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OSHA(Occupational Safety and Health Act)

Standards

  1. OSHA is responsible for promulgating legally enforceable standards.
  2. OSHA standards may require conditions or the adoption or use of one or more practices, means, methods or processes reasonable, necessary and appropriate to protect workers on the job.
  3. It is the responsibility of employers to become familiar with standards applicable to their establishments and to ensure that employees have and use personal protective equipment(PPE) when required for safety.
  4. Employees must comply with all rules and regulations which are applicable to their own actions and conduct.

Standards Development

  1. OSHA can begin standard-setting procedures or investigations on petitions from other parties.

For example, an employee might fell that safety precautions in the workplace are insufficient and complain. This would begin an investigation of the wokplace.
Negative Sanctions

  1. Fines are levied in accordance with the nature of the violation. These fines can be quite substantial.

Health Care Worker Risk Assessment
A health care worker is defined as anyone employed in the health care industry. This definition covers apprentices, students, housekeepers or others who may come into contact with contaminated materials.

Any employee who may come in contact with human blood or other potentially infective material and who comes under the blanket of OSHA¬°¯s area of concern will be affected by this standard. For this reason, acupuncturists and their affected staff members must undergo training as specified by the new standard. g 2 vii(A-M)

The new OSHA standards draw heavily on information and recommendations from the Centers for Disease Control(CDC). As early as 1986, the CDC was publishing recommendations based on the premise that any patient could be infected with a bloodborne pathogen (BBP). Therefore, it is necessary to treat each potential exposure as if the blood, needles or other materials were infected. This is called Universal Precautions.

The information from CDC regarding the nature of the transmission of infection was combined with state-of-the-art knowledge of personal protective equipment and safety in the workplace as defined by OSHA. The Universal Precautions recommendation combined with the need to inform employees of the risks involved in their occupation, the way infection could be transmitted, and the proper equipment and procedures which could minimize the risk. This is the basis of new OSHA standards.

Who Is At Risk

  1. Individuals at risk of infection

Those handling blood or blood products are at the greatest risk for HBV infection. This includes health care workers, health care providers, morticians and employees and residents of mental institutions and prisons. Also included are household members of and those intimate with an HBV-infected person. People who have multiple sexual contacts and IV drug users are also at risk. Those infected with or carrying HBV run the risk of acquiring hepatitis D, or delta factor virus. Hepatitis D has the effect of potentiating HBV, causing a more virulent illness with increased risk of possibly fatal hepatitis and serous sequela such as liver cancer.

  1. Studies in numerous medical journals such as NEJAMA and JAMA have indicated that some health care workers are at greater HBV risk than others. The table below presents some of those findings. We can see that workers who are exposed to blood, and other potentially infectious material have greater risk than others. Those handling trauma such as ER nurses, surgeons who may be injured with sharps during surgery, lab personnel who work with blood specimens, and workers who handle blood and sharps which produce needlestick/percutaneous injuries have a higher HBV risk percentage than those who have no patient contact. There is almost no data to help acupuncturists determine their risk level. But we work with sharps and are exposed to blood. Therefore we are at risk.

 

Personal Protective Equipment
Gloves
Gloves provide a barrier. They should be worn whenever there is a reasonable likelihood that blood or other potentially infectious materials will be contacted such as removing needles.

Gloves must be provided in correct size and sufficient quantity and inappropriate distribution in work area (in every room). If gloves cause skin irritationother brands including hypoallergenic are available. Thin cotton liners are available for those who are unable to wear gloves. They should be changed frequently and whenever wet or visible contaminated.

Although not required by OSHA, good infection control practices would require changing gloves between each patient.

General Rules-Gloves

  1. Remember to wash and dry hands each time gloves are removed.
  2. Do not apply hand lotion prior to gloving as dampness causes a wicking phenomena.
  3. If moisture exists inside or outside the gloves, potentially infectious materials such as virus can be drawn through the pores in the gloves. For this reason gloves cannot be reused or rewashed.
  4. If you accidentally get blood on your hands wash immediately.
  5. Utility gloves or thick rubber gloves are use when using chemicals such as decontamination of surfaces or handling reusable materials must be worn. They can be washed or reused.
  6. Latex and vinyl gloves deteriorate in disinfectants and bleach and cannot be used. Use rubber utility gloves.

Face Protection
Face protection must be worn whenever a procedure is likely to result in aerosols (small airborne particles) or splashing.

Goggles (decontaminated after use) can be used to protect eyes.

Masks (usually disposable or decontaminated after use) are used to protect mouth and nasal mucosa.

Face shields which cover both eyes and mouth can be obtained in either reusable (need to be decontaminated) and disposable varieties.

 

OSHA's mission is to assure the safety and health of America's workers by setting and enforcing standards; providing training, outreach, and education; establishing partnerships; and encouraging continual improvement in workplace safety and health.
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