Commissioner's Directive

OBJECTIVE

1. To provide a prompt and consistent response, in order to protect the health and safety of staff, inmates/offenders who have had a significant exposure to blood and/or body fluids of another person.

AUTHORITIES

2. Corrections and Conditional Release Act, section 70
   
   Canada Occupational Health and Safety Regulations, Part XV – Hazardous Occurrence Investigation Recording and Reporting
   
   Government Employees Compensation Act
   

CROSS-REFERENCES

3. Commissioner's Directive 821 - Management of Infectious Diseases
   
   Commissioner's Directive 720 - Educational Programs and Services for Offenders
   
   Guidelines 821-3 - Cleaning Blood and/or Other Body Fluid Spills
   
   Learning programs for staff and inmates
   

DEFINITIONS

4. A significant exposure is one in which an individual has:
   
   1. come into direct contact with human blood and/or body fluids capable of transmitting HIV, hepatitis B or hepatitis C, including any body fluids visibly soiled or contaminated by blood, such as feces, uterine/vaginal secretions, semen and saliva; AND
   2. one of these fluids comes into direct contact with:
      1. tissues under the skin (i.e. needle stick injury, stab wounds, or human bites breaking the skin);
      2. non-intact skin (eczema, cut, chapped, or scraped skin); or
      3. mucous membranes (eyes, nose, mouth, vagina, anus or rectum).
   Note: Blood or body fluids coming into contact with intact skin are not a significant exposure.
   
   
5. Officer-in-Charge:
   
   1. a staff member designated by the Institutional Head to exercise the powers, perform the duties or carry out the functions in the absence of the Institutional Head;
   2. the local manager or senior staff member present at a parole office or CCC.

RESPONSIBILITIES

National Headquarters

6. The Human Resource Management Sector, Labour Relations Directorate, Workforce Wellbeing Division, at National Headquarters, is responsible for reimbursing the cost of Post-Exposure Protocol (PEP) medication for CSC employees in:
   
   1. jurisdictions where the treatment is not provided free of charge by the province; and
   2. the medication is not covered by the Workers' Compensation Board.

Operational Unit Head

7. The operational unit head is responsible for:
   
   1. the effective implementation of the PEP;
   2. ensuring that arrangements have been made with a nearby hospital/clinic:
      • to perform PEP assessments, and
      • to have the appropriate PEP medication available for the treatment of staff and inmates/offenders;
   3. ensuring that the institutional Health Services pharmacy has a stock of PEP medications for inmates;
   4. ensuring that one pharmacy in the area has a supply of PEP medications and any other medications required for staff and that staff are aware of these arrangements;
   5. ensuring that an inmate/offender who has had a significant exposure receives medical follow-up by an institutional Physician and is offered counselling by the Psychologist; and
   6. ensuring that a staff member who has had a significant exposure is offered the services of the Employee Assistance Program.

Individual With a Significant Exposure to Blood and/or Body Fluids

8. The staff member, inmate/offender who has had a significant exposure will immediately:
   
   1. remove all contaminated clothing;
   2. allow immediate bleeding of the wound;
   3. wash the injured area well with soap and water; and
   4. if the eyes, nose or mouth are involved, flush them with large amounts of water.
9. The individual will report the significant exposure to a nurse if on site and if not, to the Officer-in-Charge.
   
   
10. Staff members and inmates/offenders will obtain medical follow-up with a Physician or through a hospital/clinic.

Officer-in-Charge

11. The Officer-in-Charge will immediately take all the following actions:
    
    1. arrange for the staff, inmate/offender who has had a significant exposure to be taken to the nearest hospital/clinic, where arrangements have been made for a PEP assessment;
       
       OR
       
       
    2. if it is an inmate/offender who has had the significant exposure and a nurse is on site, the nurse may make an assessment of the degree of exposure and, if the exposure is deemed significant, the institutional Physician may direct the immediate initiation of treatment at the institution;
    3. where the significant exposure involves a staff member and for jurisdictions where the treatment is not provided free of charge and not covered by the Workers' Compensation Board, the Officer-in-Charge will:
       1. complete and sign form CSC/SCC 1249 - Certification of Payment for Post-Exposure Prophylactic Treatment for Employees of the Correctional Service of Canada,
       2. provide the completed copy of form CSC/SCC 1249 to the staff member for presentation at the hospital/clinic Physician and pharmacy. CSC Workforce Wellbeing Division at National Headquarters will ensure that all expenses related to the PEP are reimbursed to the pharmacy or staff member if not covered by the Workers' Compensation Board or the provincial health care plan; and
    4. notify the receiving hospital/clinic of the pending arrival of the individual.
12. If a nurse is on site and if there is documented serological status of the source person, the nurse will notify the emergency services or Infectious Diseases Physician at the hospital/clinic of the serological status of the source person.
    
    
13. If the serological status of the source person is unknown, the Officer-in-Charge will ensure every effort is made to encourage the source person to be tested for HIV, hepatitis B and hepatitis C. Testing of the source person will only be done with his or her informed consent.
    
    
14. Where a staff member is involved in a significant exposure incident and the PEP has been implemented, the Officer-in-Charge will:
    
    1. submit to the Workforce Wellbeing Division, at National Headquarters, a copy of the completed form CSC/SCC 1249 along with the Public Service Health Care Plan (PSHCP) form;
    2. complete the Hazardous Occurrence Investigation Report (LAB 1070) for the injured employees and send a copy to the Workplace Health and Safety Committee. Depending on the type of incident, the Officer-in-Charge will send a copy of the Hazard Occurrence Investigation Report to the local Labour Program office of Human Resources and Social Development Canada; and
    3. complete the Employer's Report of Injury or Illness and submit it to the provincial Workers' Compensation Board.