Enclosure (2) to COMDTINST 6220.9A
3. Environmental Controls. The second line of defense in TB control is the use of environmental
controls to prevent the spread and reduce the concentration of infectious droplet nuclei in the air.
Primary environmental controls include: local exhaust ventilation and general ventilation.
Secondary environmental controls include: isolation rooms, high efficiency particulate air (HEPA)
filtration, and/or ultraviolet lights. Appropriate environmental controls are difficult to achieve in a
maritime environment; however, whenever possible, the aforementioned environmental controls
should be utilized.
4. Respiratory Protection Controls. The third level of protection is respiratory protection. The
majority of situations involving boardings, inspections or contact with alien migrants do not require
respiratory protection (e.g., N-95 respirators). For most Coast Guard personnel, contact with alien
migrants is brief and/or occurs in an open-air environment. Factors that should be considered when
recommending the use of N-95 respirators include:
a) Prolonged face-to-face contact with one or more alien migrants known or suspected of having
active TB disease (e.g., excessive coughing and/or coughing up blood); and
b) Exposure to one or more alien migrants known or suspected of having active TB disease (e.g.,
excessive coughing and/or coughing up blood) in a confined environment (e.g., vessel hold)
rather than in an open area (e.g., weather decks). Reference (e) provides additional guidance on
the use of respiratory protective devices.
5. Sources of Additional Resources. Commander, MLC(k), Commandant (CG-113), and Commandant
(CG-1121) can be contacted regarding TB prevention and control.
D. Bloodborne Pathogens.
1. Overview. Blood or other potentially infected material (OPIM) (e.g., semen, vaginal secretions,
cerebrospinal fluid, any body fluid contaminated with blood) can be potential sources of bloodborne
pathogens (e.g., Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Human Immunodeficiency
Virus (HIV)). Bloodborne pathogen exposure can occur through contact of the eye, nose, mouth or
non-intact skin with an infected person's blood or OPIM. In particular, personnel engaged in
boardings, inspections and AMIO may be involved in circumstances that expose them to blood (e.g.,
needle sticks, bite wounds, sexual contact). However, most exposures to bloodborne pathogens do
not result in infection. Prevention and control of bloodborne pathogens are discussed in detail in
reference (b).
2. Risk Factors. Personnel at risk for exposure to bloodborne pathogens are those engaged in activities
that involve contact with human blood and OPIM (e.g., health care, emergency service and public-
safety workers).
a) The probability of disease transmission is related to the pathogen involved, the type of exposure,
the amount of blood involved in the exposure and the amount of virus in the infected person's
blood / OPIM at the time of the exposure. Individuals are at greater risk of contracting a disease
if they do not wear appropriate PPE (e.g., masks, gloves and/or eye shields).
b) Coast Guard personnel engaged in boardings, inspections and AMIO who are at greatest risk for
exposure to bloodborne pathogens are health services personnel and emergency medical
technicians (EMTs). Other personnel ( e.g., boarding crews) may be in situations where there is
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