R 325.70013 Vaccinations and postexposure follow-up.

Rule 13. (1) An employer shall assure that all medical evaluations are procedures that are performed by or under the supervision of a licensed physician or other licensed health care professional and that all laboratory tests are conducted by an accredited laboratory. (2) An employer shall assure that all evaluations, procedures, vaccinations, and postexposure prophylaxes are provided without cost to the employee, at a reasonable time and place, and according to current recommendations of the United States public health service, unless in conflict with this rule. (3) An employer shall assure that all employees will receive appropriate counseling with regard to medical risks and benefits before undergoing any evaluations, procedures, vaccinations, or postexposure prophylaxes. (4) Within 10 working days of the time of initial assignment and after the employee has received training required by R 325.70016(5)(i), an employer shall make all of the following available to each category A employee: (a) A hepatitis B vaccination. If an employee initially declines vaccination, but at a later date, while still covered under these rules, decides to accept the HBV vaccine, the employer shall provide the vaccine at that time. If a booster dose or doses are recommended by the United States public health service at a future date, the booster dose or doses shall be made available. (b) If an employee has previously received the complete HBV vaccination series, is found to be immune to HBV by virtue of adequate antibody titer, or the vaccine is contraindicated for medical reasons, then the employer is not required to offer the HBV vaccine to that employee. (c) An employer shall not make participation in a prescreening program a prerequisite for receiving hepatitis B vaccination. (d) An employer shall assure that an employee who declines to accept hepatitis B vaccination signs a waiver statement with all of the following provisions: (i) Understanding of risk. (ii) Acknowledgment of opportunity of vaccination at no cost. (iii) Declining vaccination. (iv) Future availability of vaccination at no cost if desired, if still in at-risk status. See appendix B for a sample of an acceptable waiver statement. (5) An employer shall provide each exposed employee with an opportunity to have a confidential medical evaluation and follow-up subsequent to a reported occupational exposure incident to blood or other potentially infectious material. The evaluation and follow-up shall include, at a minimum, all of the following elements: (a) Documentation of the route or routes of exposure and the circumstances under which the exposure incident occurred. (b) Identification and documentation of the source individual, unless the employer can establish that identification is infeasible or prohibited by state or local law, shall include all of the following: (i) The source individual’s blood shall be tested as soon as feasible and after consent is obtained to determine HBV and HIV infectivity. If consent is not obtained, the employer shall establish that legally required consent cannot be obtained. If the source individual’s consent is not required by law, his or her blood, if available, shall be tested and the results documented. (ii) If the source individual is already known to be infected with HBV or HIV, testing need not be repeated. (iii) 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. (c) Collection and testing of blood or HBV and HIV serological status shall include both of the following: (i) The exposed employee’s blood shall be collected as soon as feasible and tested after consent is obtained. (ii) If the exposed employee consents to baseline blood collection, but not to HIV testing at that time, the sample shall be preserved for not less than 90 days. If within the 90 days the employee elects to have the baseline sample tested, such testing shall be done as soon as feasible. (d) Postexposure prophylaxis, when medically indicated, as recommended by the United States public health service. (e) Counseling on risk reduction and the risks and benefits of HIV testing in accordance with state law. (f) Evaluation of reported illnesses. (6) An employer shall ensure that the health care professional who is responsible for the hepatitis B Vaccination is provided with a copy of these rules and appendices. An employer shall ensure that the health care professional who evaluates an employee after an exposure incident is provided with all of the following information: (a) A description of the affected employee’s duties as they relate to the employee’s exposure incident. (b) Documentation of the route or routes of exposure and the circumstances under which exposure occurred. (c) Results of the source individual’s blood testing, if available. (d) All medical records that are relevant to the appropriate treatment of the employee, including vaccination status, and that are the employer’s responsibility to maintain. (7) For each evaluation pursuant to the provisions of this rule, an employer shall obtain, and provide an employee with a copy of, the evaluating health care professional’s written opinion within 15 working days of the completion of the evaluation. The written opinion shall be limited to the following information: (a) Whether hepatitis B vaccination is indicated for an employee and if the employee has received such vaccination. (b) A statement that the employee has been informed of the results of the medical evaluation and that the employee has been told about any medical conditions that have resulted from exposure to blood or other potentially infectious material and that require further evaluation or treatment. The written opinion obtained by the employer shall not reveal specific findings or diagnoses that are unrelated to the employee’s ability to wear protective clothing and equipment or receive vaccinations. Such findings and diagnoses shall remain confidential. (8) Medical records that are required by these rules shall be maintained in accordance with R 325.70015.