Six months after the needle stick, and after completing her PEP, Jennifer’s HIV tests remained negative. In those six months, she became extra vigilant with sharps and needles and purposely slowed down during procedures with needles. She became a strong voice on her unit for encouraging other nurses and healthcare workers to be purposeful and cautious when dealing with needles.
She also became proactive with her central supply department and administration in investigating a new needleless product that her hospital later adopted. She pondered many times how she could have avoided the original needle stick. What do you think she could have done differently? What would you do? What will you do to avoid the same mistake Jennifer experienced?
The Standard requires employers to maintain the workplace in a clean and sanitary condition, using schedules and procedures for cleaning and decontamination. Equipment and work surfaces must be cleaned and decontaminated after contact with blood or OPIM, immediately, or as soon as feasible. If protective coverings are used they should be replaced as soon as contaminated or at the end of the work shift. Waste containers should be cleaned and decontaminated on a schedule and as needed. Contaminated broken glass must not be picked up by hand.
The methods of decontaminating different surfaces must be specified, determined by the type of surface to be cleaned, the soil present, and the tasks or procedures that occur in that area. For example, different cleaning and decontamination measures would be used for a surgical operating room and a patient room. Similarly, hard-surface flooring and carpeting require separate cleaning methods. More extensive efforts will be necessary for gross contamination than for minor spattering. Likewise, such varied tasks as laboratory analyses and normal patient care require different techniques for cleanup.
Employees must clean (1) when surfaces become obviously contaminated; (2) after any spill of blood or OPIM; and (3) at the end of the work shift if contamination might have occurred. Thus, employees need not decontaminate the work area after each patient-care procedure, but only after those that actually result in contamination.
Before any equipment is serviced or shipped for repairing or cleaning, it must be decontaminated to the extent possible. If some areas remain contaminated, the equipment must be labeled, indicating which portions are still contaminated. This enables employees and those who service the equipment to take appropriate precautions to prevent exposure.
Proper handling of regulated waste is essential to prevent unnecessary exposure to blood and OPIM. All regulated waste must be placed in closeable, leakproof containers or bags that are color-coded (red-bagged) or labeled to prevent leakage during handling, storage, and transport. Disposal of waste shall be in accordance with federal, state and local regulations.
Regulated waste includes:
- Liquid or semi-liquid blood or OPIM that cannot feasibly be flushed
- Contaminated items that would release blood or OPIM in a liquid or semi-liquid state if compressed
- Items that are caked with dried blood or OPIM and are capable of releasing these materials during handling
- Contaminated sharps
- Pathological and microbiological wastes containing blood or OPIM
Safety sharps and containers for disposal of used sharps are both engineering controls and regulated waste, once used. Used syringes or sharps must never be discarded into a red bag, only into the puncture-resistant containers required by the Bloodborne Pathogens Standard.
Containers used to store regulated waste must be closable and suitable to contain the contents and prevent leakage of fluids. They must be labeled or color-coded to ensure that employees are aware of the potential hazards. Such containers must be closed before removal to prevent the contents from spilling. If the outside of a container becomes contaminated, it must be placed within a second suitable container. Regulated waste must be disposed of in accordance with applicable federal, state and local laws.
Contaminated laundry shall be handled as little as possible with a minimum of agitation. It must be bagged or contained at the location where it was used and shall not be sorted or rinsed at the location of use. Containers of soiled laundry should be color-coded or labeled to permit all employees to recognize the containers as holding soiled linen and therefore requiring the use of Universal Precautions. If the bag may leak, a secondary leak-proof container must be used.
Laundry workers must wear PPE and have sharps containers available in the event that a sharp may be within the soiled laundry.
Guidance regarding laundry handling and washing procedures in the healthcare setting can be found in CDC Guidelines for Environmental Infection Control in the Healthcare Facilities, 2003.
Hepatitis B Vaccination
The employer must make hepatitis B vaccination available to all employees with occupational exposure to bloodborne pathogens within 10 days of assignment, at no charge to the employee. This includes healthcare workers, emergency responders, morticians, first-aid personnel, law enforcement officers, correctional facilities staff, laundry workers, and others.
The vaccine is given as a series of three injections, the second and third injections given 1 month and 6 months after the first one. All three must be received for full protection. The vaccine has an excellent record of safety and effectiveness, protecting workers against a disease that may cause no symptoms, mild symptoms, or serious even fatal disease, and that can be spread to others. You may decline the vaccine and will be asked to sign a declination form, as required by the Standard, to verify that you were offered the vaccine. You may change your mind and receive the vaccine later even if you declined at first.
To ensure immunity, it is important for individuals to receive all three injections. As of 2013, the CDC says that for people with normal immune status who have been vaccinated, booster doses are not recommended. The vaccine causes no harm to those who are already immune or to those who may be HBV carriers. Testing to verify immunity following completion of the vaccine series is recommended by the CDC, but is not required.
Infection Control: Break the Chain [4:29]
Test Your Knowledge
- Must be poured into flushable tanks.
- Includes all items that have been in an HCV patient&rsuo;s room.
- Includes any object soiled with blood.
- Must be placed in closeable, leak-proof containers that are color-coded.
The hepatitis B vaccine:
- Is a series of four injections that must be completed to ensure immunity.
- May occasionally cause mild illness in the vaccinated person.
- Should not be given to those who are already immune or who may be HBV carriers.
- Conveys full protection when a series of three injections is completed.
Apply Your Knowledge
Did you realize that the cleaning protocols done by housekeeping, and environmental service personnel are actually mandated by law per OSHA Standards? When is the last time you thanked your facility housekeeper? Do you wipe down your workstation at the beginning and end of your shift with a bacteriostatic solution? Will you do so now that you have a better understanding of pathogen transmission?
Both answers: D