The Disease

Hepatitis B is a viral infection caused by the Hepatitis B virus (HBV) which causes death in 1-2% of those infected. Most people with HBV recover completely, but approximately 5 to 10% become chronic carriers of the virus. Most of these people have no symptoms, but can continue to transmit the disease to others. Some may develop chronic active Hepatitis and cirrhosis. HBV may be a causative factor in the development of liver cancer. Immunization against HBV can prevent acute Hepatitis and its complications.

 

 

The Vaccine

The HBV vaccine is produced from yeast cells. It has been extensively tested for safety and effectiveness in large-scale clinical trials.  Approximately 90% of healthy people who received two doses of the vaccine and a third dose as a booster achieve high levels of surface antibody (anti-HBs) and protection against the virus. The HBV vaccine is recommended for workers with potential for contact with blood or body fluids. Full immunization requires three doses of the vaccine over a six-month period, although some persons may not develop immunity even after three doses.

 

There is no evidence that the vaccine has ever caused Hepatitis B. However, persons who have been infected with HBV prior to receiving the vaccine may go on to develop clinical Hepatitis in spite of immunization.

 

Dosage and Administration

The vaccine is given in three intramuscular doses in the deltoid muscle. Two initial doses are given one month apart and the third dose given six months after the first.

 

Possible Vaccine Side Effects

The incidence of side effects is very low. No serious side effects have been reported with vaccines. 10 to 20 percent of persons experienced tenderness and redness at the site of injection and low-grade fever. Rash, nausea, joint pain, and mild fatigue have also been reported. The possibility exists that other side effects may be identified with more extensive use.

 

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HEPATITIS B VACCINE INFORMATION AND RECORD

    CONSENT OF HEPATITIS B VACCINATION

 

I have knowledge of the Hepatitis B and the Hepatitis B vaccination. I have had an opportunity to ask questions of a qualified nurse or physician and understand the benefits and risks of Hepatitis B vaccination. I understand I must have three doses of the vaccine to obtain immunity. However, as with all medical treatment, there is no guarantee that I will become immune or that I will not experience side effects from the vaccine. I give my consent to be vaccinated for Hepatitis B.

 

 

 

Signature of Employee:                                            Date:

 

 

Signature of Witness:                                                                          Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REFUSAL OF HEPATITIS B VACCINATION

 

I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring the Hepatitis B virus infection. I have been given the opportunity to be vaccinated with the Hepatitis B vaccine at no charge to myself. However, I declined the Hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with the Hepatitis B vaccine, I can receive the vaccination series at no charge to me.

 

 

Signature for Employee:                                              Date:

Signature of Witness:                                      Date:

 

I refuse because I believe I have (check one)

         ____ started the series                                _____ completed a series

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HEPATITIS B VACCINE INFORMATION IN RECORD

RELEASE FOR HEPATITIS B MEDICAL INFORMATION

 

I hereby authorize_________________________________________________ (individual or

organization holding Hepatitis B records and address) to release to the Wapello Community School District, by Hepatitis B vaccination records for required employee records.

 

I hereby authorize release of my Hepatitis B status to a health-care provider, in the event of an exposure incident.

 

 

Signature of Employee:                            Date:

Signature of Witness:                                Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HEPATITIS B VACCINE INFORMATION IN RECORD

CONFIDENTIAL RECORD

 

Employee Name (last, first, middle):                                                                                          Social Security:

Job Title:

 

Hepatitis B Vaccination Date Lot Number Site                    Administered by

 

1.   _________________________________________________________________

2.   _________________________________________________________________

3.   _________________________________________________________________

 

Additional Hepatitis B status information:

 

Post-exposure incident: (Date, time, circumstances, route under which exposure occurred)

 

Identification and documentation of source individual:

 

Source blood testing consent:

D

escription of employee's duties as related to the exposure incident:

 

Copy of information provided to health care professional evaluating employee after an exposure incident:

 

Attach a copy of all results of examinations, medical testing, follow up procedures, and health care professional's written opinion.

 

Training Record: (date, time, instructor, location of training summary):

 

Universal precautions (UP) are intended to prevent transmission of infection, as well as decrease the risk of exposure for employees and students. It is not currently possible to identify all infected individuals, so precautions must be used with every individual.

 

 

UP pertains to being in contact with any potentially infectious materials (OPIM) wastes (OBFW) such as saliva, sputum, feces, tears, nasal secretions, vomitus, and urine unless blood is visible in the material. However, these OBFW can be sources of other infections and should be handled as if they are infectious. The single most important step in preventing exposure to and transmission of any infection is anticipating potential contact with infectious materials in routine as well as emergency situations. Based on the type of possible contact, employees and students should be prepared to use the appropriate precautions prior to the contact. Diligent and proper hand washing, the use of barriers, appropriate disposal of waste products and needles, and proper decontamination of spills are essential techniques of infection control. All individuals should respond to situations practicing UP followed by the activation of the school response team plan. Using common sense and the application of these measures will enhance protection of employees in students.

 

Hand Washing

 

Proper hand washing is crucial to preventing the spread of infection. Textured jewelry on the hands or wrist should be removed prior to washing and kept off until completion of the procedure and the hands are washed. Use of running water, lathering with soap, and using friction to clean all hand surfaces is key. Rinse well with running water and dry hands with paper towels.

• Hands should be washed before physical contact with individuals and after contact is completed.

• Hands should be washed after contact with any used equipment.

• If hands (or other skin) come into contact with blood or body fluids, hands should be washed immediately before touching anything else.

• Hands should be washed whether gloves are worn or not and, if gloves are worn, after the gloves are removed.

 

Barriers

 

Barriers anticipated to be used at school include disposable gloves, absorbent materials, and resuscitation devices. Their use is intended to reduce the risk of contact with blood and body fluids as well as to control the spread of infectious agents from individual to individual. Gloves should be worn when in contact with blood, OPIM, or OBFW. Gloves should be removed without touching the outside and disposed of after each use.

 

Disposal of Waste

 

Blood, OPIM, OBFW, used gloves, barriers, and absorbent materials should be placed in a plastic bag and disposed of in the usual procedure. When the blood or OPIM is liquid, semi-liquid, or caked with dried blood, it is not absorbed in materials and is capable of releasing the substance if compressed, special disposal is regulated waste is required. A Band-Aid, towel, sanitary napkin towel or other absorbed waste that does not have the potential of releasing the waste if compressed would not be considered regulated waste. It is anticipated schools would only have regulated waste in the case of a severe incident. Needles, syringes, and other sharp disposable objects should be placed in special puncture proof containers and disposed of as regulated waste. Bodily wastes such as urine, vomit, or feces should be disposed of in the sanitary sewer system.

 

Cleanup

 

• Spills of blood and OPIM should be cleaned up immediately. The employee should:

• Wear gloves.

• Clean up the spill with paper towels or other dormant material.

• Use a solution of one part household bleach to 100 parts of water (1:100) or other EPA-approved disinfectant and use it to wash the area well.

• Dispose of gloves, soiled towels, and other waste in a plastic bag.

• Clean and disinfect reusable supplies and equipment.

 

Laundry

 

Laundry with blood or OPIM should be handled as little as possible with a minimum of agitation. It should be bagged at the location. If it has the potential of releasing the substance when compacted, regulated waste guidelines should be followed. Employees who have contact with this laundry should wear protective barriers.

 

Exposure

 

An exposure to blood or OPIM through contact with broken skin, mucous membrane, or by needle or sharp stick requires immediate washing, reporting, and follow-up.

• Always wash the exposed area immediately with soap and water.

• If a mucous membrane splash (I or mouth) or exposure of broken skin occurs, irrigate or wash the area thoroughly.

• If a cut or needle stick injury occurs, wash the area thoroughly with soap and water.

The exposure should be reported immediately, the parent or guardian is notified, and the person exposed contacts a physician for further health care.

 

 

 

Approved: 6/12/1995

Reviewed: 11/12/1998; 02/14/2008; 10/12/11

Revised:

 

EMPLOYEES ARE HEREBY NOTIFIED it is a violation of the Substance-Free Workplace Policy for an employee to unlawfully manufacture, distribute, dispense, possess, use, or be under the influence of in the workplace any narcotic drug, hallucinogenic drug, amphetamine, barbiturate, marijuana, or any other controlled substance or alcohol, as defined in Schedules I through V of section 202 of the Controlled Substances Act (21 U.S.C. 812) and as further defined by regulation at 21 C.F.R. 1300.11 through 1300.15 and Iowa Code Chapter 204.

"Workplace" is defined as the site for the performance of work done in the capacity as an employee. This includes school district facilities, other school premises, or school district vehicles. "Workplace" also includes non-school property if the employee is at any school-sponsored, school-approved, or school-related activity, event, or function, such as field trips or athletic events where students are under the control of the school district or where the employee is engaged in school business.

Employees who violate the terms of the Substance-Free Workplace Policy may be required to successfully participate in a substance abuse treatment program approved of the board. The superintendent retains the discretion to discipline an employee for violation of the Substance-Free Workplace Policy. If the employee fails to successfully participate in such a program the employee shall be subject to discipline up to and including termination.

EMPLOYEES ARE FURTHER NOTIFIED it is a condition of their continued employment that they comply with the above policy of the school district and will notify their supervisor of their conviction of any criminal drug statute for violation committed in the workplace, no later than five days after the conviction.

SUBSTANCE-FREE WORKPLACE ACKNOWLEDGMENT FORM

I,_________________________________ , have read and understand the Substance-Free Workplace Policy. I understand that if I violate the Substance-Free Workplace Policy, I may be subject to discipline up to and including termination or I may be required to participate in a substance abuse treatment program. If I fail to successfully participate in a substance abuse treatment program, I understand I may be subject to discipline up to and including termination. I understand that if I am required to participate in a substance abuse treatment program and I refuse to participate, I may be subject to discipline up to and including termination. I also understand that if I am convicted of a criminal drug offense committed in the workplace, I must report that conviction to my supervisor within five days of the conviction.

 

Signature of Employee

Date                                                     

Time

A superintendent who suspects an employee has a substance abuse problem shall follow these procedures:

1. Identification - the superintendent shall document the evidence the superintendent has which leads the superintendent to conclude the employee has violated the Substance-Free Workplace Policy. After the superintendent has determined there has been a violation of the Substance-Free Workplace Policy, the superintendent shall discuss the problem with the employee.

2. Discipline - if, after the discussion with the employee, the superintendent determines there has been a violation of the Substance-Free Workplace Policy, the superintendent may recommend discipline up to and including termination or may recommend the employee seek substance abuse treatment. Participation in a substance abuse treatment program is voluntary.

3. Failure to participate in referral - if the employee refuses to participate in a substance abuse treatment program or if the employee does not successfully complete a substance abuse treatment program, the employee may be subject to discipline up to and including termination.

4. Conviction - if an employee is convicted of a criminal drug offense committed in the workplace, the employee must notify the employer of the conviction within five days of the conviction.

 

 

 

Approved: 6/12/1995

Reviewed: 11/12/1998; 02/14/2008; 10/12/11

Revised:

 

 

 

 

 

Employees governed by the drug and alcohol testing policy are hereby notified they are subject to the school district's drug and alcohol testing program for pre-employment drug testing in random, reasonable suspicion and post-accident drug and alcohol testing as outlined in the Drug and Alcohol Testing Program policy, its supporting documents, and the law.

 

 

Employees who operate school vehicles are subject to drug and alcohol testing if a commercial driver's license is required to operate the school vehicle and the school vehicle transports 16 or more persons including the driver or the school vehicle weighs 26,001 pounds or more. For purposes of the drug and alcohol testing program, "employees" also includes applicants who have been offered a position to operate a school vehicle. The employee's operating a school vehicle are subject to the drug and alcohol testing program beginning the first day they operate or are offered a position to operate a school vehicle and continue to be subject to the school and alcohol testing program.

 

It is the responsibility of the superintendent to inform employees of the drug and alcohol testing program requirements. Employees with questions regarding the drug and alcohol testing requirements will contact the school district contact person.

 

Employees governed by the drug and alcohol testing policy are further notified that employees violating this policy, its supporting documents, or the law may be subject to discipline up to and including termination.

 

Employees governed by the drug and alcohol testing policy are further notified as a condition of their continued employment to comply with the Drug and Alcohol Testing Program policy, its supporting documents, and the law. It is a condition of continued employment for employees operating a school vehicle to notify their supervisor of any prescription medication they are using. Drug and alcohol testing records about a driver are confidential and are released in accordance with this policy, its supporting documents, or the law.

 

 

 

Approved: 7/10/2003                      

Reviewed: 02/14/2008; 10/12/11

Revised:

 

I, (_________________________), have received a copy, read, and understand the Drug and Alcohol Testing Program and its supporting documents. I consent to submit to the drug and alcohol testing program as required by the Drug and Alcohol Testing Program policy, its supporting documents, and the law.

 

 

I understand that if I violate the Drug and Alcohol Testing Program policy, its supporting documents, or the law, I may be subject to discipline up to and including termination.

 

I also understand that I must inform my supervisor of any prescription medication I use. I further understand that drug and alcohol testing records about me are confidential and may be released in accordance with this policy, its supporting documents, or the law.

 

 

Signature of Employee:                                                                    

 

Date:                                      

 

Time:

 

 

 

Approved: 7/10/2003

Reviewed: 02/14/2008; 10/12/11

Revised: