# School of Nursing Graduate Information Guide Appendices

***GRADUATE INFORMATION GUIDE***

***(GIG)***

***A Guide for Students in***

***MASTER OF SCIENCE IN NURSING PROGRAM OPTION***

***DOCTOR OF NURSING PRACTICE PROGRAM OPTION***

***APPENDICES A – I***

***ARKANSAS STATE UNIVERSITY***

***SCHOOL OF NURSING***

***COLLEGE OF NURSING AND HEALTH PROFESSIONS***

#### *APPENDIX A*

##### *Hepatitis B Risk Categories for Health Care Personnel*

*The following categories are drawn from several studies that have delineated differential risks of*

*hepatitis-B among groups of health care personnel. Categories 1A and 1B are regarded as high*

*risk, Category 2 as moderate risk, and Category 3 as low or negligible risk.*

*Category 1A:*

*Persons who have frequent, direct, intense contact with blood or infected tissues, who are at*

*risk of trauma, needle stick, cuts and abrasions that may result in percutaneous introduction of*

*infectious materials, and who may have the potential of transmitting hepatitis- B infection back*

*to patients. This group includes:*

*1. Surgeons and surgical house staff of all types;*

*2. Nonsurgical personnel who carry out invasive diagnostic and therapeutic procedures,*

*including endoscopists, invasive cardiologists, angiographers, and other radiologists*

*performing invasive procedures;*

*3. Anesthesiologists, anesthesiology house staff and nurse anesthetists;*

*4. Pathologists and pathology house staff who perform autopsies;*

*5. Blood bank personnel; AND*

*6. Phlebotomists and intravenous therapy nurses.*

*Category 1B:*

*Persons with slightly less exposure to infected blood other than Category 1A or less frequent*

*association with trauma, who are less likely to transmit infection to patients, but are*

*nevertheless individuals with close and direct contact with blood or infected tissues. This group*

*includes:*

*1. Clinical and clinical laboratory technical staff who work directly with blood, including but*

*not limited to chemistry and hematology technologists, clinical hematologists, respiratory*

*therapy technicians, arterial blood gas laboratory technicians, endocrine, serology,*

*clinical GI, clinical immunology, cardiac catheterization laboratory personnel;*

*2. Nurses at highest risk, including those employed in emergency wards, intensive care*

*units, coronary care units, cardiac catheterization laboratories, dialysis care units, burn*

*units, oncology units, operating rooms and obstetric suites.*

*Category 2A:*

*Persons having moderate exposure to infected blood, but only occasional, generally accidental*

*risk of percutaneous inoculation.*

*1. Nonsurgical and non-invasive medical staff;*

*2. Housekeeping and central service personnel who may handle needles or sharp*

*instruments.*

*Category 3:*

*The hepatitis risk of other physician personnel, of floor nurses in non-ICU settings, and on other*

*categories of hospital personnel is increased only slightly over the baseline risk in the general*

*population.*

*\*Risks. Risks among health-care professionals vary during the training and working career of*

*each individual, but are often highest during the professional training period. For this reason,*

*when possible, vaccination should be completed during training in schools of medicine,*

*dentistry, nursing, laboratory technology, and other allied professions before workers have their*

*first contact with blood.*

*\*Source: "Morbidity and Mortality Weekly Report," Centers for Disease Control, Feb. 9, 1990,*

*Vol. 39, No 5-2, p. 14.*

##### *FAQ’S ABOUT HEPATITIS B*

*Q. What is Hepatitis B?*

*A. Hepatitis B is a serious disease that kills 4,000 to 5,000 Americans each year and 1 million*

*people worldwide. Persons who become infected with HBV (Hepatitis B*

*Virus) have this virus circulating in their blood. Persons who become infected with HBV either*

*recover from their infection in several months or they may remain chronically infected for most*

*of their lives. Persons with chronic HBV infection are at high risk of death from cirrhosis and liver*

*cancer. In addition, they are likely to transmit their infection to other people. In the US, 1.25*

*million persons are chronically infected with HBV.*

*Although HBV is a common infection, it often goes unnoticed. Only one-third of adults will have*

*symptoms of hepatitis when they first become infected. More than 90 percent of young children*

*who become infected will have no symptoms. Chronic infection may go undetected for 20 to 40*

*years until the resulting liver disease makes the person ill. HBV is a silent, unnoticed killer*

*destroying the liver or stimulating the development of liver cancer in those who thinks they are*

*completely well.*

##### *Q. How can HBV infection be detected?*

*A. Although most individuals do not have symptoms of infection, blood tests can accurately*

*identify persons with either chronic or resolved infection.*

*National studies have shown that 5% of Americans—12.5 million people—have been infected*

*with HBV. These studies also show that about 300,000 people have been infected with HBV*

*each year for the two decades prior to 1990, and that the risk of infection is much higher among*

*African-Americans that whites. At least 25,000 children have been infected with HBV each year.*

*Q. How does one become infected with HBV?*

*A. The virus is present in saliva and blood and is spread when these fluids come in contact with*

*breaks in the skin or other body surfaces. Hepatitis B is approximately 100 times more*

*contagious than HIV (Human Immunodeficiency Virus). There are certain groups of Americans*

*who engage in activities that place them at risk, but many of the cases do not fit into these*

*groups. Between 15 and 30 percent of cases in recent years (about 45,000 to 90,000) are newly*

*infected persons who have no identified risk factors.*

##### *Q. Can HBV infection be prevented?*

*A. Hepatitis B vaccine provides protection against infection with HBV by producing immunity or*

*antibodies to the surface protein or outer coat of the virus. This outer coat is called hepatitis B*

*surface antigen or HbsAg. Currently, the vaccines used in the US since 1989 have been*

*produced in yeast recombinant DNA technology as it is considered to be safer than plasmaderived*

*vaccines, which are used widely throughout the world.*

*Hepatitis B vaccine provides greater than 90 percent protection to infants, children, and adults*

*immunized before being exposed to the virus. Many studies have provided evidence that*

*hepatitis B immunization will prevent liver cancer and chronic liver disease.*

##### *Q. Who should be vaccinated?*

*A. Hepatitis B vaccination of health care personnel who have contact with blood and body fluids*

*can prevent transmission of HBV and is strongly recommended. Vaccination prior to and during*

*training or health care professionals before such blood exposure occurs will decrease any risks*

*related to unintentional injuries or exposures while they are learning health care techniques and*

*processes.*

*Currently, there are recommendations that all children, at a very early age, should receive HBV*

*vaccinations. Eventually, if this plan is carried out, almost all of the population would be*

*protected in the future. The routine immunization of infants would significantly diminish*

*transmission of HBV infection with its ultimate outcomes.*

##### *Q. How is the vaccine administered?*

*A. The standard recommendation for HBV is a 3-dosage procedure. The hepatitis B vaccine is*

*inoculated intramuscularly, usually in the deltoid area. The first dose is followed by a second*

*dosage inoculation 1 month after the initial dose. The last dose then is administered 6 months*

*following the second dose. As stated, 90% protection is usually achieved using this procedure.*

##### *Q. How long will protection last?*

*A. A number of studies have shown that the initial 3-dose immunization series provides*

*protection from HBV infection for years. All studies indicate that the immunity is long term and*

*may be lifelong. While immunized people may lose antibody circulating in their blood, they still*

*retain protection from chronic HBV infection because their immune cells remember that they*

*were vaccinated - what is called “immune memory”. The immune cells of a person immunized*

*with hepatitis B vaccine and who has lost antibodies in their blood will remember that they were*

*immunized and rapidly make antibodies when they are exposed to HBV. In the case of Hepatitis*

*B, the long incubation period for HBV infections allows enough time for the immune system to*

*mount a protective response. Currently, booster doses of vaccine are not routinely*

*recommended.*

##### *Q. Is post-vaccination screening for antibody production necessary?*

*A. Screening for antibody to HbsAg is advised for personnel at on-going risk for blood exposure*

*to determine whether response to vaccinations has occurred and to aid in determining the*

*appropriate post-exposure prophylaxis or the need for revaccination.*

*Screening is advised but it is not mandated by CDC or by OSHA. Employers may request such*

*testing for their employees. The cost of such testing would then generally be at the employers’*

*expense. If individuals wish to determine their status, then the cost of testing would revert to the*

*individual.*

##### *Q. What is the rational for post-vaccination screening?*

*A. Individuals who do not produce antibodies or who do not complete the primary vaccination*

*series should be revaccinated with a second three-dose vaccine series or evaluated to*

*determine whether they are AbsAg seropositive. Revaccinated persons should be tested for*

*anti-HBs at the completion of the second vaccine series.*

*If they do not respond, no further vaccination series should be given and they should be*

*evaluated for the presence of the HbsAg (possible chronic HBV infection).*

##### *Q. What happens if there is an exposure?*

*A. The need for post-exposure prophylaxis, vaccination, or both depends on the HbsAg status*

*of the source of the exposure as well as the immunization status of the person exposed.*

*If the person exposed is unvaccinated, vaccine should be offered; if the source is known to be*

*HbsAg seropositive, Hepatitis B immune globulin (HBIG) should be given, preferably within 24*

*hours.*

*If the person exposed is known not to have responded to a three dose vaccine series, and if the*

*source is HbsAg seropositive, a single dose of HBIG and a dose of Hepatitis B vaccine need to*

*be given as soon as possible after the exposure with subsequent vaccine doses given at 1*

*month and at 6 months after the initial dose.*

*If the exposed person is known not to have responded to a three-dose vaccine series and to*

*revaccination, two doses of HBIG need to be given, one dose as soon as possible after*

*exposure and the second dose 1 month later.*

##### *Appendix A to Section 1910.1030 - Hepatitis B Vaccine Declamation (Mandatory)*

*I understand that due to my occupational exposure to blood or other potentially infectious*

*materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given*

*the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself. However, I*

*decline 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 hepatitis B vaccine, I can receive the vaccination series at no charge to me.*

*\[56 FR 64004, Dec. 06, 1991, as amended at 57 FR 12717, April 13, 1992; 57 FR 29206, July 1,*

*1992; 61 FR 5507, Feb. 13, 1996\]*

#### *APPENDIX B*

##### *OSHA Regulations (Standards – 29 CFR) Bloodborne pathogens. – 1910.1030*

*Standard Number: 1910.1030*

*Standard Title: Bloodborne pathogens.*

*Subpart Number: Z*

*Subpart Title: Toxic and Hazardous Substances*

*(a) Scope and Application.*

*This section applies to all occupational exposure to blood or other potentially infectious*

*materials as defined by paragraph (b) of this section.*

*(b) Definitions.*

*For purposes of this section, the following shall apply:*

*"Assistant Secretary" means the Assistant Secretary of Labor for Occupational Safety*

*and Health, or designated representative.*

*"Blood" means human blood, human blood components, and products made from*

*human blood.*

*"Bloodborne Pathogens" means pathogenic microorganisms that are present in human*

*blood and can cause disease in humans. These pathogens include, but are not limited*

*to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV).*

*"Clinical Laboratory" means a workplace where diagnostic or other screening*

*procedures are performed on blood or other potentially infectious materials.*

*"Contaminated" means the presence or the reasonably anticipated presence of blood or*

*other potentially infectious materials on an item or surface.*

*"Contaminated Laundry" means laundry which has been soiled with blood or other*

*potentially infectious materials or may contain sharps.*

*"Contaminated Sharps" means any contaminated object that can penetrate the skin*

*including, but not limited to, needles, scalpels, broken glass, broken capillary tubes, and*

*exposed ends of dental wires.*

*"Decontamination" means the use of physical or chemical means to remove, inactivate,*

*or destroy bloodborne pathogens on a surface or item to the point where they are no*

*longer capable of transmitting infectious particles and the surface or item is rendered*

*safe for handling, use, or disposal.*

*"Director" means the Director of the National Institute for Occupational Safety and*

*Health, U.S. Department of Health and Human Services, or designated representative.*

*"Engineering Controls" means controls (e.g., sharps disposal containers, self- sheathing*

*needles) that isolate or remove the blood-borne pathogens hazard from the workplace.*

*"Exposure Incident" means a specific eye, mouth, other mucous membrane, non- intact*

*skin, or parenteral contact with blood or other potentially infectious materials that results*

*from the performance of an employee's duties.*

*"Handwashing Facilities" means a facility providing an adequate supply of running*

*potable water, soap and single use towels or hot air drying machines.*

*"Licensed Healthcare Professional" is a person whose legally permitted scope of*

*practice allows him or her to independently perform the activities required by paragraph*

*(f) Hepatitis B Vaccination and Post-exposure Evaluation and Follow-up.*

*"HBV" means hepatitis B virus.*

*"HIV" means human immunodeficiency virus.*

*"Occupational Exposure" means reasonably anticipated skin, eye, mucous membrane,*

*or parenteral contact with blood or other potentially infectious materials that may result*

*from the performance of an employee's duties.*

*"Other Potentially Infectious Materials" means:*

*(1) The following human body fluids: semen, vaginal secretions, cerebrospinal*

*fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid,*

*saliva in dental procedures, any body fluid that is visibly contaminated with blood,*

*and all body fluids in situations where it is difficult or impossible to differentiate*

*between body fluids;*

*(2) Any unfixed tissue or organ (other than intact skin) from a human (living or dead);*

*and*

*(3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBVcontaining*

*culture medium or other solutions; and blood, organs, or other tissues*

*from experimental animals infected with HIV or HBV.*

*"Parenteral" means piercing mucous membranes or the skin barrier through such events*

*as needlesticks, human bites, cuts, and abrasions.*

*"Personal Protective Equipment" is specialized clothing or equipment worn by an*

*employee for protection against a hazard. General work clothes (e.g., uniforms, pants,*

*shirts or blouses) not intended to function as protection against a hazard are not*

*considered to be personal protective equipment.*

*"Production Facility" means a facility engaged in industrial-scale, large-volume or high*

*concentration production of HIV or HBV.*

*"Regulated Waste" means liquid or semi-liquid blood or other potentially infectious*

*materials; contaminated items that would release blood or other potentially infectious*

*materials in a liquid or semi-liquid state if compressed; items that are caked with dried*

*blood or other potentially infectious materials and are capable of releasing these*

*materials during handling; contaminated sharps; and pathological and microbiological*

*wastes containing blood or other potentially infectious materials.*

*"Research Laboratory" means a laboratory producing or using research-laboratoryscale*

*amounts of HIV or HBV. Research laboratories may produce high concentrations*

*of HIV or HBV but not in the volume found in production facilities.*

*"Source Individual" means any individual, living or dead, whose blood or other potentially*

*infectious materials may be a source of occupational exposure to the employee.*

*Examples include, but are not limited to, hospital and clinic patients; clients in institutions*

*for the developmentally disabled; trauma victims; clients of drug and alcohol treatment*

*facilities; residents of hospices and nursing homes; human remains; and individuals who*

*donate or sell blood or blood components.*

*"Sterilize" means the use of a physical or chemical procedure to destroy all microbial life*

*including highly resistant bacterial endospores.*

*"Universal Precautions" is an approach to infection control. According to the concept of*

*Universal Precautions, all human blood and certain human body fluids are treated as if*

*known to be infectious for HIV, HBV, and other bloodborne pathogens.*

*"Work Practice Controls" means controls that reduce the likelihood of exposure by*

*altering the manner in which a task is performed (e.g., prohibiting recapping of needles*

*by a two- handed technique).*

*(c) Exposure Control.*

*(1) Exposure Control Plan.*

*(i). Each employer having an employee(s) with occupational exposure as defined*

*by paragraph (b) of this section shall establish a written Exposure Control Plan*

*designed to eliminate or minimize employee exposure. ii. The Exposure Control*

*Plan shall contain at least the following elements: (A) The exposure*

*determination required by paragraph (c)(2),1910.1030 (c)(1)(ii)(B).*

*(B) The schedule and method of implementation for paragraphs*

*(d) Methods of Compliance,*

*(e) HIV and HBV Research Laboratories and Production*

*Facilities,*

*(f) Hepatitis B Vaccination and Post-Exposure Evaluation and*

*Follow-up,*

*(g) Communication of Hazards to Employees, and*

*(h) Recordkeeping, of this standard, and*

*(A) The procedure for the evaluation of circumstances surrounding*

*exposure incidents as required by paragraph (f)(3)(i) of this standard.*

*(iii) Each employer shall ensure that a copy of the Exposure Control Plan is*

*accessible to employees in accordance with 29 CFR 1910.1020(e).*

*(iv) The Exposure Control Plan shall be reviewed and updated at least annually*

*and whenever necessary to reflect new or modified tasks and procedures affect*

*occupational exposure and to reflect new or revised employee positions with*

*occupational exposure.*

*(v) The Exposure Control Plan shall be made available to the Assistant Secretary*

*and the Director upon request for examination and copying.*

*(2) Exposure Determination.*

*(i) Each employer who has an employee(s) with occupational exposure as*

*defined by paragraph (b) of this section shall prepare an exposure determination.*

*This exposure determination shall contain the following:*

*(A) A list of all job classifications in which all employees in those job*

*classifications have occupational exposure;*

*(B) A list of job classifications in which some employees have*

*occupational exposure, and*

*(C) A list of all tasks and procedures or groups of closely related task*

*and procedures in which occupational exposure occurs and that*

*are performed by employees in job classifications listed in*

*accordance with the provisions of paragraph (c)(2)(i)(B) of this*

*standard.*

*(ii) This exposure determination shall be made without regard to the use of*

*personal protective equipment.*

*(d) Methods of Compliance.*

*(1) General Universal precautions shall be observed to prevent contact with blood or*

*other potentially infectious materials. Under circumstances in which differentiation*

*between body fluid types is difficult or impossible, all body fluids shall be*

*considered potentially infectious materials.*

*(2) Engineering and Work Practice Controls.*

*(i) Engineering and work practice controls shall be used to eliminate or*

*minimize employee exposure. Where occupational exposure remains*

*after institution of these controls, personal protective equipment shall also*

*be used.*

*(ii) Engineering controls shall be examined and maintained or replaced on a*

*regular schedule to ensure their effectiveness.*

*(iii) Employers shall provide handwashing facilities that are readily*

*accessible to employees.*

*When provision of handwashing facilities is not feasible, the employer shall provide*

*either an appropriate antiseptic hand cleanser in conjunction with clean cloth/ paper*

*towels or antiseptic towelettes.*

*(iv) When antiseptic hand cleansers or towelettes are used, hands shall be*

*washed with soap and running water as soon as feasible.*

*(v) Employers shall ensure that employees wash their hands immediately*

*or as soon as feasible after removal of gloves or other personal protective*

*equipment.*

*(vi) Employers shall ensure that employees wash hands and any other skin*

*with soap and water, or flush mucous membranes with water immediately*

*or as soon as feasible following contact of such body areas with blood or*

*other potentially infectious materials.*

*(vii) Contaminated needles and other contaminated sharps shall not be bent,*

*recapped, or removed except as noted in paragraphs (d)(2)(vii)(A) and*

*(d)(2)(vii)(B) below. Shearing or breaking of contaminated needles is*

*prohibited.*

*(A) Contaminated needles and other contaminated sharps shall not*

*be bent, recapped or removed unless the employer can*

*demonstrate that no alternative is feasible or that such action is*

*required by a specific medical or dental procedure.*

*(B) Such bending, recapping or needle removal must be*

*accomplished through the use of a mechanical device or a onehanded*

*technique.*

*(viii) Immediately or as soon as possible after use, contaminated reusable*

*sharps shall be placed in appropriate containers until properly*

*reprocessed. These containers shall be:*

*(A) puncture resistant;*

*(B) labeled or color-coded in accordance with this standard;*

*(C) leakproof on the sides and bottom; and*

*(D) in accordance with the requirements set forth in paragraph*

*(d)(4)(ii)(E) for reusable sharps.*

*(ix) Eating, drinking, smoking, applying cosmetics or lip balm, and handling*

*contact lenses are prohibited in work areas where there is a reasonable*

*likelihood of occupational exposure.*

*(x) Food and drink shall not be kept in refrigerators, freezers, shelves,*

*cabinets or on countertops or benchtops where blood or other potentially*

*infectious materials are present.*

*(xi) All procedures involving blood or other potentially infectious materials*

*shall be performed in such a manner as to minimize splashing, spraying,*

*spattering, and generation of droplets of these substances.*

*(xii) Mouth pipetting/ suctioning of blood or other potentially infectious*

*materials is prohibited.*

*(xiii) Specimens of blood or other potentially infectious materials shall be*

*placed in a container that prevents leakage during collection, handling,*

*processing, storage, transport, or shipping.*

*(A) The container for storage, transport, or shipping shall be labeled*

*or color-coded according to paragraph (g)(1)(i) and closed prior to*

*being stored, transported, or shipped. When a facility utilizes*

*Universal Precautions in the handling of all specimens, the*

*labeling/color-coding of specimens is not necessary provided*

*containers are recognizable as containing specimens. This*

*exemption only applies while such specimens/containers remain*

*within the facility. Labeling or color-coding in accordance with*

*paragraph (g)(1)(i) is required when such specimens/containers*

*leave the facility.*

*(B) If outside contamination of the primary container occurs, the*

*primary container shall be placed within a second container which*

*prevents leakage during handling, processing, storage, transport,*

*or shipping and is labeled or color-coded according to the*

*requirements of this standard.*

*(C) If the specimen could puncture the primary container, the primary*

*container shall be placed within a secondary container that is*

*puncture-resistant in addition to the above characteristics.*

*(xiv) Equipment which may become contaminated with blood or other*

*potentially infectious materials shall be examined prior to servicing or shipping*

*and shall be decontaminated as necessary, unless the employer can*

*demonstrate that decontamination of such equipment or portions of such*

*equipment is not feasible.*

*(A) A readily observable label in accordance with paragraph*

*(g)(1)(i)(H) shall be attached to the equipment stating which*

*portions remain contaminated.*

*(B) The employer shall ensure that this information is conveyed to all*

*affected employees, the servicing representative, and/or the*

*manufacturer, as appropriate, prior to handling, servicing, or*

*shipping so that appropriate precautions will be taken.*

*(3) Personal Protective Equipment.*

*(i) Provision. When there is occupational exposure, the employer shall provide, at*

*no cost to the employee, appropriate personal protective equipment such as, but*

*not limited to, gloves, gowns, laboratory coats, face shields or masks and*

*eye protection, and mouthpieces, resuscitation bags, pocket masks, or other*

*ventilation devices. Personal protective equipment will be considered*

*"appropriate" only if it does not permit blood or other potentially infectious*

*materials to pass through to or reach the employee's work clothes, street clothes,*

*undergarments, skin, eyes, mouth, or other mucous membranes under normal*

*conditions of use and for the duration of time which the protective equipment will*

*be used.*

*(ii) Use. The employer shall ensure that the employee uses appropriate personal*

*protective equipment unless the employer shows that the employee temporarily*

*and briefly declined to use personal protective equipment when, under rare and*

*extra-ordinary circumstances, it was the employee's professional judgment that in*

*the specific instance its use would have prevented the delivery of health care or*

*public safety services or would have posed an increased hazard to the safety of*

*the worker or co-worker. When the employee makes this judgment, the*

*circumstances shall be investigated and documented in order to determine*

*whether changes can be instituted to prevent such occurrences in the future.*

*(iii) Accessibility. The employer shall ensure that appropriate personal protective*

*equipment in the appropriate sizes is readily accessible at the worksite or is*

*issued to employees. Hypoallergenic gloves, glove liners, powderless gloves, or*

*other similar alternatives shall be readily accessible to those employees who are*

*allergic to the gloves normally provided.*

*(iv) Cleaning, Laundering, and Disposal. The employer shall clean, launder, and*

*dispose of personal protective equipment required by paragraphs (d) and (e) of*

*this standard, at no cost to the employee.*

*(v) Repair and Replacement. The employer shall repair or replace personal*

*protective equipment as needed to maintain its effectiveness, at no cost to the*

*employee.*

*(vi) If a garment(s) is penetrated by blood or other potentially infectious materials, the*

*garment(s) shall be removed immediately or as soon as feasible.*

*(vii) All personal protective equipment shall be removed prior to leaving the work*

*area.*

*(viii) When personal protective equipment is removed it shall be placed in an*

*appropriately designated area or container for storage, washing, decontamination*

*or disposal.*

*(ix) Gloves. Gloves shall be worn when it can be reasonably anticipated that the*

*employee may have hand contact with blood, other potentially infectious*

*materials, mucous membranes, and non-intact skin; when performing vascular*

*access procedures except as specified in paragraph (d)(3)(ix)(D); and when*

*handling or touching contaminated items or surfaces.*

*(A) Disposable (single use) gloves such as surgical or examination gloves,*

*shall be replaced as soon as practical when contaminated or as soon as*

*feasible if they are torn, punctured, or when their ability to function as a*

*barrier is compromised.*

*(B) Disposable (single use) gloves shall not be washed or decontaminated for*

*re-use.*

*(C) 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*

*cracked, peeling, torn, punctured, or exhibit other signs of deterioration or*

*when their ability to function as a barrier is compromised.*

*(D) If an employer in a volunteer blood donation center judges that routine*

*gloving for all phlebotomies is not necessary then the employer shall:*

*(1) Periodically reevaluate this policy;*

*(2) Make gloves available to all employees who wish to use them for*

*phlebotomy;*

*(3) Not discourage the use of gloves for phlebotomy; and*

*(4) Require that gloves be used for phlebotomy in the following*

*circumstances:*

*\[i\] When the employee has cuts, scratches, or other breaks in his or*

*her skin;*

*\[ii\] When the employee judges that hand contamination with blood*

*may occur, for. example, when performing phlebotomy on an*

*uncooperative source individual; and*

*\[iii\] When the employee is receiving training in phlebotomy.*

*(x) Masks, Eye Protection, and Face Shields. Masks in combination with eye*

*protection devices, such as goggles or glasses with solid side shields, or chinlength*

*face shields, shall be worn whenever splashes, spray, spatter, or droplets*

*of blood or other potentially infectious materials may be generated and eye,*

*nose, or mouth contamination can be reasonably anticipated.*

*(xi) Gowns, Aprons, and Other Protective Body Clothing. Appropriate protective*

*clothing such as, but not limited to, gowns, aprons, lab coats, clinic jackets, or*

*similar outer garments shall be worn in occupational exposure situations. The*

*type and characteristics will depend upon the task and degree of exposure*

*anticipated.*

*(xii) Surgical caps or hoods and/or shoe covers or boots shall be worn in instances*

*when gross contamination can reasonably be anticipated (e.g., autopsies,*

*orthopedic surgery).*

*(4) Housekeeping.*

*(i) General. Employers shall ensure that the worksite is maintained in a clean and*

*sanitary condition. The employer shall determine and implement an appropriate*

*written schedule for cleaning and method of decontamination based upon the*

*location within the facility, type of surface to be cleaned, type of soil present, and*

*tasks or procedures being performed in the area.*

*(ii) All equipment and environmental and working surfaces shall be cleaned and*

*decontaminated after contact with blood or other potentially infectious materials:*

*(A) Contaminated work surfaces shall be decontaminated with an appropriate*

*disinfectant after completion of procedures; immediately or as soon as*

*feasible when surfaces are overtly contaminated or after any spill of blood*

*or other potentially infectious materials; and at the end of the work shift if*

*the surface may have become contaminated since the last cleaning.*

*(B) Protective coverings, such as plastic wrap, aluminum foil, or imperviouslybacked*

*absorbent paper used to cover equipment and environmental*

*surfaces, shall be removed and replaced as soon as feasible when they*

*become overtly contaminated or at the end of the work shift if they may*

*have become contaminated during the shift.*

*(C) All bins, pails, cans, and similar receptacles intended for reuse which*

*have a reasonable likelihood for becoming contaminated with blood or*

*other potentially infectious materials shall be inspected and*

*decontaminated on a regularly scheduled basis and cleaned and*

*decontaminated immediately or as soon as feasible upon visible*

*contamination.*

*(D) Broken glassware which may be contaminated shall not be picked up*

*directly with the hands. It shall be cleaned up using mechanical means,*

*such as a brush and dust pan, tongs, or forceps.*

*(E) Reusable sharps that are contaminated with blood or other potentially*

*infectious materials shall not be stored or processed in a manner that*

*requires employees to reach by hand into the containers where these*

*sharps have been placed.*

*(iii) Regulated Waste.*

*(A) Contaminated Sharps Discarding and Containment.*

*(1) Contaminated sharps shall be discarded immediately or as soon*

*as feasible in containers that are:*

*\[a\] Closable;*

*\[b\] Puncture resistant;*

*\[c\] Leakproof on sides and bottom; and*

*\[d\] Labeled or color-coded in accordance with paragraph (g)(1)(i)*

*of this standard.*

*(2) During use, containers for contaminated sharps shall be:*

*\[a\] Easily accessible to personnel and located as close as is*

*feasible to the immediate area where sharps are used or can be*

*reasonably anticipated to be found (e.g., laundries);*

*\[b\] Maintained upright throughout use; and*

*\[c\] Replaced routinely and not be allowed to overfill.*

*(4) When moving containers of contaminated sharps from the area of*

*use, the containers shall be:*

*\[a\] Closed immediately prior to removal or replacement to*

*prevent spillage or protrusion of contents during handling,*

*storage, transport, or shipping;*

*\[b\] Placed in a secondary container if leakage is possible. The*

*second container shall be:*

*\[i\] Closable;*

*\[ii\] Constructed to contain all contents and prevent leakage*

*during handling, storage, transport, or shipping; and*

*\[iii\] Labeled or color-coded according to paragraph (g)(1)(i)*

*of this standard.*

*(5) Reusable containers shall not be opened, emptied, or cleaned*

*manually or in any other manner which would expose employees*

*to the risk of percutaneous injury.*

*(B) Other Regulated Waste Containment.*

*(1) Regulated waste shall be placed in containers which are:*

*\[a\] Closable;*

*\[b\] Constructed to contain all con-tents and prevent*

*leakage of fluids during handling, storage, transport or*

*shipping;*

*\[c\] Labeled or color-coded in accordance with paragraph*

*(g)(1)(i) this standard; and*

*\[d\] Closed prior to removal to prevent spillage or protrusion*

*of contents during handling, storage, transport, or shipping.*

*(2) If outside contamination of the regulated waste container*

*occurs, it shall be placed in a second container. The*

*second container shall be:*

*\[a\] Closable;*

*\[b\] Constructed to contain all contents and prevent leakage*

*of fluids during handling, storage, transport or shipping;*

*\[c\] Labeled or color-coded in accordance with paragraph*

*(g)(1)(i) of this standard; and*

*\[d\] Closed prior to removal to prevent spillage or protrusion*

*of contents during handling, storage, transport, or shipping.*

*(C) Disposal of all regulated waste shall be in accordance with applicable*

*regulations of the United States, States and Territories, and political*

*subdivisions of States and Territories.*

*(iv) Laundry.*

*(A) Contaminated laundry shall be handled as little as possible with a*

*minimum of agitation.*

*(1) Contaminated laundry shall be bagged or containerized at the*

*location where it was used and shall not be sorted or rinsed in the*

*location of use.*

*(2) Contaminated laundry shall be placed and transported in bags or*

*containers labeled or color-coded in accordance with paragraph*

*(g)(1)(i) of this standard. When a facility utilizes Universal*

*Precautions in the handling of all soiled laundry, alternative*

*labeling or color- coding is sufficient if it permits all employees to*

*recognize the containers as requiring compliance with Universal*

*Precautions.*

*(3) Whenever contaminated laundry is wet and presents a reasonable*

*likelihood of soak- through of or leakage from the bag or container,*

*the laundry shall be placed and transported in bags or containers*

*which prevent soak-through and/or leakage of fluids to the*

*exterior.*

*(B) The employer shall ensure that employees who have contact with*

*contaminated laundry wear protective gloves and other appropriate*

*personal protective equipment.*

*(C) When a facility ships contaminated laundry off-site to a second facility*

*which does not utilize Universal Precautions in the handling of all laundry,*

*the facility generating the contaminated laundry must place such laundry*

*in bags or containers which are labeled or color- coded in accordance*

*with paragraph (g)(1)(i).*

*(e) HIV and HBV Research Laboratories and Production Facilities.*

*(1) This paragraph applies to research laboratories and production facilities engaged*

*in the culture, production, concentration, experimentation, and manipulation of*

*HIV and HBV. It does not apply to clinical or diagnostic laboratories engaged*

*solely in the analysis of blood, tissues, or organs. These requirements apply in*

*addition to the other requirements of the standard.*

*(2) Research laboratories and production facilities shall meet the following criteria:*

*(i) Standard Microbiological Practices. All regulated waste shall either be*

*incinerated or decontaminated by a method such as autoclaving known to*

*effectively destroy bloodborne pathogens.*

*(ii) Special Practices*

*(A) Laboratory doors shall be kept closed when work involving HIV or*

*HBV is in progress.*

*(B) Contaminated materials that are to be decontaminated at a site*

*away from the work area shall be placed in a durable, leakproof,*

*labeled or color-coded container that is closed before being*

*removed from the work area.*

*(C) Access to the work area shall be limited to authorized persons.*

*Written policies and procedures shall be established whereby only*

*persons who have been advised of the potential biohazard, who*

*meet any specific entry requirements, and who comply with all*

*entry and exit procedures shall be allowed to enter the work areas*

*and animal rooms.*

*(D) When other potentially infectious materials or infected animals are*

*present in the work area or containment module, a hazard warning*

*sign incorporating the universal biohazard symbol shall be posted*

*on all access doors. The hazard warning sign shall comply with*

*paragraph (g)(1)(ii) of this standard.*

*(E) All activities involving other potentially infectious materials shall be*

*conducted in biological safety cabinets or other physicalcontainment*

*devices within the containment module. No work with*

*these other potentially infectious materials shall be conducted on*

*the open bench.*

*(F) Laboratory coats, gowns, smocks, uniforms, or other appropriate*

*protective clothing shall be used in the work area and animal*

*rooms. Protective clothing shall not be worn outside of the work*

*area and shall be decontaminated before being laundered.*

*(G) Special care shall be taken to avoid skin contact with other*

*potentially infectious materials. Gloves shall be worn when*

*handling infected animals and when making hand contact with*

*other potentially infectious materials is unavoidable.*

*(H) Before disposal all waste from work areas and from animal rooms*

*shall either be incinerated or decontaminated by a method such*

*as autoclaving known to effectively destroy bloodborne pathogens.*

*(I) Vacuum lines shall be protected with liquid disinfectant traps and*

*high-efficiency particulate air (HEPA) filters or filters of equivalent*

*or superior efficiency and which are checked routinely and*

*maintained or replaced as necessary.*

*(J) Hypodermic needles and syringes shall be used only for*

*parenteral injection and aspiration of fluids from laboratory*

*animals and diaphragm bottles. Only needle-locking syringes or*

*disposable syringe-needle units (i.e., the needle is integral to the*

*syringe) shall be used for the injection or aspiration of other*

*potentially infectious materials. Extreme caution shall be used*

*when handling needles and syringes. A needle shall not be bent,*

*sheared, replaced in the sheath or guard, or removed from the*

*syringe following use. The needle and syringe shall be promptly*

*placed in a puncture- resistant container and autoclaved or*

*decontaminated before reuse or disposal.*

*(K) All spills shall be immediately contained and cleaned up by*

*appropriate professional staff or others properly trained and*

*equipped to work with potentially concentrated infectious*

*materials.*

*(L) A spill or accident that results in an exposure incident shall be*

*immediately reported to the laboratory director or other*

*responsible person.*

*(M) A biosafety manual shall be prepared or adopted and periodically*

*reviewed and updated at least annually or more often if necessary.*

*Personnel shall be advised of potential hazards, shall be required*

*to read instructions on practices and procedures, and shall be*

*required to follow them.*

*(iii) Containment Equipment.*

*(A) Certified biological safety cabinets (Class I, II, or III) or other*

*appropriate combinations of personal protection or physical*

*containment devices, such as special protective clothing, respirators,*

*centrifuge safety cups, sealed centrifuge rotors, and containment*

*caging for animals, shall be used for all activities with other potentially*

*infectious materials that pose a threat of exposure to droplets,*

*splashes, spills, or aerosols.*

*(B) Biological safety cabinets shall be certified when installed,*

*whenever they are moved and at least annually.*

*(3) HIV and HBV research laboratories shall meet the following criteria:*

*(i) Each laboratory shall contain a facility for hand washing and an eye wash*

*facility which is readily available within the work area.*

*(ii) An autoclave for decontamination of regulated waste shall be available.*

*(4) HIV and HBV production facilities shall meet the following criteria:*

*(i) The work areas shall be separated from areas that are open to*

*unrestricted traffic flow within the building. Passage through two sets of*

*doors shall be the basic requirement for entry into the work area from*

*access corridors or other contiguous areas. Physical separation of the*

*high-containment work area from access corridors or other areas or*

*activities may also be provided by a double-doored clothes- change room*

*(showers may be included), airlock, or other access facility that requires*

*passing through two sets of doors before entering the work area.*

*(ii) The surfaces of doors, walls, floors and ceilings in the work area shall be*

*water resistant so that they can be easily cleaned. Penetrations in these*

*surfaces shall be sealed or capable of being sealed to facilitate*

*decontamination.*

*(iii) Each work area shall contain a sink for washing hands and a readily*

*available eye wash facility. The sink shall be foot, elbow, or automatically*

*operated and shall be located near the exit door of the work area.*

*(iv) Access doors to the work area or containment module shall be selfclosing.*

*(v) An autoclave for decontamination of regulated waste shall be available*

*within or as near as possible to the work area.*

*(vi) A ducted exhaust-air ventilation system shall be provided. This system*

*shall create directional airflow that draws air into the work area through*

*the entry area. The exhaust air shall not be re-circulated to any other area*

*of the building, shall be discharged to the outside, and shall be dispersed*

*away from occupied areas and air intakes. The proper direction of the*

*airflow shall be verified (i.e., into the work area).*

*(5) Training Requirements. Additional training requirements for employees in HIV*

*and HBV research laboratories and HIV and HBV production facilities are*

*specified in paragraph (g)(2)(ix).*

*(f) Hepatitis B Vaccination and Post-exposure Evaluation and Follow-up.*

*(1) General.*

*(i) The employer shall make available the hepatitis B vaccine and*

*vaccination series to all employees who have occupational exposure, and*

*post- exposure evaluation and follow-up to all employees who have had*

*an exposure incident.*

*(ii) The employer shall ensure that all medical evaluations and procedures*

*including the hepatitis B vaccine and vaccination series and postexposure*

*evaluation and follow-up, including prophylaxis, are:*

*(A) Made available at no cost to the employee;*

*(B) Made available to the employee at a reasonable time and place;*

*(C) Performed by or under the supervision of a licensed physician or*

*by or under the supervision of another licensed healthcare*

*professional; and*

*(D) Provided according to recommendations of the U.S. Public Health*

*Service current at the time these evaluations and procedures take*

*place, except as specified by this paragraph (f).*

*(iii) The employer shall ensure that all laboratory tests are conducted by an*

*accredited laboratory at no cost to the employee.*

*(2) Hepatitis B Vaccination.*

*(i) Hepatitis B vaccination shall be made available after the employee has*

*received the training required in paragraph (g)(2) (vii)(I) and within 10*

*working days of initial assignment to all employees who have*

*occupational exposure 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.*

*(ii) The employer shall not make participation in a prescreening*

*program a prerequisite for receiving hepatitis B vaccination.*

*(iii) If the employee initially declines hepatitis B vaccination but at a later date*

*while still covered under the standard decides to accept the vaccination,*

*the employer shall make available hepatitis B vaccination at that time.*

*(iv) The employer shall assure that employees who decline to accept hepatitis*

*B vaccination offered by the employer sign the statement in Appendix A.*

*(v) If a routine booster dose(s) of hepatitis B vaccine is recommended by the*

*U.S. Public Health Service at a future date, such booster dose(s) shall be*

*made available in accordance with section (f)(1)(ii).*

*(3) Post-exposure Evaluation and Follow-up. Following a report of an exposure*

*incident, the employer shall make immediately available to the exposed*

*employee a confidential medical evaluation and follow-up, including at least the*

*following elements:*

*(i) Documentation of the route(s) of exposure, and the circumstances under*

*which the exposure incident occurred;*

*(ii) Identification and documentation of the source individual, unless the*

*employer can establish that identification is infeasible or prohibited by*

*state or local law;*

*(A) The source individual's blood shall be tested as soon as feasible*

*and consent is obtained in order to determine HBV and HIV*

*infectivity. If consent is not obtained, the employer shall establish*

*that legally required consent cannot be obtained. When the source*

*individual's consent is not required by law, the source individual's*

*blood, if available, shall be tested and the results documented.*

*(B) When the source individual is already known to be infected with*

*HBV or HIV, testing for the source individual's known HBV or HIV*

*status need not be repeated.*

*(C) Results of the source individual's testing shall be made available*

*to the exposed employee, and the employee shall be informed of*

*applicable laws and regulations concerning disclosure of the*

*identity and infectious status of the source individual.*

*(iii) Collection and testing of blood for HBV and HIV serological status;*

*(A) The exposed employee's blood shall be collected as soon as*

*feasible and tested after consent is obtained.*

*(B) If the employee consents to baseline blood collection, but does*

*not give consent at that time for HIV serologic testing, the sample*

*shall be preserved for at least 90 days. If, within 90 days of the*

*exposure incident, the employee elects to have the baseline*

*sample tested, such testing shall be done as soon as feasible.*

*(iv) Post-exposure prophylaxis, when medically indicated, as recommended*

*by the U.S. Public Health Service;*

*(v) Counseling; and*

*(vi) Evaluation of reported illnesses.*

*(4) Information Provided to the Healthcare Professional.*

*(i) The employer shall ensure that the healthcare professional responsible*

*for the employee's Hepatitis B vaccination is provided a copy of this*

*regulation.*

*(ii) The employer shall ensure that the healthcare professional evaluating an*

*employee after an exposure incident is provided the following information:*

*(A) A copy of this regulation;*

*(B) A description of the exposed employee's duties as they relate to*

*the exposure incident;*

*(C) Documentation of the route(s) of exposure and circumstances*

*under which exposure occurred;*

*(D) Results of the source individual's blood testing, if available; and*

*(E) All medical records relevant to the appropriate treatment of the*

*employee including vaccination status which are the employer's*

*responsibility to maintain.*

*(5) Healthcare Professional's Written Opinion. The employer shall obtain and provide*

*the employee with a copy of the evaluating healthcare professional's written*

*opinion within 15 days of the completion of the evaluation.*

*(i) The healthcare professional's written opinion for Hepatitis B vaccination*

*shall be limited to whether Hepatitis B vaccination is indicated for an*

*employee, and if the employee has received such vaccination.*

*(ii) The healthcare professional's written opinion for post-exposure evaluation*

*and follow-up shall be limited to the following information:*

*(A) That the employee has been in-formed of the results of the*

*evaluation; and*

*(B) That the employee has been told about any medical conditions*

*resulting from exposure to blood or other potentially infectious*

*materials which require further evaluation or treatment.*

*(iii) All other findings or diagnoses shall remain confidential and shall not be*

*included in the written report.*

*(6) Medical Recordkeeping. Medical records required by this standard shall be*

*maintained in accordance with paragraph (h)(1) of this section.*

*(g) Communication of Hazards to Employees.*

*(1) Labels and Signs.*

*(i) Labels.*

*(A) Warning labels shall be affixed to containers of regulated waste,*

*refrigerators and freezers containing blood or other potentially*

*infectious material; and other containers used to store, transport*

*or ship blood or other potentially infectious materials, except as*

*provided in paragraph (g)(1)(i)(E), (F) and (G).*

*(B) Labels required by this section shall include the following*

*legend: BIOHAZARD*

*(C) These labels shall be fluorescent orange or orange-red or*

*predominantly so, with lettering and symbols in a contrasting color.*

*(D) Labels shall be affixed as close as feasible to the container by*

*string, wire, adhesive, or other method that prevents their loss or*

*unintentional removal.*

*(E) Red bags or red containers may be substituted for labels.*

*(F) Containers of blood, blood components, or blood products that are*

*labeled as to their contents and have been released for*

*transfusion or other clinical use are exempted from the labeling*

*requirements of paragraph (g).*

*(G) Individual containers of blood or other potentially infectious*

*materials that are placed in a labeled container during storage,*

*transport, shipment or disposal are exempted from the labeling*

*requirement.*

*(H) Labels required for contaminated equipment shall be in*

*accordance with this paragraph and shall also state which portions*

*of the equipment remain contaminated.*

*(I) Regulated waste that has been decontaminated need not be*

*labeled or color-coded.*

*(ii) Signs.*

*(A) The employer shall post signs at the entrance to work areas*

*specified in paragraph (e), HIV and HBV Research Laboratory and*

*Production Facilities, which shall bear the following legend:*

*BIOHAZARD*

*(Name of the Infectious Agent)*

*(Special requirements for entering the area) (Name,*

*telephone number of the laboratory director or other*

*responsible person.)*

*(B) These signs shall be fluorescent orange-red or predominantly so,*

*with lettering and symbols in a contrasting color.*

*(2) Information and Training.*

*(i) Employers shall ensure that all employees with occupational exposure*

*participate in a training program which must be provided at no cost to the*

*employee and during working hours.*

*(ii) Training shall be provided as follows:*

*(A) At the time of initial assignment to tasks where occupational*

*exposure may take place;*

*(B) Within 90 days after the effective date of the standard; and (C) At*

*least annually thereafter.*

*(iii) For employees who have received training on bloodborne pathogens in*

*the year preceding the effective date of the standard, only training with*

*respect to the provisions of the standard which were not included need be*

*provided.*

*(iv) Annual training for all employees shall be provided within one year of*

*their previous training.*

*(v) Employers shall provide additional training when changes such as*

*modification of tasks or procedures or institution of new tasks or*

*procedures affect the employee's occupational exposure. The additional*

*training may be limited to addressing the new exposures created.*

*(vi) Material appropriate in content and vocabulary to educational level,*

*literacy, and language of employees shall be used.*

*(vii) The training program shall contain at a minimum the following elements:*

*(A) An accessible copy of the regulatory text of this standard and an*

*explanation of its contents;*

*(B) A general explanation of the epidemiology and symptoms of*

*bloodborne diseases;*

*(C) An explanation of the modes of transmission of bloodborne*

*pathogens;*

*(D) An explanation of the employer's exposure control plan and the*

*means by which the employee can obtain a copy of the written*

*plan;*

*(E) An explanation of the appropriate methods for recognizing tasks*

*and other activities that may involve exposure to blood and other*

*potentially infectious materials;*

*(F) An explanation of the use and limitations of methods that will*

*prevent or reduce exposure including appropriate engineering*

*controls, work practices, and personal protective equipment;*

*(G) Information on the types, proper use, location, removal, handling,*

*decontamination and disposal of personal protective equipment;*

*(H) An explanation of the basis for selection of personal protective*

*equipment;*

*(I) Information on the hepatitis B vaccine, including information on its*

*efficacy, safety, method of administration, the benefits of being*

*vaccinated, and that the vaccine and vaccination will be offered*

*free of charge;*

*(J) Information on the appropriate actions to take and persons to*

*contact in an emergency involving blood or other potentially*

*infectious materials;*

*(K) An explanation of the procedure to follow if an exposure incident*

*occurs, including the method of reporting the incident and the*

*medical follow-up that will be made available;*

*(L) Information on the post-exposure evaluation and follow-up that the*

*employer is required to provide for the employee following an*

*exposure incident;*

*(M) An explanation of the signs and labels and/or color coding*

*required by paragraph (g)(1); and*

*(N) An opportunity for interactive questions and answers with the*

*person conducting the training session.*

*(viii) The person conducting the training shall be knowledgeable in the subject*

*matter covered by the elements contained in the training program as it*

*relates to the work-place that the training will address.*

*(ix) Additional Initial Training for Employees in HIV and HBV Laboratories and*

*Production Facilities. Employees in HIV or HBV research laboratories and*

*HIV or HBV production facilities shall receive the following initial training*

*in addition to the above training requirements.*

*(A) The employer shall assure that employees demonstrate*

*proficiency in standard microbiological practices and techniques*

*and in the practices and operations specific to the facility before*

*being allowed to work with HIV or HBV.*

*(B) The employer shall assure that employees have prior experience*

*in the handling of human pathogens or tissue cultures before*

*working with HIV or HBV.*

*(C) The employer shall provide a training program to employees who*

*have no prior experience in handling human pathogens. Initial*

*work activities shall not include the handling of infectious agents. A*

*progression of work activities shall be assigned as techniques are*

*learned and proficiency is developed. The employer shall assure*

*that employees participate in work activities involving infectious*

*agents only after proficiency has been demonstrated.*

*(h) Recordkeeping.*

*(1) Medical Records.*

*(i) The employer shall establish and maintain an accurate record for each*

*employee with occupational exposure, in accordance with 29 CFR*

*1910.1020.*

*(ii) This record shall include:*

*(A) The name and social security number of the employee;*

*(B) A copy of the employee's hepatitis B vaccination status including*

*the dates of all the hepatitis B vaccinations and any medical*

*records relative to the employee's ability to receive vaccination as*

*required by paragraph (f)(2);*

*(C) A copy of all results of examinations, medical testing, and followup*

*procedures as required by paragraph (f)(3);*

*(D) The employer's copy of the healthcare professional's written*

*opinion as required by paragraph (f)(5); and*

*(E) A copy of the information provided to the healthcare professional*

*as required by paragraphs (f)(4)(ii)(B)(C) and (D).*

*(iii) Confidentiality. The employer shall ensure that employee medical records*

*required by paragraph (h)(1) are:*

*(A) Kept confidential; and*

*(B) Not disclosed or reported without the employee's express written*

*consent to any person within or outside the workplace except as*

*required by this section or as may be required by law.*

*(iv) The employer shall maintain the records required by paragraph (h) for at*

*least the duration of employment plus 30 years in accordance with 29*

*CFR 1910.1020.*

*(2) Training Records.*

*(i) Training records shall include the following information:*

*(A) The dates of the training sessions;*

*(B) The contents or a summary of the training sessions;*

*(C) The names and qualifications of persons conducting the training;*

*and*

*(D) The names and job titles of all persons attending the training*

*sessions.*

*(ii) Training records shall be maintained for 3 years from the date on which*

*the training occurred.*

*(3) Availability.*

*(i) The employer shall ensure that all records required to be maintained by*

*this section shall be made available upon request to the Assistant*

*Secretary and the Director for examination and copying.*

*(ii) Employee training records required by this paragraph shall be provided*

*upon request for examination and copying to employees, to employee*

*representatives, to the Director, and to the Assistant Secretary.*

*(iii) Employee medical records required by this paragraph shall be provided*

*upon request for examination and copying to the subject employee, to*

*anyone having written consent of the subject employee, to the Director,*

*and to the Assistant Secretary in accordance with 29 CFR 1910.1020.*

*(4) Transfer of Records.*

*(i) The employer shall comply with the requirements involving transfer of*

*records set forth in 29 CFR 1910.1020(h).*

*(ii) If the employer ceases to do business and there is no successor*

*employer to receive and retain the records for the prescribed period, the*

*employer shall notify the Director, at least three months prior to their*

*disposal and transmit them to the Director, if required by the Director to*

*do so, within that three-month period.*

*(i) Dates.*

*(1) Effective Date. The standard shall become effective on March 6, 1992.*

*(2) The Exposure Control Plan required by paragraph (c) of this section shall be*

*completed on or before May 5, 1992.*

*(3) Paragraph (g)(2) Information and Training and (h) Recordkeeping shall take*

*effect on or before June 4, 1992.*

*(4) Paragraphs (d)(2) Engineering and Work Practice Controls, (d)(3) Personal*

*Protective Equipment, (d)(4) Housekeeping, (e) HIV and HBV Research*

*Laboratories and Production Facilities, (f) Hepatitis B Vaccination and Post-*

*Exposure Evaluation and Follow-up, and (g)(1) Labels and Signs, shall take*

*effect July 6, 1992.*

*\[56 FR 64004, Dec. 06, 1991, as amended at 57 FR 12717, April 13, 1992; 57 FR*

*29206, July 1, 1992; 61 FR 5507, Feb. 13, 1996\]*

#### *APPENDIX C*

##### *American Nurses Association Code of Ethics*

*Provision 1 The nurse practices with compassion and respect for the inherent dignity, worth, and*

*unique attributes of every person.*

*Provision 2 The nurse’s primary commitment is to the patient, whether an individual, family,*

*group, community, or population.*

*Provision 3 The nurse promotes, advocates for, and protects the rights, health, and safety of the*

*patient.*

*Provision 4 The nurse has authority, accountability and responsibility for nursing practice; makes*

*decisions; and takes action consistent with the obligation to provide optimal patient care.*

*Provision 5 The nurse owes the same duties to self as to others, including the responsibility to*

*promote health and safety, preserve wholeness of character and integrity, maintain competence,*

*and continue personal and professional growth.*

*Provision 6 The nurse, through individual and collective effort, establishes, maintains, and*

*improves the ethical environment of the work setting and conditions of employment that are*

*conducive to safe, quality health care.*

*Provision 7 The nurse, in all roles and settings, advances the profession through research and*

*scholarly inquiry, professional standards development, and the generation of both nursing and*

*health policy.*

*Provision 8 The nurse collaborates with other health professionals and the public to protect*

*human rights, promote health diplomacy, and reduce health disparities.*

*Provision 9 The profession of nursing, collectively through its professional organizations, must*

*articulate nursing values, maintain the integrity of the profession, and integrate principles of*

*social justice into nursing and health policy.*

#### ***ARKANSAS STATE UNIVERSITY***

#### ***COLLEGE OF NURSING AND HEALTH PROFESSIONS***

#### ***APPENDIX D***

##### *STUDENT RECORD PROCEDURE*

*Family Educational Rights and Privacy Act of 1974 (Buckley Amendment) Arkansas State*

*University School of Nursing publishes the following procedures in accordance with the Family*

*Education Rights and Privacy Act of 1974 (FERPA).*

##### *DEFINITIONS*

*For the purpose of this document, the department has used the following definitions of terms.*

*1. Student- any person formally admitted and attends or has attended Arkansas State*

*University nursing program*

*2. Educational records- any record (in handwriting, print, tapes, film or other medium)*

*maintained by the department which is directly related to a student, except:*

*a. A personal record kept by a faculty or staff if it is kept in the sole possession of*

*the maker of the record and is not accessible or revealed to any other person*

*except a temporary substitute for the maker of the record.*

##### *PROCEDURE TO INSPECT EDUCATION RECORDS*

*Students may inspect and review their education records upon request to the Department Chair.*

*Students should submit to the Department Chair a written request, which identifies as precisely*

*as possible the information he or she wishes to inspect. The Department Chair will need to*

*make the needed arrangements for access as promptly as possible and notify the student of the*

*time and place where the records may be inspected.*

##### *RIGHT OF THE UNIVERSITY TO REFUSE ACCESS*

*The department reserves the right to refuse to permit a student to inspect the following records:*

*I. Letters and statements of recommendation for which the student has waived his or her*

*right of access, or which were placed on file before January 1, 1975.*

*II. Those records which are excluded from the FERPA definition of education records.*

##### *REFUSAL TO PROVIDE COPIES*

*The department reserves the right to refuse copies of the records in any of the following*

*situations:*

*I. The student has unpaid financial obligation to Arkansas State University*

*II. The student has not paid for the copying expenses.*

##### *TYPES, LOCATIONS AND CUSTODIANS OF EDUCATION RECORDS*

*The following is a list of the types of records that the university maintains, their locations and*

*their custodians.*

*Types/Location/Custodian*

*• Admission Records/Admissions Office/Director of Admissions*

*• Cumulative Academic Records/Registrar’s Office/Custodian of Records (Current*

*students and five years after graduation or withdrawal)*

*• Cumulative Academic Records/Registrar’s Office/Custodian of Records (Former*

*students; over five years after graduation or withdrawal)*

*• Health Records/Wilson Student Health Center/Student Health Center Director*

*• Financial Records/Student Account Services/Administration, Office of Finance/Student*

##### *Account Advisor*

*• Placement Records/Career Services Center/Director of Career Services*

*• Disciplinary Records/ Student Life/ Assistant Dean of Students for Judicial Affairs*

*(Student education records not included in the types above such as minutes of faculty*

*committee meetings, copies of correspondence from other offices, etc.)*

##### *DISCLOSURE OF EDUCATION RECORDS*

*The department will disclose information from a student’s education records only with the written*

*consent of the student, except:*

*I. To school officials who have a legitimate educational interest in the records. A school*

*official is:*

*a. A person employed by the university in an administrative supervisory, academic*

*or research, or support staff position.*

*b. A person employed by or under contract to the university to perform a special*

*task, such as the attorney or auditor.*

*c. Performing a task that is specified in his/her position description or by a contract*

*agreement.*

*d. Performing a task related to a student’s education.*

*e. Performing a task related to the discipline of a student.*

*II. To officials of another school, upon request, in which a student seeks or intends to enroll.*

*III. To certain officials of the U.S. Department of Education, the Comptroller General, and*

*state and local educational authorities, in connection with certain state or federally*

*supported education programs.*

*IV. To appropriate parties in connection with a student’s request for or receipt of financial*

*aid, as necessary to determine the eligibility, amount or conditions of the financial aid, or*

*to enforce the terms and conditions of the aid.*

*V. To appropriate parties required by a state law requiring disclosure that was adopted*

*before November 19, 1974.*

*VI. To organizations conducting certain studies for or on behalf of the university.*

*VII. To accrediting organizations to carry out their functions.*

*VIII. To comply with a judicial order or a lawfully issued subpoena.*

*IX. To appropriate parties in a health or safety emergency.*

*X. To an alleged victim of any crime of violence of the results of any institutional disciplinary*

*proceeding against the alleged perpetrator of that crime.*

*RECORDS OF REQUEST FOR DISCLOSURE*

*The department will maintain a record of all requests for and /or disclosure of information from a*

*student’s education records. The record will indicate the name of the party making the request,*

*any additional party to whom it may be re-disclosed, and the legitimate interest the party had in*

*requesting or obtaining the information. The record may be reviewed by the parents or eligible*

*student.*

##### *DIRECTORY INFORMATION*

*The department designates the following items as Directory Information: student name,*

*address, telephone number, class/semester, date and place of birth, major field of study,*

*participation in officially recognized activities and sports, weight and height of members of*

*athletic teams, dates of attendance, part/full-time enrollment, degrees and awards received, and*

*most recent previous school attended. The department may disclose any of those items without*

*prior written consent, unless notified in writing to the contrary.*

*CORRECTION OF EDUCATION RECORDS*

*Students have the right to ask to have records corrected when they believe these records are*

*inaccurate, misleading, or in violation of their privacy rights. Following are the procedures for the*

*correction of records:*

*I. A student must ask the department to amend a record. In so doing, the student should*

*identify the part of the record he/she wants changed and specify why he/she believes it*

*is inaccurate, misleading, or in violation of his/her privacy or other rights.*

*II. The department may comply with the request or it may decide not to comply. If it decides*

*not to comply, the department will notify the student of the decision and advise him/her*

*of his/her right to grieve the record believed to be inaccurate, misleading, or in violation*

*of the student’s rights. The department will inform the student to follow the student*

*grievance procedure found in the student handbook.*

*III. If the department decides that the challenged information is not inaccurate, misleading,*

*or in violation of the student’s right of privacy, it will notify the student that he/she has a*

*right to place in the record a statement commenting on the challenged information and*

*/or a statement setting forth reasons for disagreeing with the decision*

*IV. The statement will be maintained as part of the student’s education records as long as*

*the contested portion is maintained. If the department discloses the contested portion of*

*the record, it must also disclose the statement.*

*V. If the department decides that the information is inaccurate, misleading, or in violation of*

*the student’s right to privacy, it will amend the record and notify the student, in writing,*

*that the record has been amended.*

#### ***ARKANSAS STATE UNIVERSITY***

#### ***COLLEGE OF NURSING AND HEALTH PROFESSIONS***

#### ***APPENDIX E***

#### ***COMPUTER LITERACY AND COMPETENCIES***

*Graduate study in the Master of Science in Nursing /Doctor of Nursing Practice Program at*

*Arkansas State University requires a certain level of computer literacy. Courses in the MSN /*

*DNP (graduate) programs may be web-based or web-enhanced. Course work may include*

*internet assignments.*

*Student must be able to use word processing as well as perform other computer skills. The*

*following competencies are needed:*

*1. Send and Receive electronic mail including attachments*

*2. Use cut and paste to move between files, websites, and documents*

*3. Participation in a professional listserv.*

*4. Search the Internet for sources of health information that might be used by professionals*

*or consumers.*

*5. Evaluate web sites for credibility and usefulness.*

*6. Write a paper with proper formatting including references. Attach paper as a file and*

*send via electronic mail. Paper should retain correct formatting. \**

*7. Upload and download files.*

*8. Print from the computer.*

*9. Use a modem (or other connection to the Internet).*

#### ***ARKANSAS STATE UNIVERSITY***

#### ***COLLEGE OF NURSING AND HEALTH PROFESSIONS***

#### ***APPENDIX F***

#### ***Arkansas State University School of Nursing***

#### ***Verified Credentials, Inc.***

*CNHP students:*

*Arkansas State University College of Nursing and Health Professions now requires background*

*checks for students admitted to professional programs if the screening is required by an affiliate*

*requirement. This is to ensure compliance with agreements between the College and Clinical*

*Facilities. Arkansas State University’s College of Nursing and Health Professions has worked*

*with Verified Credentials, Inc. to establish an acceptable screening procedure. New students*

*should use the link and code found on the letter provided. If after reviewing these instructions*

*you continue to have questions or experience difficulty, please contact the Verified Credentials*

*Client Services team at clientservices@verifiedcredentials.com or 1.800.938.6090. \*\*If you*

*already have a QualifiedFirst (QF) account and need to use an additional code, log into your QF*

*account and enter the code where is says “Have a code” and click Go. If you forgot your*

*password, click Forgot Password? at the login page and follow the instructions. Contact Client*

*Services if you need further assistance.*

*Please follow the directions below for submitting your application to Verified Credentials:*

*• Go to www.myvci.com/asu*

*• Select A-State- CNHP from the drop-down menu.*

*• Complete and sign disclosure.*

*• Complete information page.*

*• Step 3 allows payment by credit card or bank transfer. Make selection and place order.*

*Upon completion, the results of the background screening will be sent to you via email that will*

*apprise you of the findings as well as your final score of:*

*• Red—Convictions or Discrepancy found*

*• Yellow—Possible Discrepancy found*

*• Green—No Convictions or Discrepancies found*

*If any information is found that would negatively affect your eligibility for clinical placement in the*

*Program, you will be given an opportunity to challenge the information through the Adverse*

*Action process associated with Verified Credentials. If you have any questions, please contact*

#### ***Verified Credentials Client Services at 800.938.6090.122***

#### ***ARKANSAS STATE UNIVERSITY***

#### ***COLLEGE OF NURSING AND HEALTH PROFESSIONS***

#### ***APPENDIX G***

#### ***Arkansas State Board of Nursing***

##### *Nurse Practice Act*

##### *17-87-312. Criminal Background Checks.*

*a) Each first-time applicant for a license issued by the Arkansas State Board of Nursing*

*shall apply to the Identification Bureau of the Department of Arkansas State Police for a*

*state and national criminal background check, to be conducted by the Federal Bureau of*

*Investigation.*

*b) The check shall conform to the applicable federal standards and shall include the taking*

*of fingerprints.*

*c) The applicant shall sign a release of information to the board and shall be responsible to*

*the Department of Arkansas State Police for the payment of any fee associated with the*

*criminal background check.*

*d) Upon completion of the criminal background check, the Identification Bureau of the*

*Department of Arkansas State Police shall forward to the board all information obtained*

*concerning the applicant in the commission of any offense listed in subsection of this*

*section.*

*e) have or hold a license issued by the board if that person has pleaded guilty or nolo*

*contendere to, or been found guilty of any of the following offenses by any court in the*

*State of Arkansas or of any similar offense by a court in another state or of any similar*

*offense by a federal court:*

*1) Capital murder as prohibited in § 5-10-101;*

*2) Murder in the first degree as prohibited in § 5-10-102 and murder in the second*

*degree as prohibited in § 5-10-103;*

*3) Manslaughter as prohibited in § 5-10-104;*

*4) Negligent homicide as prohibited in § 5-10-105;*

*5) Kidnapping as prohibited in § 5-11-102;*

*6) False imprisonment in the first degree as prohibited in § 5-11-103;*

*7) Permanent detention or restraint as prohibited in § 5-11-106;*

*8) Robbery as prohibited in § 5-12-102;*

*9) Aggravated robbery as prohibited in § 5-12-103;*

*10) Battery in the first degree as prohibited in § 5-13-201;*

*11) Aggravated assault as prohibited in § 5-13-204;123*

*12) Introduction of controlled substance into the body of another person as prohibited*

*in §5-13-210;*

*13) Terroristic threatening in the first degree as prohibited in § 5-13-301;*

*14) Rape as prohibited in §§ 5-14-103;*

*15) Sexual indecency with a child as prohibited in § 5-14-110;*

*16) Sexual assault in the first degree, second degree, third degree, and fourth*

*degree as prohibited in §§ 5-14-124 – 5-14-127;*

*17) Incest as prohibited in § 5-26-202;*

*18) Offenses against the family as prohibited in §§ 5-26-303 - 5-26-306;*

*19) Endangering the welfare of an incompetent person in the first degree as*

*prohibited in § 5-27-201;*

*20) Endangering the welfare of a minor in the first degree as prohibited in § 5- 27-*

*203;*

*21) Permitting abuse of a child as prohibited in § 5-27-221(a)(1) and (3);*

*Engaging children in sexually explicit conduct for use in visual or print media,*

*transportation of minors for prohibited sexual conduct, pandering or possessing*

*visual or print medium depicting sexually explicit conduct involving a child, or use*

*of a child or consent to use of a child in a sexual performance by producing,*

*directing, or promoting a sexual performance by a child as prohibited in §§ 5-27-*

*303 - 5-27-305, 5-27-402, and 5-27-403;*

*22) Felony adult abuse as prohibited in § 5-28-103;*

*23) Theft of property as prohibited in § 5-36-103;*

*24) Theft by receiving as prohibited in § 5-36-106;*

*25) Arson as prohibited in § 5-38-301;*

*26) Burglary as prohibited in § 5-39-201;*

*27) Felony violation of the Uniform Controlled Substances Act §§ 5-64-101 – 5- 64-*

*608 as prohibited in § 5-64-401;*

*28) Promotion of prostitution in the first degree as prohibited in § 5-70-104;*

*29) Stalking as prohibited in § 5-71-229;*

*30) Criminal attempt, criminal complicity, criminal solicitation, or criminal conspiracy*

*as prohibited 124 in §§ 5-3-201, 5-3-202, 5-3-301, and 5-3-401, to commit any of*

*the offenses listed in this subsection;*

*31) Computer child pornography as prohibited in § 5-27-603; and*

*32) Computer exploitation of a child in the first degree as prohibited in § 5-27- 605.*

*f) (1) (A) The board may issue a nonrenewable temporary permit for licensure to a*

*first-time applicant pending the results of the criminal background check*

*(B) The permit shall be valid for no more than six (6) months.*

*(2) Except as provided in subdivision (l) (1) of this section, upon receipt of information*

*from the Identification Bureau of the Department of Arkansas State Police that the*

*person holding the letter of provisional licensure has pleaded guilty or nolo contendere*

*to, or has been found guilty of, any offense listed in subsection (e) of this section, the*

*board shall immediately evoke the provisional license.*

*g) (1) The provisions of subsections (e) and subdivision (f) (2) of this section may be*

*waived by the board upon the request of:*

*(A) An affected applicant for licensure; or*

*(B) The person holding a license subject to revocation.*

*(2) Circumstances for which a waiver may be granted shall include, but not be*

*limited to, the following:*

*(A) The age at which the crime was committed*

*(B) The circumstances surrounding the crime;*

*(C) The length of time since the crime;*

*(D) Subsequent work history;*

*(E) Employment references;*

*(F) Character references; and*

*(G) Other evidence demonstrating that the applicant does not pose a threat to the*

*health or safety of the public.*

*h) (1) Any information received by the board from the Identification Bureau of the*

*Department of Arkansas State Police pursuant to this section shall not be available for*

*examination except by:*

*(A) The affected applicant for licensure, or his authorized representative; or*

*(B) The person whose license is subject to revocation or his or her authorized*

*representative.*

*(2) No record, file, or document shall be removed from the custody of the Department of*

*Arkansas State Police.*

*i) Any information made available to the affected applicant for licensure or the person*

*whose license is subject to revocation shall be information pertaining to that person only.*

*j) Rights of privilege and confidentiality established in this section shall not extend to any*

*document created for purposes other than this background check.*

*k) The board shall adopt the necessary rules and regulations to fully implement the*

*provisions of this section.*

*l) (1) For purposes of this section, an expunged record of a conviction or a plea of guilty or*

*nolo contendere to an offense listed in subsection (e) of this section shall not be*

*considered a conviction, guilty plea, or nolo contendere plea to the offense unless the*

*offense is also listed in subdivision (l)(2) of this section.*

*(2) Because of the serious nature of the offenses and the close relationship to the type*

*of work that is to be performed, the following shall result in permanent disqualification:*

*(A) Capital murder as prohibited in § 5-10-101;*

*(B) Murder in the first degree as prohibited in § 5-10-102 and murder in*

*the second degree as prohibited in § 5-10-103;*

*(C) Kidnapping as prohibited in § 5-11-102;*

*(D) Rape as prohibited in § 5-14-103;*

*(E) Sexual assault in the first degree as prohibited in § 5-14-124 and*

*sexual assault in the second degree as prohibited in § 5-14-125;*

*(F) Endangering the welfare of a minor in the first degree as prohibited in*

*§ 5-27- 203 and endangering the welfare of a minor in the second*

*degree as prohibited in § 5-27-204;*

*(G) Incest as prohibited in § 5-26-202*

*(H) Arson as prohibited in § 5-38-301;*

*(I) Endangering the welfare of incompetent person in the first degree as*

*prohibited in § 5-27-201; and*

*(J) Adult abuse that constitutes a felony as prohibited in § 5-28-103.*

#### ***ARKANSAS STATE UNIVERSITY***

#### ***COLLEGE OF NURSING AND HEALTH PROFESSIONS***

#### ***APPENDIX H***

##### ***Provider Statement/Ability to Return to Clinical***

*Student:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

*The above student is enrolled in the A-State-Graduate nursing program. Program requirements*

*include participation in a variety of clinical settings and providing direct care to patients of*

*various age ranges.*

*In order to participate in or return to clinical the following Essential Functions must be present.*

*Visual ability*

*• Read for prolonged· periods of time either hardcopy or on computer screen • Visualize*

*small font (6 font) written words and information on paper, computer screen and*

*medication labels*

*• Distinguish and appropriately respond to multiple visual inputs • Prepare and administer*

*medications including correct use of small calibrated syringes (1/2 cc), ampules etc.*

*• Monitor and assess subtle changes in patient status (ex: signs/symptoms, drainage,*

*wound color/appearance, wound depth, cyanosis etc.) Auditory ability*

*• Hear monitor alarm(s), emergency signals, ringing telephones, telephone interactions,*

*calls for assistance*

*• Respond and react immediately to spoken instruction and/or monitor equipment*

*• Tolerate occasional exposure to loud and unpleasant noises*

*• Distinguish changes in tone and pitch in heart, lung, and bowel sounds using a*

*stethoscope or modified stethoscope*

*• Distinguish sounds and understand verbal communication in environments with multiple*

*auditory inputs Olfactory ability*

*• Ability to detect smoke and odors*

*• Ability to tolerate occasional unpleasant odors*

*Tactile ability*

*• Palpate for pulses, temperature, texture hardness or softness, physical landmarks etc.*

*• Discriminate subtle differences between sharp/dull and hot/cold Motor function ability*

*• Handle small delicate equipment/objects or hand-held devices without extraneous*

*movement, contamination or destruction*

*• Move, position, tum, transfer, assist with lifting or lift and carry adult patients without*

*injury to patient, self, or others*

*• Lift, push, pull or transfer (bed-to-chair, chair-to-chair, bed-to-bed) an adult or pediatric*

*patient*

*• Use hands, wrists, and arms to apply up to 10 pounds of pressure to bleeding sites or*

*when performing CPR*

*• Coordinate eye/hand, fine and gross motor movements • Perform electronic*

*keyboarding/documentation and/or extensive writing with a pen and/or pencil*

*• Stand, bend, walk, stoop, squat while providing patient care Communication abilities*

*• Effectively read, write, comprehend, and speak the English language*

*• Communicate relevant, accurate, and complete information in a concise and clear*

*manner both verbally and in writing to patients and health care members\\*

*• Communicate and function effectively in environments with multiple auditory and visual*

*inputs*

*Cognitive abilities*

*• Perform mathematical calculations accurately for medication preparation and*

*administration*

*• Make appropriate rapid decisions in stressful or emergency situations*

*• Manage multiple priorities and function effectively in stressful situations*

*• Remember multiple messages and information*

*• Adapt rapidly to environmental changes and multiple task demands*

*• Maintain concentration and focus in professional care settings*

*My signature indicates that the above student/patient has no activity restrictions and is able to*

*perform all of the above and may return to clinical practice on the following*

*Date:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

*Printed Name of Provider:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

*Provider’s Signature:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

*Office Telephone Number:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

#### ***ARKANSAS STATE UNIVERSITY***

#### ***COLLEGE OF NURSING AND HEALTH PROFESSIONS***

#### ***APPENDIX I***

#### ***COVID-19***

*The Graduate Nursing programs/options will follow national/state/local directives relevant to the*

*Covid- 19 pandemic. Please refer to your individual program and or instructors for specific*

*information each semester*