Emergency Room Health Risks
From bloodborne pathogens to hazardous chemicals, there are many different types of health risks emergency department (ED) personnel have to deal with on a regular basis.
This module will take a closer look at some possible solutions to keep workers safe.
Blood, OPIM, and Bloodborne Pathogens
Emergency department workers are at particular risk for exposure to blood, other potentially infectious materials (OPIM), and bloodborne pathogens due to the immediate
and life-threatening nature of emergency treatment.
The Bloodborne Pathogen Standard requires precautions when dealing with blood and OPIM.
Here are some ways to reduce bloodborne pathogens and OPIM when working with blood:
- Provide engineering and work practice controls.
- Engineering and work practice controls must be the primary means to eliminate or minimize exposure to bloodborne pathogens. Where engineering controls will reduce employee exposure either by removing, eliminating, or isolating the hazard, they must be used, and changes to the Exposure Control Plan (ECP) must include these engineering controls.
For more information on creating an ECP, please see OSHAcademy course 655-Bloodborne Pathogens in the Workplace.
- Ensure employees wear appropriate personal protective equipment (PPE), gloves, gowns, and face masks, when anticipating blood or OPIM exposure
[29 CFR 1910.1030(d)(3)(i)].
- Ensure employees discard contaminated needles and other sharp instruments immediately, or as soon as feasible, after use into appropriate containers
[29 CFR 1910.1030(d)(4)(iii)(A)(1)]
- Provide in their exposure control plan documentation of consideration and implementation of appropriate commercially available and effective engineering
controls designed to eliminate or minimize exposure to blood and OPIM.
[Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens.]
- Practice Universal Precautions: Treat all blood and other potentially infectious body fluids as if they are infected and take appropriate precautions to avoid
contact with these materials [29 CFR 1910.1030(d)(1)].
- The Bloodborne Pathogens Standard does allow hospitals to practice acceptable alternatives to
Universal Precautions such as Standard Precautions or Body Substance Isolation.
- The Revised Bloodborne Pathogen Standard requires needlestick/sharps injuries be
recorded on a Sharps Injury Log 29 CFR 1910.1030(h)(5).
The sharps injury log must be established and maintained and the confidentiality of the injured employee must be protected.
- Follow-up area for needlestick injuries and/or exposure incidents: The Bloodborne Pathogens Standard
29 CFR 1910.1030(f)(3) requires the employer to make immediately available a confidential medical evaluation and follow-up to an employee reporting an exposure incident. This follow-up often occurs in the emergency department.
Employee exposure to hazardous chemicals, such as pesticides, disinfectants, and hazardous drugs in the workplace.
- A program should be in place to maximize employee safety during decontamination of patients.
- A program should be in place to maximize employee safety during administration, disposal, and preparation of hazardous drugs.
OSHA requires employers to implement a written program that meets the requirements of the Hazard Communication Standard (HCS) to provide for worker training, warning labels, and access to
Material Safety Data Sheets (MSDSs).
The Hazard Communication Standard ensures employee awareness of the
hazardous chemicals they are exposed to in the workplace.
For more information on the Hazard Communication Standard, please see OSHAcademy course 705: Hazard Communication
Slips, Trips, and Falls
Because of the emergency atmosphere, (i.e., high traffic and compact treatment spaces) slips/trips/falls may be a specific concern for ED areas.
There is a potential slip and fall hazard if water is spilled on the floor accidentally, electrical cords run across pathways, and/or if emergency equipment or supplies block passageways.
It is estimated that 8-12 percent of health care workers are latex sensitive with reactions ranging from irritant contact dermatitis and allergic contact sensitivity, to immediate,
possibly life-threatening, sensitivity. Some ED employees may develop a latex sensitivity or allergy from exposure to latex in products like latex gloves.
Many workers who are not traditional health care workers, such as housekeepers, laundry workers, and gardeners, may also be exposed to latex products and latex allergy.
- Employers must provide appropriate gloves when exposure to blood or other potentially infectious materials (OPIM) exists.
- Alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided
[29 CFR 1910.1030(d)(3)(iii)].
Emergency department (ED) staff may be exposed to Tuberculosis (TB) and other infectious agents from patients in waiting room and treatment areas. They may be treating an emergency and be
unaware of other pre-existing infectious conditions.
- Provide and practice early patient screening in the ED to identify potentially infectious patients, and provide isolation to prevent employee exposures. The Centers for Disease Control
guidelines say ED employees should treat patients as having suspected infectious TB if they have both a persistent cough lasting at least three weeks, and at least two of the following additional symptoms:
- bloody sputum
- night sweats
- weight loss
- Provide engineering, work practice, and administrative procedures to reduce the risk of exposure. For example:
- Patients with a productive cough could be asked to wear a mask to prevent the spread of infection.
- Post waiting rooms signs that state, "If you are coughing you may be asked to wear a mask."
- Isolate patient until verification testing is negative.
- Some EDs provide an isolation room to safely isolate potentially infectious patients. Others can designate an isolation area for infectious patients. Isolation rooms must be respiratory acid-fast
bacilli (AFB) rooms that are maintained under negative pressure. AFB isolation refers to a negative-pressure room or an area that exhausts room air directly outside or through HEPA filters if
re-circulation is unavoidable.
- Protect employees from exposure to the exhaled air of an individual with suspected or confirmed TB
[29 CFR 1910.134(a)(2)].
- Isolate patients who have suspected or confirmed TB.
- Post a warning sign outside the ED respiratory isolation room
29 CFR 1910.145(a)(1) to prevent accidental entry. 29 CFR 1910.145(f)(4) requires that a signal word (i.e. "STOP", "HALT", or "NO ADMITTANCE") or biological hazard symbol be presented
as well as a major message. An example of a description of necessary precautions is "Respirators must be donned before entering."
- Employers must provide suitable respirators when such equipment is necessary to protect the health of the employee
[29 CFR 1910.134(d)(1)(i)].
The minimally acceptable level of respiratory protection for TB is the Type N95 Respirator.
- Establish and maintain a respiratory protective program which includes the requirements outlined in [29 CFR 1910.134(c)].
- Worker education: OSHA requires worker education and training to ensure employee knowledge of TB, including signs, symptoms, transmission, controls, and post-exposure protocols.
Methicillin-Resistant Staphylococcus Aureus (MRSA)
ED staff can be exposed to MRSA infections from environmental sources (e.g., homeless patients or IV drug abuse patients). Staff can become infected and then become carriers who can infect
other staff members or patients. As MRSA becomes more resistant to antibiotics such as methicillin and potentially vancomycin, it will become more difficult to treat.
- Hospitals in different geographical locations will need to establish their own local MRSA data and provide treatment information to clinicians.
- Practice Universal Precautions to help protect employees from infection.
- Universal Precautions is an approach to infection control to treat all human blood and certain human body fluids as if they were known to be infectious for HIV, HBV and other bloodborne pathogens.
- The CDC's recommendations for preventing transmission of MRSA in hospitals consist of Standard Precautions, which should be used for all patient care. In addition, the CDC
recommends “contact precautions” (used for infections spread by skin to skin contact or contact with other surfaces such as herpes simplex virus) in special cases, when the
facility deems the multi-drug-resistant microorganism to be of special clinical and epidemiological significance.
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