Course Book : #112 - OSHA Update

OSHA

Two contact hours

Course #112

Written By: Monica Oram, RN, BSN

 

Upon Completion of this course the reader will be able to achieve the following objectives:

 

  1. Define OSHA

  2. Understand Universal Precautions

  3. Understand the Bloodborne pathogen standard under OSHA

  4. Understand the exposure plan

  5. Understand the Needle Safety and Prevention Act

  6. Understand the purpose of PPE and when to use appropriately

 

Overview

 

What Is OSHA?

 

The Following is a reprint from OSHA’s website: www.osha.gov

OSHA stands for the Occupational Safety and Health Administration. OSHA was implemented in 1971, by Congress. OSHA has a mission statement that goes like this… “ The mission of OSHA is to save lives, prevent injuries and protect the health of America’s workers.” To accomplish this, Federal and State governments work together in a partnership with more than 100 Million working men and women and their six and a half million employers who are covered and mandated by OSHA regulations. This mission is to ensure that all workers are in a safe working environment and the employer is practicing safe working conditions.

OSHA and its state partners have approximately 2100 inspectors, plus complaint discrimination investigators, engineers, physicians, educators, standards writers, and other technical and support staff all spread out in over 200 offices throughout the country. OSHA ’s Partnership programs spread out to over 6,200 sites.

Nearly every working man and woman in the nation comes under OSHA ’s jurisdiction ( with some exceptions such as miners, transportation workers, and a few self employed)

OSHA has a service plan that is dedicated to use its resources effectively to stimulate management commitment and employee participation in comprehensive workplace safety and health programs throughout the Country. One of the principle actions of OSHA is to conduct surveys for compliance. Because workplace inspections are one of OSHA’s biggest areas of focus, their efforts are to improve working conditions by strong enforcement and inspection. It is reported that OSHA conducted 35, 778 inspections in 2001.

 

OSHA states that since beginning in 1971, work related deaths have declined 50%. On the job deaths declined 2% in 2000. The leading cause of deaths on the job account mostly for highway incidents, followed by falls, and third, homicides!

 

Over the past thirty years, it is reported by OSHA that workplace injury and illness rates have dropped 40%.

 

OSHA reports that in 2000, only 6% of all workers were involved in a work related injury. ( 6.1 per 100 workers)

Over 1.4 million businesses are regulated under OSHA laws through out the United States.

 

Understanding Universal Precautions

 

Universal Precautions came about in 1984 in light of the raising concern of the HIV epidemic. The Center For Disease Control ( CDC) recognized there was an urgent need to protect healthcare workers from blood and bloodborne pathogens. In 1985 the CDC officially introduced universal precautions. It took OSHA and the CDC another 6 years to put the final plan into action to improve working environments and promote safety in healthcare facilities and workers. So, in 1991 the rules became final for OSHA law and regulations regarding Universal Precautions and expectations. This new law came about mandating healthcare facilities to put policies and action plans into place to meet OSHA safety guidelines.

 

Universal Precautions have since been replaced with a new term, “standard precautions” which states that EVERY person is to be treated as if they have an infectious disease” This will require that all healthcare workers are to wear gloves and use personal protective equipment as needed (PPE) when it is probable or likely to come in contact with any blood or body fluid. The problem we face today, is you can’t look at someone and know if they are infectious. Therefore, it is essential that all persons are treated as if they are infectious. PREVENTION IS THE KEY!

The requirements under standard precautions states all healthcare workers will wash hands frequently, before and after contact with EVERY patient, and anytime there is visible soiling present. Hands are to be washed after removing gloves. Gloves do not eliminate the need for hand washing.

 

The use of PPE is designed to protect healthcare workers from coming into contact with blood or body fluids. This will include, but is not limited to, the use of gloves, gowns, masks, eye protection, shoe covers and head bonnets. In the event of cardiopulmonary resuscitation, one should always utilize the use of a rescue barrier or face mask.

One should choose appropriate PPE in conjunction with the task at hand.

 

Planning ahead will make a difference in the outcome of self protection should you come in contact with blood or body fluids.

 

Standard precautions are a set of rules that are designed to reduce the transmission of disease from the following body substances:

  • All body fluids

  • Secretions

  • Excretions

  • Non intact skin

  • Open sores

  • Acne

  • Mucous membranes

 

If you follow standard precautions while caring for a person with HIV or AIDS, you will greatly reduce your chances of coming in contact with an infectious body fluid. Under standard precautions, it is clearly stated that ALL individuals are treated as if they are infectious, and if all are treated in the same manner, it does not matter who is infected.

 

 

Again, the most important thing you can do is wear gloves and wash your hands!

 

Reminder:

  • Gloves should be worn whenever there is the possibility that you might touch body substances, mucous membranes, or non intact skin. Be certain you remove the gloves promptly after use and wash your hands.

  • Remove gloves before touching non-contaminated objects such as doorknobs, and sink faucets. NEVER wear the same gloves to care for more than one patient.

  • Face masks, eye shields, and gowns are meant to protect you and your clothing during procedures and care provided. Use good judgment if there is any likelihood that you may be splashed by any body fluid.

  • All PPE must be replaced with clean PPE if they become torn or wet.

  • Remember to always wash hands after removing any PPE.

  • Be careful on how you handle equipment that is soiled.

  • Be careful not to shake or agitate soiled linens. DO not expose your skin or mucous membranes, your clothing, or anyone in your care to contaminated equipment or soiled linens.

  • Never use single use equipment more than once, and be certain that reusable items are properly cleaned and/or sterilized as appropriate prior to reuse.

  • Environmental surfaces such as beds, bedrails, and bedside equipment should always be cleaned and disinfected appropriately.

  • Do not ever recap a needle. There should never ever be time in which a needle should have to be recapped. If it is absolutely unavoidable, and it MUST be recapped for some reason, then be certain you use the one handed scoop method ONLY.

  • Dispose of used needles only in an approved hard rigid sharps container for this purpose. They should be discarded at the point of origin, and never carried down a hall uncapped. Never bend, break, or manipulate a needle in any way.

  • Use resuscitation devices instead of direct mouth to mouth resuscitation when needed. This prevents mucous membranes from being in direct contact during mouth to mouth resuscitation.

 

OSHA KEY TERMS

To better understand the standard, it is important to understand the following key terms:

Bloodborne Pathogen - Disease causing organisms (pathogens) present in human blood and or body fluids that can cause infection and disease in humans. A blood borne pathogen can be a bacteria or a viral organism that gets into the blood system causing many types of infections such as, HIV, Hepatitis, Meningitis, Syphilis, Malaria, Ebola, to name a few…..

 

Hepatitis B Virus ( HBV) - A potentially life threatening viral liver infection. Hepatitis means inflammation of the liver. For more on Hepatitis see online course related to Hepatitis Update 2003.

 

Hepatitis C Virus ( HCV) - Another significant type of hepatitis causing liver damage and disease.

 

Human Immunodeficiency Virus ( HIV) - The virus that causes AIDS, Blood borne pathogen that is incurable and fatal when progresses to AIDS.

 

Standard Precautions- An approach to infection control designed for patients and healthcare workers to use precautions to prevent coming in contact with blood or body fluids. All patients are assumed to be infectious and PPE should always be used.

 

Bloodborne Pathogen Standard per OSHA

 

OSHA’s Bloodborne pathogen standard, 29 CFR 1910.1030 as amended pursuant to the 2000 needle stick prevention act, is a regulation that prescribes safeguards to protect workers against health hazards related to blood borne pathogens. It is a provision dealing with exposure control plans, engineering and work practices and hepatitis B vaccinations. It also deals with hazard communication, training, and record keeping. The standard imposes laws of compliance for healthcare facilities to keep workers safe from blood and body fluid exposure.

 

The Exposure Control Plan

 

The blood borne pathogen standard requires employers to review and update their exposure control plan annually or whenever necessary to reflect new or modified tasks or procedures affecting employee exposure. The use of engineering controls such as sharp boxes, safety medical devices, PPE, and removal of regulated wastes.

 

All healthcare workers should be offered the hepatitis B vaccination at no cost to the employee if exposure to blood is possible. The employee has the right to decline the vaccination, but it has to recorded on a form that it was offered and refused, by OSHA law. The employee may choose to accept it at a later date. The employer must offer it free of cost to the employee upon request and consent.

 

As a primary method of employee protection, the Standard requires employers to eliminate or minimize exposure to blood and other potentially infectious materials, to consider using appropriate commercially effective safer medical devices to meet this obligation, and to document that the exposure control plan is updated at least annually.

 

The exposure control plan also includes adequate training for all staff who has a potential for exposure to blood, body fluids or any other potentially infectious material. There should always be a specific needle stick policy in all facilities as to how to treat, record and report such incidents.

 

Any activity performed by a healthcare worker that requires handling of contaminated devices, or exposure to blood and body fluids are to be evaluated on an ongoing basis and altered to reduce the likelihood of exposure, such as the use of puncture resistant containers, and not recapping needles.

 

There are many products becoming available all the time to reduce the risk of needle sticks and blood exposure. The primary purpose is to reduce workplace exposure to healthcare workers. Sometimes it will become necessary to learn how to use new products and be open to changes in the work environment that will promote safety and help reduce risks of potential exposure.

 

On the job education is mandated under OSHA. All employees in a healthcare facility who have the potential for exposure must be educated on initial employment and annually thereafter. The employee is taught the basics of bloodborne pathogens, modes of transmission and topics related to OSHA rules and regulations.

 

OSHA requires that an in-service record be maintained for a period of no less than three years, and all those trained need to sign and document that training was received in the workplace.

 

Exposure control plans identify those employees that are covered by the OSHA standard. It gives policies and procedures on implementation of the standard by eliminating or reducing the risk of exposure.

An exposure control plan also outlines specifically what an individual is expected to do if an exposure happens.

 

The exposure control plan includes six key areas of focus:

  1. Engineering controls

  2. Work place practice controls

  3. Personal Protective Equipment (PPE)

  4. Housekeeping practices

  5. Hepatitis B Vaccination

  6. Standard Precautions

 

Reporting Needle sticks

 

Each healthcare facility is required by law to have an exposure policy into place for employees who sustain a needle stick, blood exposure, mucous membrane splash, or exposure to non-intact skin.

The employee should know to report the incident IMMEDIATELY to a supervisor.

CDC recommends that no more than 2 hours should elapse from time of exposure to time of treatment. The employee should then be offered treatment which will include a physician evaluation, confidential medical evaluation and blood testing for HIV. The physician will want a baseline HIV test to assess current status of the exposed worker, and will most likely want a blood test done on the “ source patient” to determine if the source of exposure is potentially infectious. The employee may begin prophylaxis medication for exposure as the physician deems appropriate. The worker exposed will most likely be advised to follow up with HIV and Hepatitis blood testing in one month, three months, six months and one year.

 

Needle Safety Prevention Act

 

The Needle Safety Prevention Act directing OSHA to revise the bloodborne pathogens standard to establish a greater detail requiring employers to identify and make use of effective and safer medical devices. Employers are required under this act and by OSHA law to purchase and use any new equipment that is made available to protect healthcare workers from potential exposure, such as the use of needleless systems and IV start catheters with a protective sheath over the needle.

This revision was published on January 18, 2001 and became effective April 18, 2001.

 

 

 

A little more on PPE

 

According to the Bloodborne pathogen Standard, the provision of 1910.1030(d) (3) (i) provision states:

When there is an 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, masks, and eye protection, mouth pieces, and resuscitation bags/barriers.

 

Personal protective equipment will be considered “appropriate” only if it will not permit blood or other potentially infectious material to 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.

 

Summary

 

The revision to OSHA’s bloodborne pathogens standard added new requirements for employers, including additions to the exposure control plan and keeping a sharps injury log. It does not impose new requirements for employers to protect workers from sharps injuries. The original standard has provisions to protect employees from needle stick exposure. The original standard has already included a provision for work controls, and engineering control plans that would eliminate or reduce exposure from hazards associated with bloodborne pathogens.

 

The revision does in fact, specify in greater detail engineering controls, such as safer medical devices, which must be used to reduce or eliminate worker exposure.

 

By understanding OSHA regulations, and practice methods and techniques to keep safe, you will greatly reduce the likelihood of an exposure to a blood or body fluid exposure. Remember the keys to good hand washing, and the use of PPE. Remember that under universal and standard precautions we should treat all patients as if they are potentially infectious under all circumstances. By taking all necessary precautions, you can prevent coming in contact with diseases. One thought to think…. “ If it’s wet and sticky, and not yours, Don’t touch it!”

 

References:

www.osha.gov

 

OSHA Guidelines

Federal Administration Safety and Health

401 M. Street SW

Washington, DC 20460

 

Occupational Health and Safety

1835 Newport Blvd

Suite D - 258

Costa Mesa, California 92627

 

Occupational Safety and Health Administration

200 Constitution Avenue, NW

Washington, D.C. 20210

OSHA

Two contact hours

Course #112

Written By: Monica Oram, RN, BSN

 

Upon Completion of this course the reader will be able to achieve the following objectives:

 

  1. Define OSHA

  2. Understand Universal Precautions

  3. Understand the Bloodborne pathogen standard under OSHA

  4. Understand the exposure plan

  5. Understand the Needle Safety and Prevention Act

  6. Understand the purpose of PPE and when to use appropriately

 

Overview

 

What Is OSHA?

 

The Following is a reprint from OSHA’s website: www.osha.gov

OSHA stands for the Occupational Safety and Health Administration. OSHA was implemented in 1971, by Congress. OSHA has a mission statement that goes like this… “ The mission of OSHA is to save lives, prevent injuries and protect the health of America’s workers.” To accomplish this, Federal and State governments work together in a partnership with more than 100 Million working men and women and their six and a half million employers who are covered and mandated by OSHA regulations. This mission is to ensure that all workers are in a safe working environment and the employer is practicing safe working conditions.

OSHA and its state partners have approximately 2100 inspectors, plus complaint discrimination investigators, engineers, physicians, educators, standards writers, and other technical and support staff all spread out in over 200 offices throughout the country. OSHA ’s Partnership programs spread out to over 6,200 sites.

Nearly every working man and woman in the nation comes under OSHA ’s jurisdiction ( with some exceptions such as miners, transportation workers, and a few self employed)

OSHA has a service plan that is dedicated to use its resources effectively to stimulate management commitment and employee participation in comprehensive workplace safety and health programs throughout the Country. One of the principle actions of OSHA is to conduct surveys for compliance. Because workplace inspections are one of OSHA’s biggest areas of focus, their efforts are to improve working conditions by strong enforcement and inspection. It is reported that OSHA conducted 35, 778 inspections in 2001.

 

OSHA states that since beginning in 1971, work related deaths have declined 50%. On the job deaths declined 2% in 2000. The leading cause of deaths on the job account mostly for highway incidents, followed by falls, and third, homicides!

 

Over the past thirty years, it is reported by OSHA that workplace injury and illness rates have dropped 40%.

 

OSHA reports that in 2000, only 6% of all workers were involved in a work related injury. ( 6.1 per 100 workers)

Over 1.4 million businesses are regulated under OSHA laws through out the United States.

 

Understanding Universal Precautions

 

Universal Precautions came about in 1984 in light of the raising concern of the HIV epidemic. The Center For Disease Control ( CDC) recognized there was an urgent need to protect healthcare workers from blood and bloodborne pathogens. In 1985 the CDC officially introduced universal precautions. It took OSHA and the CDC another 6 years to put the final plan into action to improve working environments and promote safety in healthcare facilities and workers. So, in 1991 the rules became final for OSHA law and regulations regarding Universal Precautions and expectations. This new law came about mandating healthcare facilities to put policies and action plans into place to meet OSHA safety guidelines.

 

Universal Precautions have since been replaced with a new term, “standard precautions” which states that EVERY person is to be treated as if they have an infectious disease” This will require that all healthcare workers are to wear gloves and use personal protective equipment as needed (PPE) when it is probable or likely to come in contact with any blood or body fluid. The problem we face today, is you can’t look at someone and know if they are infectious. Therefore, it is essential that all persons are treated as if they are infectious. PREVENTION IS THE KEY!

The requirements under standard precautions states all healthcare workers will wash hands frequently, before and after contact with EVERY patient, and anytime there is visible soiling present. Hands are to be washed after removing gloves. Gloves do not eliminate the need for hand washing.

 

The use of PPE is designed to protect healthcare workers from coming into contact with blood or body fluids. This will include, but is not limited to, the use of gloves, gowns, masks, eye protection, shoe covers and head bonnets. In the event of cardiopulmonary resuscitation, one should always utilize the use of a rescue barrier or face mask.

One should choose appropriate PPE in conjunction with the task at hand.

 

Planning ahead will make a difference in the outcome of self protection should you come in contact with blood or body fluids.

 

Standard precautions are a set of rules that are designed to reduce the transmission of disease from the following body substances:

  • All body fluids

  • Secretions

  • Excretions

  • Non intact skin

  • Open sores

  • Acne

  • Mucous membranes

 

If you follow standard precautions while caring for a person with HIV or AIDS, you will greatly reduce your chances of coming in contact with an infectious body fluid. Under standard precautions, it is clearly stated that ALL individuals are treated as if they are infectious, and if all are treated in the same manner, it does not matter who is infected.

 

 

Again, the most important thing you can do is wear gloves and wash your hands!

 

Reminder:

  • Gloves should be worn whenever there is the possibility that you might touch body substances, mucous membranes, or non intact skin. Be certain you remove the gloves promptly after use and wash your hands.

  • Remove gloves before touching non-contaminated objects such as doorknobs, and sink faucets. NEVER wear the same gloves to care for more than one patient.

  • Face masks, eye shields, and gowns are meant to protect you and your clothing during procedures and care provided. Use good judgment if there is any likelihood that you may be splashed by any body fluid.

  • All PPE must be replaced with clean PPE if they become torn or wet.

  • Remember to always wash hands after removing any PPE.

  • Be careful on how you handle equipment that is soiled.

  • Be careful not to shake or agitate soiled linens. DO not expose your skin or mucous membranes, your clothing, or anyone in your care to contaminated equipment or soiled linens.

  • Never use single use equipment more than once, and be certain that reusable items are properly cleaned and/or sterilized as appropriate prior to reuse.

  • Environmental surfaces such as beds, bedrails, and bedside equipment should always be cleaned and disinfected appropriately.

  • Do not ever recap a needle. There should never ever be time in which a needle should have to be recapped. If it is absolutely unavoidable, and it MUST be recapped for some reason, then be certain you use the one handed scoop method ONLY.

  • Dispose of used needles only in an approved hard rigid sharps container for this purpose. They should be discarded at the point of origin, and never carried down a hall uncapped. Never bend, break, or manipulate a needle in any way.

  • Use resuscitation devices instead of direct mouth to mouth resuscitation when needed. This prevents mucous membranes from being in direct contact during mouth to mouth resuscitation.

 

OSHA KEY TERMS

To better understand the standard, it is important to understand the following key terms:

Bloodborne Pathogen - Disease causing organisms (pathogens) present in human blood and or body fluids that can cause infection and disease in humans. A blood borne pathogen can be a bacteria or a viral organism that gets into the blood system causing many types of infections such as, HIV, Hepatitis, Meningitis, Syphilis, Malaria, Ebola, to name a few…..

 

Hepatitis B Virus ( HBV) - A potentially life threatening viral liver infection. Hepatitis means inflammation of the liver. For more on Hepatitis see online course related to Hepatitis Update 2003.

 

Hepatitis C Virus ( HCV) - Another significant type of hepatitis causing liver damage and disease.

 

Human Immunodeficiency Virus ( HIV) - The virus that causes AIDS, Blood borne pathogen that is incurable and fatal when progresses to AIDS.

 

Standard Precautions- An approach to infection control designed for patients and healthcare workers to use precautions to prevent coming in contact with blood or body fluids. All patients are assumed to be infectious and PPE should always be used.

 

Bloodborne Pathogen Standard per OSHA

 

OSHA’s Bloodborne pathogen standard, 29 CFR 1910.1030 as amended pursuant to the 2000 needle stick prevention act, is a regulation that prescribes safeguards to protect workers against health hazards related to blood borne pathogens. It is a provision dealing with exposure control plans, engineering and work practices and hepatitis B vaccinations. It also deals with hazard communication, training, and record keeping. The standard imposes laws of compliance for healthcare facilities to keep workers safe from blood and body fluid exposure.

 

The Exposure Control Plan

 

The blood borne pathogen standard requires employers to review and update their exposure control plan annually or whenever necessary to reflect new or modified tasks or procedures affecting employee exposure. The use of engineering controls such as sharp boxes, safety medical devices, PPE, and removal of regulated wastes.

 

All healthcare workers should be offered the hepatitis B vaccination at no cost to the employee if exposure to blood is possible. The employee has the right to decline the vaccination, but it has to recorded on a form that it was offered and refused, by OSHA law. The employee may choose to accept it at a later date. The employer must offer it free of cost to the employee upon request and consent.

 

As a primary method of employee protection, the Standard requires employers to eliminate or minimize exposure to blood and other potentially infectious materials, to consider using appropriate commercially effective safer medical devices to meet this obligation, and to document that the exposure control plan is updated at least annually.

 

The exposure control plan also includes adequate training for all staff who has a potential for exposure to blood, body fluids or any other potentially infectious material. There should always be a specific needle stick policy in all facilities as to how to treat, record and report such incidents.

 

Any activity performed by a healthcare worker that requires handling of contaminated devices, or exposure to blood and body fluids are to be evaluated on an ongoing basis and altered to reduce the likelihood of exposure, such as the use of puncture resistant containers, and not recapping needles.

 

There are many products becoming available all the time to reduce the risk of needle sticks and blood exposure. The primary purpose is to reduce workplace exposure to healthcare workers. Sometimes it will become necessary to learn how to use new products and be open to changes in the work environment that will promote safety and help reduce risks of potential exposure.

 

On the job education is mandated under OSHA. All employees in a healthcare facility who have the potential for exposure must be educated on initial employment and annually thereafter. The employee is taught the basics of bloodborne pathogens, modes of transmission and topics related to OSHA rules and regulations.

 

OSHA requires that an in-service record be maintained for a period of no less than three years, and all those trained need to sign and document that training was received in the workplace.

 

Exposure control plans identify those employees that are covered by the OSHA standard. It gives policies and procedures on implementation of the standard by eliminating or reducing the risk of exposure.

An exposure control plan also outlines specifically what an individual is expected to do if an exposure happens.

 

The exposure control plan includes six key areas of focus:

  1. Engineering controls

  2. Work place practice controls

  3. Personal Protective Equipment (PPE)

  4. Housekeeping practices

  5. Hepatitis B Vaccination

  6. Standard Precautions

 

Reporting Needle sticks

 

Each healthcare facility is required by law to have an exposure policy into place for employees who sustain a needle stick, blood exposure, mucous membrane splash, or exposure to non-intact skin.

The employee should know to report the incident IMMEDIATELY to a supervisor.

CDC recommends that no more than 2 hours should elapse from time of exposure to time of treatment. The employee should then be offered treatment which will include a physician evaluation, confidential medical evaluation and blood testing for HIV. The physician will want a baseline HIV test to assess current status of the exposed worker, and will most likely want a blood test done on the “ source patient” to determine if the source of exposure is potentially infectious. The employee may begin prophylaxis medication for exposure as the physician deems appropriate. The worker exposed will most likely be advised to follow up with HIV and Hepatitis blood testing in one month, three months, six months and one year.

 

Needle Safety Prevention Act

 

The Needle Safety Prevention Act directing OSHA to revise the bloodborne pathogens standard to establish a greater detail requiring employers to identify and make use of effective and safer medical devices. Employers are required under this act and by OSHA law to purchase and use any new equipment that is made available to protect healthcare workers from potential exposure, such as the use of needleless systems and IV start catheters with a protective sheath over the needle.

This revision was published on January 18, 2001 and became effective April 18, 2001.

 

 

 

A little more on PPE

 

According to the Bloodborne pathogen Standard, the provision of 1910.1030(d) (3) (i) provision states:

When there is an 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, masks, and eye protection, mouth pieces, and resuscitation bags/barriers.

 

Personal protective equipment will be considered “appropriate” only if it will not permit blood or other potentially infectious material to 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.

 

Summary

 

The revision to OSHA’s bloodborne pathogens standard added new requirements for employers, including additions to the exposure control plan and keeping a sharps injury log. It does not impose new requirements for employers to protect workers from sharps injuries. The original standard has provisions to protect employees from needle stick exposure. The original standard has already included a provision for work controls, and engineering control plans that would eliminate or reduce exposure from hazards associated with bloodborne pathogens.

 

The revision does in fact, specify in greater detail engineering controls, such as safer medical devices, which must be used to reduce or eliminate worker exposure.

 

By understanding OSHA regulations, and practice methods and techniques to keep safe, you will greatly reduce the likelihood of an exposure to a blood or body fluid exposure. Remember the keys to good hand washing, and the use of PPE. Remember that under universal and standard precautions we should treat all patients as if they are potentially infectious under all circumstances. By taking all necessary precautions, you can prevent coming in contact with diseases. One thought to think…. “ If it’s wet and sticky, and not yours, Don’t touch it!”

 

References:

www.osha.gov

 

OSHA Guidelines

Federal Administration Safety and Health

401 M. Street SW

Washington, DC 20460

 

Occupational Health and Safety

1835 Newport Blvd

Suite D - 258

Costa Mesa, California 92627

 

Occupational Safety and Health Administration

200 Constitution Avenue, NW

Washington, D.C. 20210

OSHA

Two contact hours

Course #112

Written By: Monica Oram, RN, BSN

 

Upon Completion of this course the reader will be able to achieve the following objectives:

 

  1. Define OSHA

  2. Understand Universal Precautions

  3. Understand the Bloodborne pathogen standard under OSHA

  4. Understand the exposure plan

  5. Understand the Needle Safety and Prevention Act

  6. Understand the purpose of PPE and when to use appropriately

 

Overview

 

What Is OSHA?

 

The Following is a reprint from OSHA’s website: www.osha.gov

OSHA stands for the Occupational Safety and Health Administration. OSHA was implemented in 1971, by Congress. OSHA has a mission statement that goes like this… “ The mission of OSHA is to save lives, prevent injuries and protect the health of America’s workers.” To accomplish this, Federal and State governments work together in a partnership with more than 100 Million working men and women and their six and a half million employers who are covered and mandated by OSHA regulations. This mission is to ensure that all workers are in a safe working environment and the employer is practicing safe working conditions.

OSHA and its state partners have approximately 2100 inspectors, plus complaint discrimination investigators, engineers, physicians, educators, standards writers, and other technical and support staff all spread out in over 200 offices throughout the country. OSHA ’s Partnership programs spread out to over 6,200 sites.

Nearly every working man and woman in the nation comes under OSHA ’s jurisdiction ( with some exceptions such as miners, transportation workers, and a few self employed)

OSHA has a service plan that is dedicated to use its resources effectively to stimulate management commitment and employee participation in comprehensive workplace safety and health programs throughout the Country. One of the principle actions of OSHA is to conduct surveys for compliance. Because workplace inspections are one of OSHA’s biggest areas of focus, their efforts are to improve working conditions by strong enforcement and inspection. It is reported that OSHA conducted 35, 778 inspections in 2001.

 

OSHA states that since beginning in 1971, work related deaths have declined 50%. On the job deaths declined 2% in 2000. The leading cause of deaths on the job account mostly for highway incidents, followed by falls, and third, homicides!

 

Over the past thirty years, it is reported by OSHA that workplace injury and illness rates have dropped 40%.

 

OSHA reports that in 2000, only 6% of all workers were involved in a work related injury. ( 6.1 per 100 workers)

Over 1.4 million businesses are regulated under OSHA laws through out the United States.

 

Understanding Universal Precautions

 

Universal Precautions came about in 1984 in light of the raising concern of the HIV epidemic. The Center For Disease Control ( CDC) recognized there was an urgent need to protect healthcare workers from blood and bloodborne pathogens. In 1985 the CDC officially introduced universal precautions. It took OSHA and the CDC another 6 years to put the final plan into action to improve working environments and promote safety in healthcare facilities and workers. So, in 1991 the rules became final for OSHA law and regulations regarding Universal Precautions and expectations. This new law came about mandating healthcare facilities to put policies and action plans into place to meet OSHA safety guidelines.

 

Universal Precautions have since been replaced with a new term, “standard precautions” which states that EVERY person is to be treated as if they have an infectious disease” This will require that all healthcare workers are to wear gloves and use personal protective equipment as needed (PPE) when it is probable or likely to come in contact with any blood or body fluid. The problem we face today, is you can’t look at someone and know if they are infectious. Therefore, it is essential that all persons are treated as if they are infectious. PREVENTION IS THE KEY!

The requirements under standard precautions states all healthcare workers will wash hands frequently, before and after contact with EVERY patient, and anytime there is visible soiling present. Hands are to be washed after removing gloves. Gloves do not eliminate the need for hand washing.

 

The use of PPE is designed to protect healthcare workers from coming into contact with blood or body fluids. This will include, but is not limited to, the use of gloves, gowns, masks, eye protection, shoe covers and head bonnets. In the event of cardiopulmonary resuscitation, one should always utilize the use of a rescue barrier or face mask.

One should choose appropriate PPE in conjunction with the task at hand.

 

Planning ahead will make a difference in the outcome of self protection should you come in contact with blood or body fluids.

 

Standard precautions are a set of rules that are designed to reduce the transmission of disease from the following body substances:

  • All body fluids

  • Secretions

  • Excretions

  • Non intact skin

  • Open sores

  • Acne

  • Mucous membranes

 

If you follow standard precautions while caring for a person with HIV or AIDS, you will greatly reduce your chances of coming in contact with an infectious body fluid. Under standard precautions, it is clearly stated that ALL individuals are treated as if they are infectious, and if all are treated in the same manner, it does not matter who is infected.

 

 

Again, the most important thing you can do is wear gloves and wash your hands!

 

Reminder:

  • Gloves should be worn whenever there is the possibility that you might touch body substances, mucous membranes, or non intact skin. Be certain you remove the gloves promptly after use and wash your hands.

  • Remove gloves before touching non-contaminated objects such as doorknobs, and sink faucets. NEVER wear the same gloves to care for more than one patient.

  • Face masks, eye shields, and gowns are meant to protect you and your clothing during procedures and care provided. Use good judgment if there is any likelihood that you may be splashed by any body fluid.

  • All PPE must be replaced with clean PPE if they become torn or wet.

  • Remember to always wash hands after removing any PPE.

  • Be careful on how you handle equipment that is soiled.

  • Be careful not to shake or agitate soiled linens. DO not expose your skin or mucous membranes, your clothing, or anyone in your care to contaminated equipment or soiled linens.

  • Never use single use equipment more than once, and be certain that reusable items are properly cleaned and/or sterilized as appropriate prior to reuse.

  • Environmental surfaces such as beds, bedrails, and bedside equipment should always be cleaned and disinfected appropriately.

  • Do not ever recap a needle. There should never ever be time in which a needle should have to be recapped. If it is absolutely unavoidable, and it MUST be recapped for some reason, then be certain you use the one handed scoop method ONLY.

  • Dispose of used needles only in an approved hard rigid sharps container for this purpose. They should be discarded at the point of origin, and never carried down a hall uncapped. Never bend, break, or manipulate a needle in any way.

  • Use resuscitation devices instead of direct mouth to mouth resuscitation when needed. This prevents mucous membranes from being in direct contact during mouth to mouth resuscitation.

 

OSHA KEY TERMS

To better understand the standard, it is important to understand the following key terms:

Bloodborne Pathogen - Disease causing organisms (pathogens) present in human blood and or body fluids that can cause infection and disease in humans. A blood borne pathogen can be a bacteria or a viral organism that gets into the blood system causing many types of infections such as, HIV, Hepatitis, Meningitis, Syphilis, Malaria, Ebola, to name a few…..

 

Hepatitis B Virus ( HBV) - A potentially life threatening viral liver infection. Hepatitis means inflammation of the liver. For more on Hepatitis see online course related to Hepatitis Update 2003.

 

Hepatitis C Virus ( HCV) - Another significant type of hepatitis causing liver damage and disease.

 

Human Immunodeficiency Virus ( HIV) - The virus that causes AIDS, Blood borne pathogen that is incurable and fatal when progresses to AIDS.

 

Standard Precautions- An approach to infection control designed for patients and healthcare workers to use precautions to prevent coming in contact with blood or body fluids. All patients are assumed to be infectious and PPE should always be used.

 

Bloodborne Pathogen Standard per OSHA

 

OSHA’s Bloodborne pathogen standard, 29 CFR 1910.1030 as amended pursuant to the 2000 needle stick prevention act, is a regulation that prescribes safeguards to protect workers against health hazards related to blood borne pathogens. It is a provision dealing with exposure control plans, engineering and work practices and hepatitis B vaccinations. It also deals with hazard communication, training, and record keeping. The standard imposes laws of compliance for healthcare facilities to keep workers safe from blood and body fluid exposure.

 

The Exposure Control Plan

 

The blood borne pathogen standard requires employers to review and update their exposure control plan annually or whenever necessary to reflect new or modified tasks or procedures affecting employee exposure. The use of engineering controls such as sharp boxes, safety medical devices, PPE, and removal of regulated wastes.

 

All healthcare workers should be offered the hepatitis B vaccination at no cost to the employee if exposure to blood is possible. The employee has the right to decline the vaccination, but it has to recorded on a form that it was offered and refused, by OSHA law. The employee may choose to accept it at a later date. The employer must offer it free of cost to the employee upon request and consent.

 

As a primary method of employee protection, the Standard requires employers to eliminate or minimize exposure to blood and other potentially infectious materials, to consider using appropriate commercially effective safer medical devices to meet this obligation, and to document that the exposure control plan is updated at least annually.

 

The exposure control plan also includes adequate training for all staff who has a potential for exposure to blood, body fluids or any other potentially infectious material. There should always be a specific needle stick policy in all facilities as to how to treat, record and report such incidents.

 

Any activity performed by a healthcare worker that requires handling of contaminated devices, or exposure to blood and body fluids are to be evaluated on an ongoing basis and altered to reduce the likelihood of exposure, such as the use of puncture resistant containers, and not recapping needles.

 

There are many products becoming available all the time to reduce the risk of needle sticks and blood exposure. The primary purpose is to reduce workplace exposure to healthcare workers. Sometimes it will become necessary to learn how to use new products and be open to changes in the work environment that will promote safety and help reduce risks of potential exposure.

 

On the job education is mandated under OSHA. All employees in a healthcare facility who have the potential for exposure must be educated on initial employment and annually thereafter. The employee is taught the basics of bloodborne pathogens, modes of transmission and topics related to OSHA rules and regulations.

 

OSHA requires that an in-service record be maintained for a period of no less than three years, and all those trained need to sign and document that training was received in the workplace.

 

Exposure control plans identify those employees that are covered by the OSHA standard. It gives policies and procedures on implementation of the standard by eliminating or reducing the risk of exposure.

An exposure control plan also outlines specifically what an individual is expected to do if an exposure happens.

 

The exposure control plan includes six key areas of focus:

  1. Engineering controls

  2. Work place practice controls

  3. Personal Protective Equipment (PPE)

  4. Housekeeping practices

  5. Hepatitis B Vaccination

  6. Standard Precautions

 

Reporting Needle sticks

 

Each healthcare facility is required by law to have an exposure policy into place for employees who sustain a needle stick, blood exposure, mucous membrane splash, or exposure to non-intact skin.

The employee should know to report the incident IMMEDIATELY to a supervisor.

CDC recommends that no more than 2 hours should elapse from time of exposure to time of treatment. The employee should then be offered treatment which will include a physician evaluation, confidential medical evaluation and blood testing for HIV. The physician will want a baseline HIV test to assess current status of the exposed worker, and will most likely want a blood test done on the “ source patient” to determine if the source of exposure is potentially infectious. The employee may begin prophylaxis medication for exposure as the physician deems appropriate. The worker exposed will most likely be advised to follow up with HIV and Hepatitis blood testing in one month, three months, six months and one year.

 

Needle Safety Prevention Act

 

The Needle Safety Prevention Act directing OSHA to revise the bloodborne pathogens standard to establish a greater detail requiring employers to identify and make use of effective and safer medical devices. Employers are required under this act and by OSHA law to purchase and use any new equipment that is made available to protect healthcare workers from potential exposure, such as the use of needleless systems and IV start catheters with a protective sheath over the needle.

This revision was published on January 18, 2001 and became effective April 18, 2001.

 

 

 

A little more on PPE

 

According to the Bloodborne pathogen Standard, the provision of 1910.1030(d) (3) (i) provision states:

When there is an 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, masks, and eye protection, mouth pieces, and resuscitation bags/barriers.

 

Personal protective equipment will be considered “appropriate” only if it will not permit blood or other potentially infectious material to 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.

 

Summary

 

The revision to OSHA’s bloodborne pathogens standard added new requirements for employers, including additions to the exposure control plan and keeping a sharps injury log. It does not impose new requirements for employers to protect workers from sharps injuries. The original standard has provisions to protect employees from needle stick exposure. The original standard has already included a provision for work controls, and engineering control plans that would eliminate or reduce exposure from hazards associated with bloodborne pathogens.

 

The revision does in fact, specify in greater detail engineering controls, such as safer medical devices, which must be used to reduce or eliminate worker exposure.

 

By understanding OSHA regulations, and practice methods and techniques to keep safe, you will greatly reduce the likelihood of an exposure to a blood or body fluid exposure. Remember the keys to good hand washing, and the use of PPE. Remember that under universal and standard precautions we should treat all patients as if they are potentially infectious under all circumstances. By taking all necessary precautions, you can prevent coming in contact with diseases. One thought to think…. “ If it’s wet and sticky, and not yours, Don’t touch it!”

 

References:

www.osha.gov

 

OSHA Guidelines

Federal Administration Safety and Health

401 M. Street SW

Washington, DC 20460

 

Occupational Health and Safety

1835 Newport Blvd

Suite D - 258

Costa Mesa, California 92627

 

Occupational Safety and Health Administration

200 Constitution Avenue, NW

Washington, D.C. 20210