The OSHA Bloodborne
Pathogen Standard says that “ When there is occupational exposure , the employer shall provide , at no cost to the employee , appropriate personal protective equipment such as , but not limited to , gloves , gowns , laboratory coats , face shields or masks and eye protection , and mouthpieces , resuscitation bags , pocket masks , or other ventilation devices .”
“ Making PPE , including protective eyewear , goggles , and face shields visible and available is a cue to action for workers that a risk has been identified and it should be worn ,” Mitchell says . “ PPE should not be primarily housed in a closet down the hall or a cart that needs to be rolled around . It should be placed in wall mounts or prominent locations within a unit or department . Additionally , since so many of us need corrective lenses , a variety of products should be available to be used so that one does not need to compromise sight for safety and vice versa .”
Lack of PPE usage remains a significant concern not only for COVID-19 infection , but for blood and body fluid exposure as well as exposure to other opportunistic pathogens in the healthcare setting . As the ISC ( 2017 ) observes , “ According to EPINet data , compliance with PPE use when an exposure to blood , body fluid , or biologic hazard occurs is lower than ideal . It can range from more than 70 percent ( glove use ) to less than 2 percent ( goggle use ), depending on the body location and type of incident . Even when PPE is worn to protect a worker from an exposure or contamination , studies indicate that upon removal a worker contaminates him / herself almost half of the time . The most frequent self-contamination occurs on the hands , forearms , neck , and face , as well as in hair and on clothing ( Tomas , JAMA Intern Med 2015 ).”
The OSHA Bloodborne Pathogen Standard says that “ When there is occupational exposure , the employer shall provide , at no cost to the employee , appropriate personal protective equipment such as , but not limited to , gloves , gowns , laboratory coats , face shields or masks and eye protection , and mouthpieces , resuscitation bags , pocket masks , or other ventilation devices . Personal protective equipment will be considered ‘ appropriate ’ only if it does not permit blood or other potentially infectious materials to pass through to or 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 .”
Further , OSHA indicates that “ The employer shall ensure that the employee uses appropriate personal protective equipment unless the employer shows that the employee temporarily and briefly declined to use personal protective equipment when , under rare and extraordinary circumstances , it was the employee ’ s
professional judgment that in the specific instance its use would have prevented the delivery of health care or public safety services or would have posed an increased hazard to the safety of the worker or co-worker . When the employee makes this judgment , the circumstances shall be investigated and documented to determine whether changes can be instituted to prevent such occurrences in the future .”
OSHA also mandates accessibility : “ The employer shall ensure that appropriate personal protective equipment in the appropriate sizes is readily accessible at the worksite or is issued to employees . Hypoallergenic gloves , glove liners , powderless gloves , or other similar alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided .”
Mitchell says a paradigm shift is needed . “ In my opinion , facilities should motivate good and safe practices by rewarding employees with eye and face protection that they are as proud to wear as a lab coat or embroidered scrubs ,” she says . “ Perhaps providing protective eyewear in multiple colors and styles and giving vouchers for protective eyewear with corrective lenses . Every manufacturing floor I ’ ve been on has a thick yellow line to indicate that you must not step past it without some kind of PPE – either a hard hat , hearing protection , eye protection , reflective wear , or all . In healthcare , we seem to only have blurred , gray lines . That needs to change .”
Human behavior being what it is , the Hierarchy of Controls , developed by industrial hygienists and safety professionals is designed to provide a structure that guides the most effective means of isolating a hazard , which is to eliminate it , and works through several levels of additional controls . Because biological hazards like the ones faced by healthcare personnel daily cannot readily be eliminated , the next best control is to engineer the hazard out – ranging from safer medical devices that protect workers from a needle or sharp object , to closed systems used for suctioning and HEPA-filtration in HVAC systems .
When a hazard cannot be eliminated or engineered out , it is then that professionals rely on safe work practices , administrative controls , and the use of PPE , according to the ISC ( 2017 ): “ These controls are highly dependent on personal and professional behavior , training , education , availability and access , adequate staffing , and the overall anticipation of hazard being likely to occur . We have already indicated that PPE use and compliance is low during an exposure with blood and body fluids , often times because that exposure is not anticipated and a worker cannot adequately prepare for it . This in part is because all factors may not be in place to create the safest environment . In short , it is difficult to create reliable systems of protection if there are too many opportunities for that system to fail – exposures are not anticipated , PPE use is low even when they are anticipated , and PPE when worn during anticipated exposures is unreliable .”
www . healthcarehygienemagazine . com • august 2022
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