Diagnostic Medical Parasitology. Lynne Shore Garcia
chief of microbiology at once for instructions on procedures for safe cleanup.
All laboratories should adhere to the concept of standard precautions, which state that all patients and all laboratory specimens are potentially infectious and should be handled accordingly (8, 24–26). This concept arose from the observation that infections are often unrecognized in patients. “Standard precautions” replaces earlier terms such as Blood and Body Fluid Precautions, Universal Precautions, and Body Substance Precautions found in OSHA documents (8, 26). The OSHA documents place the emphasis on blood-borne pathogens such as HIV and hepatitis B and C viruses, whereas the concept of standard precautions recognizes that all infectious agents and all other potentially infectious material, except sweat, pose a risk to the health care worker (8).
OSHA identifies a number of practices that should be implemented to protect the worker from exposure to blood-borne pathogens, including an exposure control and risk assessment plan (7). Methods should be implemented to minimize exposure to infectious agents, to shield the laboratory worker from infectious material through a set of engineering and work practice controls, and to use personal protective equipment. In addition, the OSHA regulations require that employers provide hepatitis B vaccination and postexposure evaluation and follow-up; communicate the hazards to employees; and maintain appropriate records (8). Employees who decline immunization against hepatitis B virus are required to sign a hepatitis B vaccine declination form.
Note Under circumstances in which differentiation between body fluid types is difficult or impossible, all body fluids shall be considered potentially infectious.
1. All job positions with any exposure to blood and body fluids must be listed on an exposure form, which must match up with continuing education training records from the facility.
A. Training must be provided at no cost to the employee and during working hours.
B. Training shall be provided as follows:
a. At the time of initial assignment to job functions in which occupational exposure may occur
b. Within 90 days after the effective date of the standard
c. At least annually thereafter
2. A complete task assessment must be performed for employees who have any exposure; protective measures, including equipment, must be defined.
A. Engineering controls
B. Immunization programs
C. Work practices (hand washing and procedures for handling sharps)
D. Disposal and handling of infectious waste
E. Use of personal protective gloves, gowns, and goggles
F. Use of mouthpieces, resuscitation bags, or other ventilation devices
G. Use of disinfectants
H. Labeling and signs
I. Training and education programs
J. Postexposure follow-up
Some of the specifics are as follows:
A. All procedures shall be performed to minimize splashing, spraying, spattering, and generation of droplets of these substances.
B. When there is occupational exposure, the employer shall provide, at no cost to the employee, PPE such as (but not limited to) gloves (including hypoallergenic gloves, glove liners, powderless gloves, or other alternatives), gowns, laboratory coats, face shields or masks, and eye protection. Other options might include mouthpieces, resuscitation bags, pocket masks, or other ventilation devices.
C. PPE is considered “appropriate” only if it does not permit blood or other potentially infectious materials to pass through or to reach the employee’s work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes. The type and characteristics of outer garments depend on the tasks and degree of exposure anticipated.
D. All working surfaces shall be cleaned and decontaminated after contact with blood or other potentially infectious materials. All spills shall be immediately contained and cleaned up by appropriate professional staff or others trained and equipped to work with potentially concentrated infectious materials.
E. Specimens of blood or other potentially infectious materials shall be placed in a container which prevents leakage during collection, handling, processing, storage, transport, or shipping (27–29).
F. Mouth pipetting or suctioning of blood or other potentially infectious material is prohibited.
G. Certified BSCs or other combinations of personal protection or physical containment devices shall be used for all activities that may pose a threat of exposure. BSCs shall be certified when installed, whenever they are moved, and at least annually.
3. Key questions that people ask concerning these rules are listed below (30).
A. How does OSHA define “occupational exposure”?
“Reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties”
B. What does “reasonably anticipated” mean?
“Actual contact would be expected during an autopsy or surgery. In these cases, blood or other potentially infectious materials come in direct contact with the employee’s gloves or other protective clothing. In other cases, contact may not occur each time the task or procedure is performed, but when blood or other potentially infectious materials are an integral part of the activity, it is reasonable to anticipate that contact may result.”
C. What should the exposure control plan contain?
“The Exposure Control Plan is a key provision because it requires the employer to identify the individuals who will receive the training, protective equipment, vaccination, and other provisions of the standard.”
D. What is considered “appropriate” personal protective equipment?
“Gloves, gowns, lab coats, face shields or masks and eye protection, mouthpieces, resuscitation bags, pocket masks, or other ventilation devices. Such protection will be considered ‘appropriate’ only if it does not permit blood or other potentially infectious materials to pass through to or to reach the employee’s work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used. The type and characteristics of outer garments will depend upon the tasks and degree of exposure anticipated.”
E. Does this mean that protective clothing must be “impervious” or “fluid-proof”?
“Selection of personal protective equipment is performance-oriented. Selection of the type and characteristics of necessary personal protective equipment is based upon the exposure anticipated to be associated with the task. In those instances where such equipment was incapable of halting penetration of blood or other potentially infectious materials normally encountered during a procedure, then additional protection such as a plastic apron should be worn or used.”
Note