ATrain Education

 

Continuing Education for Health Professionals

Bloodborne Pathogens: HBV, HCV, and HIV

Module 3

Engineering Controls

[Material in this section is largely from OSHA, 2013a.]

Engineering controls are devices that isolate or remove the bloodborne pathogen hazard from the workplace. They include:

  • Hand washing, that sends pathogens on hands down the drain and out of the workplace
  • Elimination of hazardous materials from the workplace, such as the replacement of a hazardous chemical with a safer one or needleless systems for injection
  • Devices that contain the hazard, such as specimen containers, safety sharps, sharps disposal containers, and red bags

Engineering controls, including facilities for hand washing, must be maintained or replaced on a regular schedule to ensure their effectiveness. When handwashing facilities are not available, an antiseptic hand cleanser should be provided. Hands must be washed after gloves are removed or any time there is skin contact with blood or other body fluids.

Specimen containers should not leak; if there is a possibility of leakage a secondary container must be used.

Safety When Handling Sharps

[Material in this section is largely from OSHA, 2013a.]

The federal OSHA Bloodborne Pathogens Standard was amended in 2001 to add the provisions of the Needlestick Safety and Prevention Act of 2001 (public law 106-430). Since then, safety syringes are required for use whenever possible in healthcare facilities. This legislation mandates that institutions conduct annual product reviews of sharps safety devices and that non-managerial employees be involved in the decision-making process.

An estimated 800,000 needle sticks and other sharps injuries are reported each year but the CDC believes that even more such injuries go unreported. Researchers at Johns Hopkins University reported that nearly 60% of medical school graduates surveyed had been stuck by a needle during medical school but half of them did not report the injury to hospital officials. The primary reason for not reporting was the amount of time and paperwork involved in making a report. Those surveyed had trained to become surgeons at seventeen medical centers in the United States (Sharma et al., 2009).

Two-thirds of nurses report being accidentally stuck by a needle while working and three-fourths of them were contaminated needle sticks. Although the overwhelming majority of nurses knew the workplace protocol concerning needle stick injuries, only 7 out of 10 reported the incident (ANA, 2008).

Evaluation and implementation of safer medical devices must be documented in the exposure control plan. Safer medical device lists can be accessed through websites maintained by the California Division of Occupational Safety and Health SHARP program, the National Association for the Primary Prevention of Sharps Injuries, and the International Healthcare Worker Safety Center.

Care must be used whenever handling sharps, especially contaminated sharps. Needlesticks and other sharps injuries carry extra risk of exposure since they bypass the protection of intact skin.

The best way to prevent cuts and sticks is to minimize contact with sharps. That means:

  • Not using a sharp when an alternative method is available
  • Activating safety sharps immediately following completion of use
  • Disposing of used sharps immediately

A needlestick or a cut from a contaminated scalpel can lead to infection by one of the bloodborne viruses. Risk of infection varies by which pathogen is involved.

Puncture-resistant containers must be available nearby to hold contaminated sharps. When reusable sharps must be used, puncture-resistant transport containers must not require employees to reach a hand into the holding container.

Recapping, bending, or removing needles should not be done unless there is no feasible alternative or if required for a specific medical procedure. If recapping, bending, or removal is necessary, workers must use either a mechanical device or a one-handed technique. If recapping is required, a one-handed “scoop” technique may be used, using the needle itself to pick up the cap, pushing cap and sharp together against a hard surface to ensure a tight fit.

There has been considerable media attention about disease outbreaks caused by unsafe injection practices. The CDC has reported nearly 50 outbreaks linked to unsafe injection practices, with more than 150,000 patients affected since 2001. These outbreaks have included transmission of hepatitis B and C as well as bacterial infections.

Syringes and needles must be used for only one patient in every circumstance. This is a matter of protecting patients from diseases spread by injection. It is a matter of good science and is not addressed by OSHA. 

Sharps Containers

[Material in this section is largely from OSHA, 2013a.]

Containers of used sharps are regulated waste and must be handled as specified in the Standard. They must be puncture-resistant, closable, and the sides and the bottom must be leakproof. They must be labeled or color-coded red to ensure that everyone knows the contents are hazardous. Containers for disposable sharps must be easily accessible and they must be maintained upright to keep liquids and sharps inside.

Containers need to be located as near as feasible to the area of use. In some cases, they may be placed on carts to prevent access by mentally disturbed or pediatric patients. Containers also should be available wherever sharps may be found, such as in laundries. The containers must be replaced routinely and not be overfilled.

Employees must never reach by hand into containers of contaminated sharps. Containers for reusable sharps could be equipped with wire basket liners for easy removal during reprocessing, or employees could use tongs or forceps to withdraw the contents. Reusable sharps disposal containers may not be opened, emptied, or cleaned manually.

Employees should use caution when handling full containers of used sharps, looking carefully for needles that may have punctured the container. Lids should be closed before discard and transportation.

If there is a chance of leakage from the primary container, a secondary container that is closable, labeled, or color coded and leak resistant should be used.

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