand) • Protective equipment or clothing that was used at the time of the exposure incident (gloves, eye shields, etc. January 2007 A-43 International Association Infectious Diseases of Fire Fighters Appendices Model Exposure Control Plan (Continued) (Name of responsible person) will record all percutaneous injuries from contaminated sharps in the Sharps Injury Log. Training materials for this facility are available at ________________________________. A-44 January 2007 Infectious Diseases International Association Appendices of Fire Fighters Model Exposure Control Plan (Continued) Recordkeeping Training Records Training records are completed for each employee upon completion of training. These documents will be kept for at least three years at (Name of responsible person or location of records). The training records include: • The dates of training sessions • The contents or a summary of the training sessions • The names and qualifications of persons conducting the training • The names and job titles of all persons attending the training sessions Employee training records are provided upon request to the employee or the employee’s authorized representative within 15 working days. These confidential records are kept at (list location) for at least the duration of employment plus 30 years. Employee medical records are provided upon request of the employee or to anyone having written consent of the employee within 15 working days. Such requests should be sent to (Name of responsible person or department and address). This determination and the recording activities are done by (Name of responsible person or department). January 2007 A-45 International Association Infectious Diseases of Fire Fighters Appendices Model Exposure Control Plan (Continued) Sharps Injury Log In addition to the 1904 Recordkeeping Requirements, all percutaneous injuries from contaminated sharps are also recorded in the Sharps Injury Log. All incidences must include at least: • The date of the injury • The type and brand of the device involved • The department or work area where the incident occurred • An explanation of how the incident occurred This log is reviewed at least annually as part of the annual evaluation of the program and is maintained for at least five years following the end of the calendar year that it covers. If a copy is requested by anyone, it must have any personal identifiers removed from the report. Sample Sharps Injury Log Case Type of Brand Name Where Injury Description of How Date No. Blood Tears Feces Urine Saliva Vomitus Sputum Sweat Other _____________________________________________________________________________________ What part(s) of your body became exposed? Be specific: ____________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Did you have any open cuts, sores, or rashes that became exposed? Be specific: _________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ How did exposure occur? Be specific: ____________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Did you seek medical attention? Subtitle B of the act is designed to allow for requests of notification of exposure by emergency response employees who believe they may have had an exposure and a procedure for that notification to manifest. The law provides for emergency response employee notification following a documented exposure to blood or body fluids, verified by the receiving hospital.

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Phlebotomines become infective about 7 days after biting an infected person and remain so for their normal life span of about 1 month cheap 20 mg torsemide overnight delivery. Susceptibility—Susceptibility is universal; homologous acquired immunity is probably lasting torsemide 10mg on line. Relative resistance of native populations in sandfly areas is probably attributable to infection early in life discount torsemide 20 mg without prescription. Preventive measures: Personal protective measures to prevent sandfly feeding; control of sandflies is the principal objective (see Leishmaniasis, cutaneous and mucosal, 9A2). Control of patient, contacts and the immediate environment: 1) Report to local health authority: In selected endemic areas; in most countries, not a reportable disease, Class 3 (see Report- ing). Epidemic measures: 1) Educate the public about conditions leading to infection and the importance of preventing sandfly bites by use of repel- lents, particularly after sundown. Identification—A viral disease with sudden onset of fever, malaise, weakness, irritability, headache, severe pain in limbs and loins and marked anorexia. There may be bleeding from gums, nose, lungs, uterus and intestine, but only in serious or fatal cases does this occur in large amounts, often associated with severe liver damage. Fever is constantly elevated for 5–12 days or may be biphasic; it falls rapidly by lysis. In the Russian Federation, an estimated 5 infections occur for each hemorrhagic case. Specific IgM may be present during the acute phase; conva- lescent sera often have low neutralization antibody titres. Infectious agent—The Crimean-Congo hemorrhagic fever virus (Bunyaviridae, Nairovirus). Occurrence—Observed in the steppes of western Crimea and in the Rostov and Astrakhan regions of the Russian Federation, as well as in Afghanistan, Albania, Bosnia and Herzegovina, Bulgaria, western China, the Islamic Republic of Iran, Iraq, Kazakhstan, Pakistan, South Africa, Turkey, Uzbekistan, the Arabian Peninsula and sub-Saharan Africa. Seasonal occurrence in the Russian Federation is from June to September, the period of vector activity. Immature ticks are believed to acquire infection from the animal hosts and by transovarian transmission. Nosocomial infection of medical workers, occurring after exposure to blood and secretions from patients, has been important in recent outbreaks; tertiary cases have occurred in family members of medical workers. Control of patient, contacts and the immediate environment: 1) Report to local health authority: In selected epidemic areas; in most countries, not a reportable disease, Class 3 (see Reporting). Identification—These two viral diseases have marked similarities: Onset is sudden with chills, headache, fever, pain in lower back and limbs and severe prostration, often associated with conjunctivitis, diarrhea and vomiting by the 3rd or 4th day. A papulovesicular eruption on the soft palate, cervical lymphadenopathy and conjunctival suffusion are usually present. The febrile period ranges from 5 days to 2 weeks, at times with a secondary rise in the third week. Diagnosis is made through isolation of virus from blood in suckling mice or cell cultures (virus may be present up to 10 days following onset) or through serological tests. Occurrence—In the Kyasanur Forest of the Shimoga and Kanara districts of Karnataka, India, principally in young adult males exposed in the forest during the dry season, from November to June. The Novosibirsk district reported 2 to 41 cases per year between 1989 and 1998, mostly in muskrat trappers. Susceptibility and resistance—Men and women of all ages are probably susceptible; previous infection leads to immunity. Identification—A helminthic infection of the small intestine gen- erally associated with few or no overt clinical symptoms. Live worms, passed in stools or occasionally from the mouth, anus, or nose, are often the first recognized sign of infection. Some patients have pulmonary manifestations (pneumonitis, Lo¨ffler syndrome) caused by larval migration (mainly during reinfections) and characterized by wheezing, cough, fever, eosinophilia and pulmonary infiltration. Heavy parasite burdens may aggravate nutritional deficiency and, if chronic, may affect work and school performance. Serious complications, sometimes fatal, include bowel obstruction by a bolus of worms, particularly in children; or obstruction of bile duct, pancreatic duct or appendix by one or more adult worms. Diagnosis is made by identifying eggs in feces, or adult worms passed from the anus, mouth or nose. Intestinal worms may be visualized by radiological and sonographic techniques; pulmonary involvement may be confirmed by identifying ascarid larvae in sputum or gastric washings. Infectious agent—Ascaris lumbricoides, the large intestinal round- worm of humans. Occurrence—Common and worldwide, with greatest frequency in moist tropical countries where prevalence often exceeds 50%. Prevalence and intensity of infection are usually highest in children between 3 and 8 years. Mode of transmission—Ingestion of infective eggs from soil contaminated with human feces or from uncooked produce contaminated with soil containing infective eggs, but not directly from person to person or from fresh feces. Transmission occurs mainly in the vicinity of the home, where children, in the absence of sanitary facilities, fecally pollute the area; heavy infections in children are frequently the result of ingesting soil (pica). Contaminated soil may be carried long distances on feet or footwear into houses and conveyances; transmission of infection by dust is also possible. Eggs reach the soil in the feces, then undergo development (embryo- nation); at summer temperatures they become infective after 2–3 weeks and may remain infective for several months or years in favorable soil. Ingested embryonated eggs hatch in the intestinal lumen; the larvae penetrate the gut wall and reach the lungs via the circulatory system.

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