Occupational Exposure Program
It’s probably safe to say that very few people come to work for TDCJ thinking about occupational exposures. When you filled out your application did you really think that having someone throw urine or feces on you may be part of your day-to-day activities? If an inmate spits in your face, is this something that you need to worry about contracting a disease from?
The Texas Department of Criminal Justice goes to great effort to prepare employees for potential occupational exposure to individuals who have bloodborne infectious diseases—especially Human Immunodeficiency Virus (HIV) Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV). To date there has never been a TDCJ correctional or medical employee who has filed with Workers’ Compensation claiming to have contracted HIV, HBV or HCV as a result of a work-related exposure.
HIV and hepatitis are viruses that can be contracted anywhere—not just the workplace. Employees should be as careful in their personal lives as they are at work about protecting themselves against infection. Many myths still persist about how these viruses are transmitted (No, you can’t get AIDS from a mosquito bite), and it is to every employee’s advantage to get the facts.
The information used in the Occupational Exposure Program comes from the Centers for Disease Control and Prevention (CDC) and the Texas Department of Health (TDH), so you can feel comfortable knowing you are receiving accurate, updated information.
What is an occupational exposure?
On January 20, 1990, the CDC published the definition of an occupational exposure in the Morbidity and Mortality Weekly Report. This definition says that an occupational exposure occurs when all three of the following criteria are met:
- The exposure occurs during the performance of the employee’s duties;
- There is a route of exposure—in other words, a way for the viruses to enter your body. This could happen in one or more of the following ways:
- A percutaneous injury (i.e., needlestick, puncture wound or cut with a contaminated object, or from a human bite that breaks the skin); or
- Contact with the mucous membrane linings of the eyes, nose and/or mouth; or
- Contact with the skin, especially if the exposed skin is chapped, abraded or afflicted with dermatitis, or the contact is prolonged or involving an extensive portion of the body.
- The employee is exposed to a body fluid to which universal precautions apply. These fluids include:
- Blood (including menstrual)
- Vaginal secretions
- Amniotic fluid
- Cerebrospinal (brain and backbone) fluid
- Synovial (joint) fluid
- Pleural (chest) fluid
- Peritoneal (abdominal) fluid
- Pericardial (heart) fluid
Saliva in a dental setting is considered a risk factor for HIV exposure since it is possible that blood or tissue may be present in the saliva.
In a correctional setting the only fluids you should be concerned about coming into contact with are blood, semen, and possibly vaginal secretions. All the other fluids listed above are body cavity fluids and unless you are working in an operating room, you should never be exposed to them. (If you are a correctional officer and get spinal fluids on your hands, you’re probably operating outside of your job description.)
The body fluids that correctional staff are most likely to come into contact with don’t transmit HIV or hepatitis unless visible blood is present. These fluids include:
- Nasal secretions
*Saliva in a human bite is considered a risk factor for the transmission of hepatitis B only, although the CDC has never documented a case of a person contracting HBV this way.
What are my chances of contracting HIV or hepatitis if I have an exposure?
HIV: When we talk about the risks of occupational exposure we always use the example of getting stuck with a known HIV-positive patient’s contaminated (bloody) needle. Not just anybody’s needle—an HIV-positive patient’s needle. And not just any kind of needle—a used hypodermic (hollow-bored) syringe. (Tattoo needles found under bunks and behind dayroom benches are usually made from pieces of wire or staples filed to a point and therefore are far less of a risk than hypodermics.)
We use the example of an HIV-positive patient’s contaminated needle because this is the most effective way to transmit the virus. But even with this most direct route of exposure, the CDC tells us that the chances of infection are 0.3 percent (or three out of 1,000). This means that if you had 1,000 correctional officers, and each one was stuck with a different, known HIV-positive patient’s bloody needle, only three of those 1,000 officers would become positive from that exposure. And that’s using the very best way we know to transmit HIV. Anything that’s not this high-risk, needlestick exposure, will be considerably less than that 0.3 percent chance.
Many people have a hard time believing this, but the reason this number is so low is because HIV is a very fragile virus when it’s outside the body. It breaks down quickly when it’s exposed to air and on environmental surfaces. No virus reproduces outside a cell.
HCV: The makeup of the hepatitis C virus is similar to that of the HIV virus, and that makes it pretty fragile outside the body. An employee stuck with an HCV-infected needle would have about a 1.8 percent chance of becoming infected with the virus.
Currently there is not a vaccine for HIV or HCV.
HBV: People tend to be more concerned about contracting HIV, and it is a scary disease—there’s not a cure or a vaccine available, but in reality, people should be more concerned about contracting hepatitis B. HBV is a much heartier virus. It can survive for several days outside the body. It can even live on surfaces that haven’t been cleaned properly (like that tattoo gun you found under a bunk).
Let’s use the needlestick example again. Instead of starting out with 1,000 correctional officers, this time we’ll start out with 100. Between six and 40 of them will become positive after getting stuck with a known hepatitis B patient’s contaminated needle—a risk of six to 40 percent.
But the good news that goes along with hepatitis B is that there’s a vaccine available, and TDCJ has a policy that allows correctional staff to receive the vaccine series free of charge through their unit Coordinator of Infectious Disease (CID) nurse. The vaccine is given in a series of three shots over a six month period and is very effective if the employees sticks to the vaccine schedule and gets all three shots. It’s a good idea for all correctional staff to take advantage of this program and be vaccinated against HBV. The vaccine series should be completed before an exposure occurs.
What happens if I haven’t been vaccinated and I have an exposure that puts me at risk of contracting HBV?
Even if a person hasn’t been vaccinated prior to an exposure (s)he can receive an HBIG (hepatitis B immune globulin) injection and the first shot of the hepatitis B vaccine series as much as seven days after an exposure. As long as the employee sticks to the vaccine series, this will provide just as much protection as if (s)he’d been vaccinated before the exposure.
What should I do if I have an occupational exposure?
If an employee has an exposure that meets the CDC’s criteria, (s)he should immediately wash the exposure area with water or soap and water. Mucous membranes, such as eyes or mouth, should be flushed liberally with water. The employee should then immediately report the incident to a supervisor and the unit medical department.
After treatment for any injuries, the employee shall be referred to the unit CID nurse for in-depth counseling and baseline blood testing. Counseling and testing are done on state time and at state expense.
Baseline blood testing
The HIV tests most commonly used do not look for the virus in your bloodstream. The enzyme-linked immunosorbent assay (ELISA or EIA) and Western Blot or Immuno-Flourescent Assay (IFA) look for the antibodies, or fighter cells, that build up in a person’s body to fight off the virus. In most cases, if someone is going to become infected with HIV these antibodies will begin to be detected by laboratory tests six to 12 weeks after an exposure. Because we know it takes six to 12 weeks for antibodies to be detected, Workers’ Compensation guidelines require an employee receive a baseline HIV test within 10 days after an exposure. A negative test, done within 10 days, is an employee’s proof that at the time of the exposures (s)he was HIV negative. On the other hand, a positive test done within 10 days would be the Agency’s proof to the employee that his/her infection could not possibly have been caused by the exposure.
Hepatitis B baseline testing is a little bit different. When someone’s tested for HBV the lab test can detect the virus in the blood, but in most cases it will take between six weeks and six months to be at a detectable level. At this time the employee will also be tested to see if they have antibodies to hepatitis B. HBV antibodies are a good thing—they are what you hope to develop after you’ve been vaccinated.
The most common test used for HCV detects antibodies to the virus. If an employee were to test antibody-positive after an exposure, (s)he would be referred to their physician for further testing to determine what, if any, treatment was indicated.
Follow-up testing for all three viruses is determined by the healthcare provider, and may include any combination of testing six-weeks, 12 weeks, six months and maybe even a year after the exposure.
Personal protective equipment
TDCJ Infection Control Policy B-14.31, "Personal Protective Equipment and Other Protective Supplies" states: "TDCJ will provide a sufficient quantity of appropriate personal protective equipment (PPE) in appropriate sizes to ensure that workers have equipment available when there is potential for occupational exposure."
"All workers will use appropriate PPE to the extent judged appropriate based on any possibility of contracting an infection from bloodborne pathogens. Universal precautions should be used at all times."
(It is not appropriate for an officer to wear gloves when pat-searching an inmate or searching inmate living quarters.)
TDCJ wants you to be protected against bloodborne diseases. If you have any questions regarding the Occupational Exposure Program or Hepatitis B vaccination, please contact your unit CID nurse or the TDCJ Public Health Department at (409) 437-3570.
Vernon’s Civil Statute, Health and Safety Code, 85.116(C)
Centers for Disease Control and Prevention (Guidelines for Health Care Workers) July 12, 1991
Communicable Disease Prevention and Control Act, Texas Health and Safety Code, 81.001
Department of Labor, Occupational Safety and Health Administration, 29, CRF Part 1910.1030
Occupational Exposure to Bloodborne Pathogens, Final Rule
TDCJ Health Services Policy B-14.4, "Prevention of Hepatitis B Virus (HBV) in TDCJ Facilities."
TDCJ Administrative Directive 6.60, "Management of Inmate and Employee Bloodborne Pathogen Issues (with Special
Reference to Human Immunodeficiency Virus [HIV] and Hepatitis B Virus [HBV])"
January 20, 1990, Morbidity and Mortality Weekly Report, CDC