Occupational Hazards in Home Health Care. Blood Borne Pathogens

Transcription

1 Occupatinal Hazards in Hme Health Care Bld Brne Pathgens Healthcare persnnel are at risk fr ccupatinal expsure t bldbrne pathgens, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immundeficiency virus (HIV). Expsures ccur thrugh needlesticks r cuts frm ther sharp instruments cntaminated with an infected patient's bld r thrugh cntact f the eye, nse, muth, r skin with a patient's bld. Cmmn safety and health tpics Expsure Cntrl Plan Pst Expsure Fllw-up Recrdkeeping fr Bldbrne Pathgens Needle Stick Injuries Other Sharps Universal Precautins Persnal Prtective Equipment Latex Allergy HBV, HIV, and HCV Slips/Trips/Falls This tl is used t help develp a cmprehensive health and safety prgram. Within this tl are links that will lead t resurces which will require internet cnnectivity fr yu t view them. The Care West Team has captured key elements in which we believe are pertinent t develping a successful health and safety prgram.

2 Bld Brne Pathgens Standard Ptential Hazard: Pssible Emplyee Expsure t bld and OPIM because f an ineffective Expsure Cntrl Plan (ECP). Pssible Slutins: Prvide an effective ECP and training as required by the Bldbrne Pathgens Standard. Each emplyer must: As mandated by the Needle Stick Safety and Preventin Act, OSHA has revised its Bldbrne Pathgens Standard , effective date April 18, The Revised Expsure Cntrl Plan requirements make clear that emplyers must implement the safer medical devices that are apprpriate, cmmercially available, and effective, and get input frm thse respnsible fr direct patient care in [(c)(1)(v)]. The updated standard als requires emplyers t maintain a lg f injuries frm cntaminated sharps. Identify emplyees wh have ccupatinal expsure t bld r OPIM, and then establish and implement a written Expsure Cntrl Plan (ECP), designed t eliminate r minimize emplyee expsure. Identify emplyees wh have ccupatinal expsure t bld r, and then establish and implement a written Expsure Cntrl Plan (ECP), designed t eliminate r minimize emplyee expsure. The ECP must be made available t all emplyees and be reviewed and updated at least yearly. Ensure that emplyees with ccupatinal expsure t bldbrne pathgens receive apprpriate training at n cst t emplyees, and during wrking hurs. Training requirements are listed in. The revised Expsure Cntrl Plan requirements include: Emplyers must implement the safer medical devices that are apprpriate, cmmercially available, and effective and dcument cnsideratin and implementatin f safer medical devices annually. Emplyers must get input fr these devices frm thse respnsible fr direct patient care. This input must be dcumented. Back t Tp

3 Example Expsure Cntrl Plans: A Mdel Expsure Cntrl Plan is prvided t assist emplyers in develping their wn plans [OSHA Directive CPL (2001, Nvember 27). Fr additinal infrmatin, see - Needlesticks. Additinal Infrmatin: l Bldbrne Pathgens, Safety and Health Tpics Page. Back t Tp

4 Pst Expsure Fllw-up Ptential Hazard: N pst expsure fllw-up made available after a needle stick/sharps injury, t help dcument injury r ffer medically indicated pst-expsure prphylaxis. Pssible Slutins: A Needlestick Preventin Prgram in place t deal with needlesticks r ther sharps injuries: The Bldbrne Pathgens Standard requires immediate fllw-up f emplyees after a needlestick. It is recmmended that such fllw-up include identifying injury patterns and accident analysis t determine if ther training, prcedures, r safer needle devices shuld be used t prevent future accidents. The updated standard requires emplyers t maintain a lg f injuries frm cntaminated sharps. Pst-expsure Evaluatin and Fllw-up als includes: A cnfidential medical exam. Dcumentatin f the rute(s) f expsure, and the circumstances under which the expsure incident ccurred. Testing f the surce individual's bld and making the results f the surce individual's testing usually after cnsent, available t the expsed emplyee. Administratin f pst-expsure prphylaxis, when medically indicated, as recmmended by the U.S. Public Health Service. MMWR Recmmendatins and Reprts, Vlume 50, Number RR-11 Updated U.S. Public Health Service Guidelines fr the Management f Occupatinal Expsures t HBV, HCV, and HIV and Recmmendatins fr Pstexpsure Prphylaxis (PDF frmat, 329 KB) June 29, 2001, Mst recent guidelines. NIOSH recmmends if yu experienced a needlestick r ther sharps injury r were expsed t the bld r ther bdy fluid f a patient during the curse f yur wrk, immediately fllw these steps: Wash needlesticks and cuts with sap and water Flush splashes t the nse, muth, r skin with water Irrigate eyes with clean water, saline, r sterile irritants Reprt the incident t yur supervisr Immediately seek medical treatment If yu have questins abut apprpriate medical treatment fr ccupatinal expsures t bld, 24 hur assistance is available frm the Clinicians' Pst Expsure Prphylaxis Htline (PEPline) at ( ). Back t Tp

5 Recrdkeeping fr Bldbrne Pathgens Ptential Hazard: Lack f infrmatin necessary t adequately implement bldbrne pathgens prgram and address bldbrne pathgen hazards. Pssible Slutins: The Bldbrne Pathgens Standard, requires bth medical and training recrds be maintained. Medical Recrds must be preserved and maintained fr each emplyee with ccupatinal expsure t bldbrne pathgens. Fr at least the duratin f emplyment plus 30 years, and must be kept cnfidential (nt disclsed withut written permissin f emplyee, except by law) and separate frm ther persnnel recrds and must als include: The emplyee's name and scial security number, hepatitis B vaccinatin status, including the dates f vaccinatin and medical recrds related t the emplyee's ability t receive vaccinatins. If an expsure incident ccurs, reprts are added t the medical recrd t dcument the incident, including testing results fllwing the incident, fllw-up prcedures, and the written pinin f the health care prfessinal. Training Recrds: Emplyers must establish and maintain a training recrd fr all expsed emplyees fr 3 years, frm the date the training ccurred which includes: The names and jb titles f all persns attending the training sessins, the dates, and cntent f the training sessins, and the trainer's name and qualificatins. If the emplyer ceases t d business: Training and medical recrds must be transferred t the next emplyer r successr emplyer. If there is n successr emplyer, the emplyer must ntify the Directr f the Natinal Institute fr Occupatinal Safety and Health (NIOSH) fr specific directins fr the recrds at least 3 mnths prir t intended dispsal. Bth medical and training recrds must be available t: Directr f NIOSH. Assistant Secretary f Labr fr Occupatinal Safety and Health. Emplyees r emplyee representatives (smene having written cnsent f the emplyee) Back t Tp

6 Cmply with OSHA revised Bldbrne Pathgens Standard: Emplyers must maintain a lg f injuries frm cntaminated sharps fr each injury including: Type and brand f device invlved. Department r wrk area f ccurrence. Explanatin f hw the incident ccurred. Des nt apply t emplyer nt required t maintain injury/illness lg under Additinal Infrmatin: Recrdkeeping Safety and Health Tpics Page. Back t Tp

7 Needlestick Injuries An estimated 800,000 needlestick injuries ccur each year. Nursing staff are mst frequently injured. EPINET Data shw needlestick injuries ccur mst frequently in patient rms. Needlestick injuries accunt fr up t 80 percent f accidental expsures t bld. (OSHA JSHQ, 1998). Ptential Hazard Expsure t bld and OPIM frm needlestick injuries due t: Unsafe needle devices Imprper handling and dispsal f needles Pssible Slutins Use safer needle devices and needleless devices t decrease needlestick r ther sharps expsures. Prper handling and dispsal f needles and ther sharps accrding t the Bldbrne Pathgens Standard can help prevent needlestick injuries. Other Sharps "Cntaminated Sharps" means any cntaminated bject that can penetrate the skin including, but nt limited t, needles, scalpels, brken glass, brken capillary tubes, and expsed ends f dental wires. Ptential Hazard Expsure t bld and OPIM thrugh ther sharps: Glass Capillary Tubes that break when used may result in a penetrating wund and expse wrkers t bld and OPIM. I.V. Cnnectrs that use needle systems increase the risk f expsure t bldbrne pathgens thrugh needlestick injuries. Dispsable razrs that culd be cntaminated with bld shuld be cnsidered "cntaminated sharps" and dispsed f prperly in apprpriate sharps cntainers. Pssible Slutins Implement engineering and wrk practice cntrls t help prevent expsures. Fr additinal infrmatin, see - Needlesticks. Back t Tp

8 Universal Precautins An apprach t infectin cntrl which treats all human bld and ther ptentially infectius materials as if they were infectius fr HIV and HBV r ther bldbrne pathgens. Ptential Hazard Expsure t bldbrne pathgens because emplyees are nt using Universal Precautins. Pssible Slutins Implement Universal Precautins accrding t the Bldbrne Pathgens Standard. Treat all bld and ther ptentially infectius materials with apprpriate precautins such as: Use glves, masks, and gwns if bld r OPIM expsure is anticipated. Use engineering and wrk practice cntrls t limit expsure. There are ther cncepts in infectin cntrl that are acceptable alternatives t universal precautins, such as Bdy Substance Islatin (BSI) and Standard Precautins (OSHA CPL ,): These methds define all bdy fluids and substances as infectius and incrprate nt nly the fluid and materials cvered by the Bldbrne Pathgens Standard, but expand cverage t include all bdy fluids and substances. Fr additinal infrmatin, see - Universal Precautins. Back t Tp

9 Persnal Prtective Equipment (PPE) Ptential Hazard Expsure t bld and OPIM due t an ineffective PPE prgram. Pssible Slutins Apprpriate Use f PPE: Persnal Prtective Equipment (PPE) is required by the Bldbrne Pathgens Standard (if expsure t bld and OPIM is anticipated and where ccupatinal expsure remains, after institutin f engineering and wrk practice cntrls. Glves must be wrn when hand cntact with bld, mucus membranes, OPIM, r nn-intact skin is anticipated, and when perfrming vascular access prcedures, r when handling cntaminated items r surfaces. Emplyers must ensure that emplyees wash their hands after cntact with bld r OPIM. Emplyers must prvide readily accessible hand washing facilities. Emplyers must ensure that emplyees wash hands and any ther skin with sap and water r flush mucus membranes with water as sn as feasible after cntact with bld r ther ptentially infectius materials. Dispsal f PPE Prtective clthing must be remved befre leaving the rm, and dispsed f in an apprpriately designated area r cntainer fr strage, washing, decntaminatin r dispsal. Back t Tp

10 Latex Allergy Ptential Hazard Develping latex sensitivity r latex allergy frm expsure t latex in prducts like latex glves. Pssible Slutins Emplyers must prvide apprpriate glves when expsure t bld r ther ptentially infectius materials (OPIM) exists [ Bldbrne Pathgens Standard]. Alternatives shall be readily accessible t thse emplyees wh are allergic t the glves nrmally prvided. Fr additinal infrmatin, see - Latex Allergy. Back t Tp

11 Bldbrne Illnesses - Hepatitis B Virus Hepatitis is an inflammatin f the liver that can lead t liver damage and/r death. The CDC estimates 800 health care wrkers became infected with HBV in This figure represents a 95% decline in new infectins frm the 1983 figures. The decline is largely due t the immunizatin f wrkers with the Hepatitis B vaccine, and cmpliance with ther prvisins f OSHA's Bldbrne Pathgens Standard. Ptential Hazard Expsure t ptentially fatal bldbrne illnesses such as Hepatitis B Virus (HBV). Hepatitis is much mre transmissible than HIV. Risk f infectin frm a single needlestick is 6%-30% (CDC 1997). 50% f the peple with HBV infectin are unaware that they have the virus. The CDC states that HBV can survive fr at least ne week in dried bld n envirnmental surfaces r cntaminated needles and instruments. Fr additinal infrmatin see Cntaminated Wrk Envirnments Pssible Slutins Prevent the expsure in the first place by implementing an effective Expsure Cntrl Plan as required by the Bldbrne Pathgens Standard. Emplyers must ffer t all emplyees wh have ccupatinal expsure t bld r OPIM, under the supervisin f a licensed physician the hepatitis b vaccinatin: Except as prvided in (f)(2)(i). At n cst t emplyee, at a reasnable time and place. After the emplyee has received the required training. Within 10 wrking days f initial assignment. Thse declining the hepatitis b vaccine must sign a declinatin statement [ Appendix A]. A sample declinatin frm is available. OSHA prvides the fllwing nn-mandatry sample frm: Written Opinin fr Hepatitis B Vaccinatin. Back t Tp

12 Health care wrkers wh have nging cntact with patients r bld and are at nging risk fr injuries with sharp instruments r needlesticks must be ffered testing fr antibdy t hepatitis B surface antigen ne t tw mnths after the cmpletin f the three-dse vaccinatin series. Emplyees wh d nt respnd t the primary vaccinatin series must be ffered a secnd three-dse vaccine series and retesting. Nn-respnders must be ffered medical evaluatin. Fllwing a reprt f an expsure incident the emplyer shall make immediately available t the expsed emplyee a cnfidential medical evaluatin and fllw-up. If a wrker is expsed t HBV, timely pst-expsure fllw-up with hepatitis b immune glbulin and initiatin f hepatitis b vaccine which must be ffered, are mre than 90% effective in preventing HBV infectin. A health care prfessinal's written pinin is required after an expsure incident. OSHA prvides the fllwing nn-mandatry sample frm: Written Opinin fr Pst-Expsure Evaluatin. The updated standard als requires emplyers t maintain a lg f injuries frm cntaminated sharps. Additinal Infrmatin: Updated US Public Health Service Guidelines fr the Management f Occupatinal Expsures t HBV, HCV, and HIV and Recmmendatins fr Pstexpsure Prphylaxis. CDC (2001, June 29). Mrbidity and Mrtality Weekly Reprt (MMWR) 50(RR11);1-42. The latest CDC recmmendatins. Issues in Healthcare Settings: Bldbrne Pathgens. CDC, Divisin f Healthcare Quality Prmtin (2001). Viral Hepatitis: CDC site fr Hepatitis. Immunizatin f Health Care wrkers. CDC, Recmmendatins f the Advisry Cmmittee n Immunizatin Practices (ACIP) and the Hspital Infectin Cntrl Practices Advisry Cmmittee (HICPAC) (1997, December 26), 46(RR-18);1-42. Enfrcement Prcedures fr the Occupatinal Expsure t Bldbrne Pathgens Standard. OSHA Directive, CPL (2001, Nvember 27). l Mdel Plans and Prgrams fr the OSHA Bldbrne Pathgens and Hazard Cmmunicatins Standards. OSHA Publicatin 3186 (2003), 521 KB PDF, 29 pages. Back t Tp

13 Bldbrne Illnesses - Human Immundeficiency Virus (HIV) HIV infectin has been reprted fllwing ccupatinal expsures t HIV-infected bld thrugh needlesticks r cuts; splashes in the eyes, nse, r muth; and skin cntact. Mst ften, hwever, infectin ccurs frm needlestick injury r cuts. Ptential Hazard Expsure t ptentially fatal bldbrne illnesses such as HIV. Risk f HIV infectin after needlestick is 1 in 3000 r 0.3%. The CDC dcumented 55 cases and 136 pssible cases f ccupatinal HIV transmissin t U.S. health care wrkers between 1985 and Pssible Slutins Prevent the expsure by implementing an effective Expsure Cntrl Plan as required by the Bldbrne Pathgens Standard [ (c)(1)]. Under certain circumstances pst-expsure prphylaxis fr HIV must be prvided t health care wrkers wh have an expsure incident, as defined in (b). Limited data suggests that such prphylaxis may cnsiderably reduce the chance f becming infected with HIV. Hwever, the drugs used fr prphylaxis have many adverse side effects. N vaccine currently exists t prevent HIV infectin, and n treatment exists t cure it. Emplyees wh have an incident must be ffered a cnfidential medical evaluatin and fllw-up. m A health care prfessinal's written pinin is required after an expsure incident. The fllwing nn-mandatry sample frm is available: Written Opinin fr Pst- Expsure Evaluatin. l The updated standard als requires emplyers t maintain a lg f injuries frm cntaminated sharps. Additinal Infrmatin: Updated US Public Health Service Guidelines fr the Management f Occupatinal Expsures t HBV, HCV, and HIV and Recmmendatins fr Pstexpsure Prphylaxis. CDC (2001, June 29). Mrbidity and Mrtality Weekly Reprt (MMWR) 50(RR11);1-42. The latest CDC recmmendatins. Enfrcement Prcedures fr the Occupatinal Expsure t Bldbrne Pathgens Standard. OSHA Directive, CPL (2001, Nvember 27). Mdel Plans and Prgrams fr the OSHA Bldbrne Pathgens and Hazard Cmmunicatins Standards. OSHA Publicatin 3186 (2003), 521 KB PDF, 29 pages. Back t Tp

14 Bldbrne Illnesses - Hepatitis C Virus (HCV) HCV infectin is the mst cmmn chrnic bldbrne infectin in the United States, affecting apprximately 4 millin peple. Hepatitis C infectin is caused mst cmmnly by needlestick injuries. HCV infectin ften ccurs with n symptms, but chrnic infectin develps in 75% t 85% f patients, with 70% develping active liver disease (CDC 1998). Ptential Hazard Expsure t ptentially fatal bldbrne illnesses such as Hepatitis C Virus (HCV), which is: A majr cause f chrnic liver disease. The leading reasn fr liver transplants in the United States in 1997 (CDC). Pssible Slutins Prevent the expsure in the first place by implementing an effective Expsure Cntrl Plan as required by the Bldbrne Pathgens Standard [ (c)(1)]. Emplyees wh have an expsure incident shall be ffered a cnfidential medical evaluatin and fllwup. A health care prfessinal's written pinin is required after an expsure incident. The fllwing nn-mandatry sample frm is available: Written Opinin fr Pst-Expsure Evaluatin. N vaccine is available fr hepatitis C. Immunglbulin r antiviral therapy is nt recmmended and n effective pstexpsure prphylaxis is knwn at this time (CDC 1998). Additinal Infrmatin: Recmmendatins fr Preventin and Cntrl f Hepatitis C Virus (HCV) Infectin and HCV-Related Chrnic Disease. CDC Vl. 47, N. RR-19;1-39 (1998, Octber 16). Hepatitis C: What Clinicians and ther Health Prfessinal Need t Knw. CDC, (2001). Viral Hepatitis C. CDC site fr Hepatitis C. Updated US Public Health Service Guidelines fr the Management f Occupatinal Expsures t HBV, HCV, and HIV and Recmmendatins fr Pst-expsure Prphylaxis. CDC (2001, June 29). Mrbidity and Mrtality Weekly Reprt (MMWR) 50(RR11);1-42. The latest CDC recmmendatins. Issues in Healthcare Settings: Bldbrne Pathgens. CDC, Divisin f Healthcare Quality Prmtin (2001). Enfrcement Prcedures fr the Occupatinal Expsure t Bldbrne Pathgens Standard. OSHA Directive, CPL (2001, Nvember 27). Mdel Plans and Prgrams fr the OSHA Bldbrne Pathgens and Hazard Cmmunicatins Standards. OSHA Publicatin 3186 (2003), 521 KB PDF, 29 pages. Back t Tp

15 Labeling and Signs Ptential Hazard Expsure t bldbrne pathgens due t imprper labeling f ptential hazards. Dispsal f cntaminated I.V. tubing int a bihazardus waste cntainer. Bihazard label n regulated waste cntainers. Individual units f bld, fr transfusin. Pssible Slutins Implement labeling and signs required by the Bldbrne Pathgens Standard, such as: Bihazardus Waste Cntainer: Regulated waste, such as I.V. tubing used t administer bld, cntaminated PPE, and needles etc., must be dispsed f int apprpriately labeled bihazardus waste cntainers. Bihazard Label: Cntainers that cntain regulated waste, (cntaminated PPE, needles, etc.), must bear the bihazard symbl, in accrdance with (g)(1)(i)(A). These labels shall be flurescent range r range-red, with lettering and symbls in a cntrasting clr. Red bags r red cntainers may be substituted fr labels. Exceptin fr Bld Prducts: Individual cntainers f bld, bld cmpnents r prducts that are labeled as t their cntents and have been released fr transfusin r ther clinical use need nt be labeled as hazardus. Individual cntainers f bld r OPIM need nt be labeled if placed in a labeled cntainer fr strage, transprt, shipment r dispsal. Back t Tp

16 Needlesticks: Bldbrne Pathgens Definitins fr bldbrne pathgens, ther ptentially infectius materials (OPIM), and ccupatinal expsure are fund in the Bldbrne Pathgens Standard, Definitins (b). Ptential Hazard Expsure t bld and OPIM frm cntaminated sharps injuries. Pssible Slutins Fllw the requirements f the Bldbrne Pathgens Standard and implement engineering and wrk practice cntrls t minimize expsure t bld and bldbrne pathgens. Engineering and Wrk Practice Cntrls must be the primary means used t eliminate r minimize expsure t bldbrne pathgens. Where engineering cntrls will reduce emplyee expsure either by remving, eliminating, r islating the hazard, they must be used, and changes t the Expsure Cntrl Plan (ECP) must include these engineering cntrls [ (c)(1)(iv), (d)(2)(i), OSHA Directive CPL Engineering Cntrls are measures (e.g., sharps dispsal cntainers, self-sheathing needles, safer medical devices, such as sharps injury prtectins and needleless systems) that islate r remve the bldbrne pathgens hazard frm the wrkplace [ (b)]. NOTE: The expsure cntrl plan must dcument cnsideratin and implementatin f apprpriate cmmercially available and effective engineering cntrls designed t eliminate r minimize expsure [OSHA Directive OSHA Directive CPL ], and revised Standard Expsure Cntrl Plan [ (c)(1)(iv)(B)]. Wrk Practice Cntrls are measures that reduce the likelihd f expsure by altering the manner in which a task is perfrmed (e.g., prhibiting recapping f needles by a tw-handed technique). The revised Bldbrne Pathgens and NeedleStick Preventin Standard requirements (effective date April 18, 2001) include: Emplyers must implement the safer medical devices that are apprpriate, cmmercially available, and effective [ (c)(1)(iv)(B)] and dcument cnsideratin and implementatin f safer medical devices annually. Emplyers must get input fr these devices frm thse respnsible fr direct patient care in [ (c)(1)(v)]. This input must be dcumented. Emplyers must train emplyees t use new devices and/r prcedures and dcument training in the Expsure Cntrl Plan. Emplyers must maintain a lg f injuries frm cntaminated sharps (h)(5)(i). The new Recrd keeping Standard als requires needlestick injuries t be recrded n the OSHA 300 Lg. This includes all wrk related needlestick injuries and cuts frm sharp bjects that are cntaminated with anther persn's bld r OPIM. If this recrded emplyee injury is later diagnsed with an infectius bldbrne disease the OSHA 300 lg must be updated. Back t Tp

17 Other Bldbrne Pathgens Standard requirements include: Cmpliance with Universal Precautins (an infectin cntrl principle that treats all human bld and OPIM as infectius) [ (d)(1)]. Persnal Prtective Equipment (PPE). Engineering and wrk practice cntrls shall be used t eliminate r minimize emplyee expsure. Where ccupatinal expsure remains after institutin f these cntrls, PPE shall als be used [ (d)(2)(i)]. Wrker training in apprpriate engineering cntrls and wrk practices, t eliminate r minimize wrker expsure. [ (g)(2)]. Prper handling and cntainerizatin f sharps. Pst-expsure evaluatin and fllw-up, including pst-expsure prphylaxis when apprpriate [ (f) (3)]. Back t Tp

18 Needlesticks: Other Sharps Injury "Cntaminated sharps" means any cntaminated bject that can penetrate the skin including, but nt limited t, needles, scalpels, brken glass, brken capillary tubes, and expsed ends f dental wires. Ptential Hazard Expsure t bld and ther ptentially infectius materials (OPIM), frm cntaminated sharps fr example: Glass Capillary Tubes that may break when used and if handled incrrectly may result in a penetrating wund f emplyee. Used Dispsable Razrs that culd be cntaminated with bld. Pssible Slutins I.V. Cnnectr Systems that use needles t cnnect I.V. setups. Fllw the requirements f the Bldbrne Pathgens Standard and implement engineering and wrk practice cntrls t help prevent needlesticks r ther sharps expsures. Glass Capillary Tubes: D nt pick up brken glassware, such as capillary tubes directly with the hands. Dispse f regulated wastes including capillary tubes prperly. Wear glves when amng ther things, handling r tuching cntaminated items r surfaces, such as capillary tubes. In their jint dcument (Glass Capillary Tubes: Jint Safety Advisry Abut Ptential Risks (1999, February)), OSHA, FDA and NIOSH warn health care wrkers abut the hazards frm breakage f glass capillary tubes and recmmend using: Capillary tubes that are nt made f glass. Glass capillary tubes wrapped in puncture-resistant film. Prducts that use a methd f sealing that des nt require manually pushing ne end f the tube int putty t frm a plug. Used Dispsable Razrs shuld be cnsidered cntaminated waste and dispsed f prperly in apprpriate sharps cntainers. I.V. cnnectr systems: Use needleless cnnectr systems with I.V. setups t minimize ccupatinal expsure t needles and bldbrne pathgens. Avid using needles where safe and effective alternatives are available. Back t Tp

19 The FDA urges using needleless systems, r recessed needle systems t reduce the risk f needlestick injuries. (Figure 1) Needleless I.V. Cnnectr These cnnectrs use devices ther than needles t cnnect ne I.V. t anther. This example shws the plunger-type system. Back t Tp

20 Cntaminated Wrk Envirnments Ptential Hazard Expsure f husekeeping staff t bld r Other Ptentially Infectius Materials (OPIM) thrugh cntaminated wrk envirnments. OPIM is defined in (b). Pssible Slutins OSHA requires: Clean and sanitary wrk envirnments t prevent cntact with bld r OPIM. Bldbrne Pathgens Standard. The emplyer must: Determine and implement an apprpriate written schedule fr cleaning and methds f decntaminatin. This written schedule must be based n the: Lcatin within the facility. Type f surfaces t be cleaned. Type f sil present. The tasks r prcedures t be perfrmed in the area. Back t Tp

21 Needlestick Injuries In an average hspital, wrkers incurred apprximately 30 needlestick injuries fr 100 beds per year [EPINET 1996]. Ptential Hazard Expsure t bld and ther ptentially infectius materials (OPIM) because f: Unsafe needle devices. Imprper handling and dispsal f needles. Pssible Slutins Use safer needle devices and needleless devices t decrease needlestick r ther sharps expsures. See Safer Needle Devices Sectin. Prperly handle and dispse f needles and ther sharps accrding t the Bldbrne Pathgens Standard. Handling Needles/Sharps: D nt bend, recap, r remve cntaminated needles and ther sharps unless such an act is required by a specific prcedure r has n feasible alternative. D nt shear r break cntaminated sharps. (OSHA defines cntaminated as the presence r the reasnably anticipated presence f bld r ther ptentially infectius materials n an item r surface). Cntainerizatin: Have needle cntainers available near areas where needles may be fund. Discard cntaminated sharps immediately r as sn as feasible int apprpriate cntainers. Apprpriate cntainers must be: Clsable, puncture-resistant, and leak-prf n sides and bttm. Accessible, maintained upright, and nt allwed t verfill. Labeled r clr cded accrding t (g)(1)(i) Clred red r labeled with the bihazard symbl. Labeled in flurescent range r range-red, with lettering and symbls in a cntrasting clr. Red bags r cntainers may be substituted fr labels. Back t Tp

22 Other Sharps Injury "Cntaminated sharps" means any cntaminated bject that can penetrate the skin including, but nt limited t, needles, scalpels, brken glass, brken capillary tubes, and expsed ends f dental wires [ (b),] Definitins. Ptential Hazard Expsure t bld and ther ptentially infectius materials (OPIM), frm cntaminated sharps fr example: Glass Capillary Tubes that may break when used and if handled incrrectly may result in a penetrating wund f emplyee. Used Dispsable Razrs that culd be cntaminated with bld. I.V. Cnnectr Systems that use needles t cnnect I.V. setups. Pssible Slutins Fllw the requirements f the Bldbrne Pathgens Standard and implement engineering and wrk practice cntrls t help prevent needlesticks r ther sharps expsures. Glass Capillary Tubes: D nt pick up brken glassware, such as capillary tubes directly with the hands. Dispse f regulated wastes including capillary tubes prperly. Wear glves when amng ther things, handling r tuching cntaminated items r surfaces, such as capillary tubes. In their jint dcument (Glass Capillary Tubes: Jint Safety Advisry Abut Ptential Risks (1999, February)), OSHA, FDA and NIOSH warn health care wrkers abut the hazards frm breakage f glass capillary tubes and recmmend using: Capillary tubes that are nt made f glass. Glass capillary tubes wrapped in puncture-resistant film. Prducts that use a methd f sealing that des nt require manually pushing ne end f the tube int putty t frm a plug. Back t Tp