Healthcare workers face a wide range of hazards on the job, including needlestick injuries, back injuries, latex allergy, violence, and stress. Although it is possible to prevent or reduce exposure to such hazards, healthcare workers continue to experience these injuries and illnesses in the workplace. With ongoing training and education, we can reduce the number of injuries and illnesses afflicting clinicians and patients.
Bloodborne Pathogens in the Healthcare Environment
Bloodborne pathogens, such as bacteria and viruses, are present in blood and body fluids and can cause disease in humans. The bloodborne pathogens of primary concern are Hepatitis B, Hepatitis C and HIV. These and other bloodborne pathogens are spread primarily through:
- Direct contact – Infected blood or body fluid from one person enters another person’s body at a correct entry site, such as infected blood splashing in the eye.
- Indirect contact – A person’s skin touches an object that contains the blood or body fluid of an infected person, such as picking up soiled dressings contaminated with an infected person’s blood or body fluid.
- Respiratory droplet transmission – A person inhales droplets from an infected person, such as through a cough or sneeze.
- Vector-borne transmission – A person’s skin is penetrated by an infectious source, such as an insect bite.
Healthcare workers are urged to take advantage of available engineering controls and work practices to prevent exposure to blood and other body fluids. Follow standard precautions to help prevent the spread of bloodborne pathogens and other diseases whenever there is a risk of exposure to blood or other body fluids. These precautions require that all blood and other body fluids be treated as if they are infectious. Standard precautions include maintaining personal hygiene and using personal protective equipment (PPE), engineering controls, work practice controls, and proper equipment cleaning and spill cleanup procedures.
To Prevent Infection, Follow These Guidelines:
- Avoid contact with blood and other body fluids.
- Use CPR breathing barriers, such as resuscitation masks, when giving ventilations (rescue breaths).
- Wear disposable gloves whenever providing care, particularly if you may come into contact with blood or body fluids. Also wear protective coverings, such as a mask, eyewear and a gown, if blood or other body fluids can splash.
- Cover any cuts, scrapes or sores and remove jewelry, including rings, before wearing disposable gloves.
- Change gloves before providing care to a different victim.
- Remove disposable gloves without contacting the soiled part of the gloves and dispose of them in a proper container.
- Thoroughly wash your hands and other areas immediately after providing care. Use alcohol-based hand sanitizer where hand-washing facilities are not available if your hands are not visibly soiled. When practical, wash your hands before providing care.
To Reduce the Risk of Exposure, Follow These Engineering and Work Practice Controls:
- Use biohazard bags to dispose of contaminated materials, such as used gloves and bandages. Place all soiled clothing in marked plastic bags for disposal or cleaning. Biohazard warning labels are required on any container holding contaminated materials.
- Use sharps disposal containers to place sharps items, such as needles.
- Clean and disinfect all equipment and work surfaces soiled by blood or body fluids.
- Use a fresh disinfectant solution of approximately 1½ cups of liquid chlorine bleach to 1 gallon of water (1 part bleach per 9 parts water, or about a 10% solution) and allow it to stand for at least 10 minutes.
- Scrub soiled boots, leather shoes and other leather goods, such as belts, with soap, a brush and hot water. If worn, wash and dry uniforms according to the manufacturer’s instructions.
If You Are Exposed, Take the Following Steps Immediately
- Wash needlestick injuries, cuts and exposed skin thoroughly with soap and water.
- If splashed in or around the eyes, irrigate with clean water, saline or sterile irrigants for 20 minutes.
- Report the incident to the appropriate person identified in your employer’s exposure control plan immediately, located in your Orientation Handbook. Additionally, report the incident to emergency medical services (EMS) personnel who take over care.
- Record the incident by writing down what happened. Include the date, time and circumstances of the exposure, any actions taken after the exposure, and any other information required by your employer.
- Seek immediate follow-up care as identified in your employer’s exposure control plan, located in your Orientation Handbook.
Occupational Safety and Health Administration (OSHA) regulations require employers to have an exposure control plan, a written program outlining the protective measures the employer will take to eliminate or minimize employee exposure incidents. The exposure control plan guidelines should be made available to employees and should specifically explain what they need to do to prevent the spread of infectious diseases.
Additionally, OSHA requires that a Hepatitis B vaccination series be made available to all employees who have occupational exposure within 10 working days of initial assignment, after appropriate training has been completed. However, employees may decide not to have the vaccination. The employer must make the vaccination available if an employee later decides to accept the vaccination.
Check out OSHA’s website (www.osha.gov) or refer to your employer’s exposure control officer for more information on OSHA’s Bloodborne Pathogens Standard (29 CFR part 1910.1030).
Infection Control Practice
Instruments and other reusable equipment used in performing invasive procedures should be appropriately disinfected and sterilized by keeping the following in mind.
- Equipment and devices that enter the patient’s vascular system or other normally sterile areas of the body should be sterilized before being used for each patient.
- Equipment and devices that touch intact mucous membranes, but don’t penetrate the patient’s body surfaces should be sterilized when possible or undergo high-level disinfection if they cannot be sterilized before being used for each patient.
- Equipment and devices that do not touch the patient or that only touch intact skin of the patient need only be cleaned with a detergent or as indicated by the manufacturer.
Preventing Needlestick and Sharps Injuries
Needlestick and other sharps injuries are a serious hazard in any healthcare setting. Contact with contaminated needles, scalpels, broken glass, and other sharps may expose healthcare workers to blood that contains pathogens which pose a grave, potentially lethal risk.
Employees should avoid using needles whenever safe and effective alternatives are available and avoid recapping or bending needles that might be contaminated. Employees should bring standard-labeled, leak-proof, puncture-resistant sharps containers to clients’ homes. Employees should not assume that such containers will be available there. Promptly dispose of used needle devices and sharps, which might be contaminated, in the containers. Always plan for the safe handling and disposal of needles before use. Storing sharps containers out of reach of children, pets and others who don’t need access reduce the risk of injury. Secure used sharps containers during transport to prevent spilling. Make sure to follow standard precautions, infection prevention, and general hygiene practices consistently. Plan to participate in bloodborne pathogens training programs and help your employer select and evaluate devices with safety features. Always use devices with safety features provided by your employer. Please report any needlestick and other sharps injury immediately to your employer.
Home healthcare workers can be at risk for needlestick or sharps injuries when they are involved in any of the following activities:
- Handle needles that must be taken apart or manipulated after use.
- Dispose of needles attached to tubing.
- Manipulate the needle in the client.
- Recap a needle.
- Use needles or glass equipment to transfer body fluid between containers.
- Fail to dispose of used needles in puncture-resistant sharps containers.
- Lack proper workstations for procedures using sharps.
- Work too quickly.
- Bump into a needle, a sharp, or another worker while either person is holding a sharp.
Compliance with universal precautions and recommendations for disinfection and sterilization of medical devices should be scrupulously monitored in all healthcare settings. Training of healthcare workers in proper infection control technique should begin in professional and vocational schools and continue as an ongoing process. Institutions should provide all healthcare workers with appropriate in-service education regarding infection control and safety and should establish procedures for monitoring compliance with infection control policies. All healthcare workers who might be exposed to blood in an occupational setting should receive a Hepatitis B vaccine, preferably during their period of professional training and before any occupational exposures could occur.
All healthcare workers should adhere to universal precautions, including the appropriate use of hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments. Those who have exudative lesions or weeping dermatitis should refrain from all direct patient care and from handling patient-care equipment and devices used in performing invasive procedures until the condition resolves. Healthcare workers should also comply with current guidelines for disinfection and sterilization of reusable devices used in invasive procedures.