Occupational Health Issues Associated With Long Term Care Facilities

Bloodborne pathogens Tuberculosis Latex allergies Hazard communication Indoor air quality

Bloodborne Pathogens in Nursing Homes

Exposure Control Plan

Exposure Determination - List of job classifications (all employees exposed, some exposed) - List of tasks and procedures where exposure may occur (without regard to use of ppe) Methods of Compliance - Universal Precautions - Engineering Controls - Work Practice Controls - Personal Protective Equipment

Universal Precautions
Treat all blood samples and potentially infected materials as if infected..

Use proper personal protective equipment Immediate washing of hands and other skin surfaces if contact with materials Wash hands immediately after glove removal Management of sharps Exposure incident reporting and follow-up Spill response

Engineering and Work Practice Controls

Handwashing facilities and procedures Contaminated needles handling (no bending, recapping) Placement of used sharps in special containers (puncture resistant, labeled, leakproof, color coded) No eating, drinking, smoking, hangling contacts, use of cosmetics in exposure areas No storage of food where blood is present Minimize splashing, spraying, spattering No mouth pipetting Placement of blood in leakproof containers ( labeled, color coded) De-contamination of equipment

Personal Protective Equipment

Must be provided, cleaned, laundered, disposed of, replaced, and used properly. Gloves, gowns, face shields, masks, resusitation bags, eye protection, aprons, and caps Consider possibility of soiling (aprons when changing dressing), and spattering (eyewear during mouth examinations) Cleaning and disposal Removal before leaving workplace Stored in containers after use

Housekeeping

Keep written schedules and methods of cleaning and decontaminating surfaces and equipment Maintain clean and sanitary worksite De-contaminate work surfaces Use protective coverings Cleaning of receptacles, pails, bins No hand contact with broken contaminated glassware Handling of re-usable sharps

Discarding of contaminated sharps

Container must be closable, puncture resistant, leakproof, labeled and color coded Keep closed Secondary containment if leak occurs Disposal according to Federal, State, local requirements

Handling of contaminated laundry

Bag and containerize where used (no rinsing or sorting) Bags labeled and color coded and leakproof Protective gloves used when handling laundry

Employee training

Available hepatitis B vaccine, post exposure evaluation, and follow-up to employees who had incident Training at initial assignment and annually OSHA standard Explanation of HIV and hepatitis B diseases Modes of transmission Exposure identification Tasks which involve exposure Methods used to prevent exposure Personal protective equipment use Decontamination procedures Emergency procedures Exposure incident procedures

Labels and signs

BIOHAZARD Use of red bags and containers in stead of labels

Recordkeeping
Vaccination and other medical records Training records

Medical Waste Handling

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State and local laws (44 states require disposal and tracking) and RCRA Subtitle J Medical Waste Tracking Act Demonstration Program Council of State Govenors - Model State Plans for Medical Waste Identify waste Packaging and lable Segregation Destruction of waste Disposal - most require treatment before disposal Recordkeeping and tracking Training employees Incineration, steam autoclave, microwave, grinding and chemical treatment Transporter and disposal site permitting and insurance concerns

Tuberculosis

Drug resistant strains Homeless population HIV 14% increase since 1985 (recent decline due to greater awareness) Outbreaks in hospitals, homeless shelters, nursing homes, and AIDS residential care centers TB is an inhalable airborne infectious disease

OSHA Enforcement Policy

In response to employee complaints, or Part of regular IH inspection for CDC identified workplaces - Health care facilities, homeless shelters, LTC facilities, correctional institutions, and drug treatment centers Inspect if confirmed or suspected TB in passed 6 months Based on 1994 CDC revised guidelines Use of general duty clause 5(a)(1) - ...workplace free of recognized hazards ... Infection control plan Proposed standard in 1997?

Infection Control Plan

Early detection through skin tests Training and information - signs and symptoms - medical surveillance and therapy - Site procedures - Use of controls Medical screening and re-test every 6 months ( 3 months for high risk and 12 months for low risk) Management and restriction of infected individuals Isolation rooms under negative pressure and warning signs PPE - HEPA respirators

Latex Allergies

Rise in latex glove use as result of OSHA bloodborne pathogen standard and CDC recommendations for universal precautions Affects about 8% to 10% of health care workers Direct skin contact with latex or airborne powders from inside Severity and hypersensitivity grows with exposure Symptoms include contact dermatitis, anaphylactic shock, respiratory failure Can be confirmed through patch skin testing Cornstarch powder can carry latex protein and become airborne - air sampling can be done to assess exposure Control through education, substitution, low powder/low allergy gloves, manufacturing rinse processes, complete avoidance, and medical history and screening New non-powdered gloves, low allergen gloves, non-latex gloves, establishment of safe zones for sensitized

Hazard Communication Plan

OSHA 29CFR1910.1200 Written plan Labeling of hazardous materials MSDSs obtained and available Employee training - Health effects - Signs and symptoms of exposure - Controls - OSHA requirements

Indoor Air Quality/Sick Building Syndrome

Sensitive elderly population Investigation techniques - Questionnaire - Air sampling (specific contaminants or indicator gasses) - Ventilation evaluation - Heat/humidity evaluation Sources (chemical, biological, inside, outside, chemicals, off-gassing of furnishings) Controls (low emmission furnishings, HVAC maintenance, chemical control, local ventilation of sources, moisture control, fresh air volume and mixing) Standards (chemical levels, CO, ventilation)