In December 29, 1970 the 91st Congress of the United States of America enacted the Occupational Safety and Health Administration (OSHA), a set of rules and regulations aimed to assure safe and healthful working conditions for working men and women, especially those in the medical field. The goal of the act is to establish a safe working environment for everyone.
The act places special importance to health workers because they are especially at risk of injury due to the nature of their job. Consider the following facts:
- Hepatitis B virus (HBV), a blood-borne hazard, infects 8,700 workers a year resulting in hospitalizations and 200 deaths among health care workers. HBV is asymptomatic in most cases and can easily spread through exposure to blood, semen and vaginal fluids. People infected with HBV die due to liver failure, cirrhosis and liver cancer. It has no cure.
- Hepatitis C virus (HCV), also a blood-borne hazard, affects approximately 400,000 people and kills 10,000 yearly. It has no vaccine and has no cure.
- HIV, another blood-borne disease that causes AIDS, can spread through needlestick injury and cuts; estimates show that nearly 16,000 needlestick injuries may be contaminated with HIV. Once infected, the person carries the virus and may spread it to others without exhibiting symptoms. Once full-blown symptoms develop (AIDS), the person dies from numerous diseases due to a compromised immune system.
- HBV, HCV and HIV viruses can be present in blood, semen, vaginal secretions and cerebrospinal fluids. It can also be present in unfixed tissue or organs, cell and tissue cultures, culture media and donated blood.
In addition, these diseases can be transmitted by exposure of open cuts, nicks and even dermatitis and acne and mucous membranes, and indirect transmission by touching a contaminated object and transferring infectious material into the mouth, nose and eyes or open skin. Handling other sharp objects, like ends of dental wires and broken glass, can also allow blood borne pathogens to enter the body too.
Health care workers perform more hypodermic needle injections, handle blood, tissues and organs, use more scalpels and blades, do or assist in surgical operations and perform intra-vaginal procedures than any other profession worldwide. This means they are especially at risk of being infected with blood-borne diseases.
General duty clause
In the Act, it states that employers must provide a hazard-free environment for his employees:
“Each employer shall furnish to each of his employees employment and a place of employment, which are free from recognized hazards that are causing or likely to cause death or physical harm to employees.”
Penalties
Violations may result in citations and fines for the employer if discovered. In addition, the employer maybe found liable under state laws too.
Here are some penalties employers can incur for varying degrees of violations:
Willful $25,000 to $70,000 maximum
Serious $7,000
Less than serious $1,000 to $7,000
Repeat $7,000
de Minimus Technical violation with no fine
Standard (Universal) Precautions
Since many people with HIV, HCV and HBV infection do not exhibit symptoms or may only display flu-like symptoms, OSHA states that all health workers must treat all blood and body fluids (except sweat) as if infected with blood borne pathogens.
It also states that all health workers must wear personal protective equipment (PPE) whenever they handle such fluids.
Risk Reduction
The OSHA states that all health workers must employ methods designed to reduce risk of harming themselves while doing their work. One of the best methods to reduce risk is use of personal protective equipment, good housekeeping, work practice controls, engineering controls and vaccinations.
Engineering controls
Use of physical or mechanical systems to reduce risk of injury at source such as:
- Sharps with Engineered Sharps Injury Protection (SESIP) like self-sheathing needles and one-use syringes
- Needleless systems
- Sharps disposal containers
- Biosafety cabinets
- Autoclaves
Work Practice Controls
These are specific procedures aimed to reduce exposure to injury:
- Avoid needle sticks by careful use of syringes
- Do not bend, hand recap, shear or break needles/sharps
- Only remove or recap needles when medically necessary. For recapping, use a mechanical device or one-handed technique
- Place used or discarded sharps in puncture-resistant, leak-proof container immediately
- Immediately report any sharps containers mounted improperly, at risk of spillage and actual spillage
- Wash hands using proper technique before and after use of gloves, in contact with blood or infectious fluids (flush with water ASAP)
- If hand washing facilities are unavailable, use antiseptic hand cleanser or towelettes. But wash hands ASAP
- Avoid using abrasive soaps, which can cause microscopic nicks and tears during hand washing
- Avoid using bleach when washing hands because it can corrode skin
- Minimize splashing when working around with blood
- Do not eat and apply cosmetics in potential exposure situations
- Never use mouth for pipetting, and never use petroleum-based lubricants (i.e. petroleum jelly) on latex gloves
Personal protective equipment (PPE)
PPE is equipment designed to protect specific areas of the body from infectious materials. It includes:
- Gloves
- Masks
- Gowns
- Aprons
- Lab coats
- Face shields
- Protective eyewear
- Mouth covers
- Resuscitation bags and ventilation devices for CPR
OSHA states that employers must furnish PPE to employees at no cost, and must carry the cost of ways of disposing used PPE.
Good housekeeping
Health workers must employ good housekeeping at all times to protect their health and their patients. It is the responsibility of every worker:
- Cleaning and decontamination at the end of work shift
- Use of protective covering equipment at the end of the shift
- Use of tongs or brush and dust pan to pick up broken glass
- Placing sharps and infectious waste into its appropriate containers
- Special handling of laundry to minimize touching and agitation
- Placing warning labels (biohazard signs, orange-red color)on potentially contaminated materials or equipment
Vaccinations
It is stated that:
- Employers must vaccinate employees with HBV vaccine at no cost within 10 days of hire
- Vaccine is administered by 3 vaccinations over a six-month period
- For cases of exposure, the source must be identified and documented with consent from patient. Then the affected employee must be tested for titers and given HBV prophylaxis, then counseled and watched for symptoms. All must be provided at no cost to the employee.