Occupational Health Issues Associated With Long Term Care Facilities

1. Occupational Health Issues Associated With Long Term Care Facilities • Bloodborne pathogens • Tuberculosis • Latex allergies • Hazard communication • Indoor air quality

2. Bloodborne Pathogens in Nursing Homes

3. 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

4. Universal PrecautionsTreat 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. Labels and signs • “BIOHAZARD” • Use of red bags and containers in stead of labels

12. Recordkeeping • Vaccination and other medical records • Training records

13. Medical Waste Handling • 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

14. 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

15. 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?

16. 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

17. 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

18. 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

19. 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)