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Introduction   

The Occupational Safety and Health Administration (O.S.H.A.) is an agency of the United States Department of Labor created in 1970 to improve safety and healthy working conditions in various workplace settings. O.S.H.A. accomplishes this goal through proper training, outreach, education, and assistance. O.S.H.A. is essential to the healthcare industry related to exposure to bloodborne pathogens, patient handling, and use of medical resources (12).

Nine O.S.H.A. Standards for Healthcare  

While O.S.H.A. guidelines have multiple standards or regulations, several apply directly to healthcare. The nine standards of O.S.H.A. that apply to healthcare include the following (11): 

• Hazard Communication Standard 
• Bloodborne Pathogen Standard 
• Ionizing Radiation Standard 
• Exit Routes Standards 
• Electrical Standards 
• Emergency Action Plan Standard 
• Fire Safety Standard 
• Medical and First Aid Standard 
• Personal Protective Equipment 

Hazard Communication Standard  

O.S.H.A. developed the Hazard Communication Standard (H.C.S.) to regulate the disclosure of workplace hazards, including dangers associated with chemical exposure. O.S.H.A.’s Hazard Communication Standard aligns closely with the Globally Harmonized System (G.H.S.), a globally accepted labeling standard for the same purpose. The Hazard Communication Standard and the G.H.S. have defined rules for manufacturers, importers, and employers to label hazards properly. Furthermore, employers must provide Safety Data Sheets (S.D.S.) for each chemical stored or used within the workplace (14).  

Safety Data Sheets (S.D.S.) 

The S.D.S. will cover sixteen items, including identification, hazard identification, composition or ingredients, first-aid measures, firefighting measures, accidental release measures, handling and storage, exposure controls and personal protection, physical and chemical properties, stability and reactivity, toxicological information, ecological information, disposal considerations, transport information, regulatory information, and other information (2).  

Hazard Communication Standard (H.C.S.) Pictograms 

Lastly, the Hazard Communication Standard dictates the need to communicate exposure to harmful chemicals with appropriate signage and pertinent information. To aid in this signage, O.S.H.A. has developed the H.C.S. Pictograms and Hazards [see Figure 1].

Figure 1. H.C.S. Pictograms and Hazards (13)

Bloodborne Pathogen Standard 

Bloodborne pathogens are infectious microorganisms from the blood that lead to severe diseases. Twenty known bloodborne pathogens can lead to illness, including Malaria, Syphilis, Hemorrhagic fever, Hepatitis B, Hepatitis C, and Human immunodeficiency (5). 

O.S.H.A. developed the Bloodborne Pathogen Standard because healthcare workers are at a higher risk of exposure to blood and bodily fluids. These regulations were designed to protect healthcare workers and patients from transmitting serious infectious microorganisms and diseases (5). 

Employer Requirements 

The employer must meet specific regulations to protect its workers from bloodborne pathogens, including the following (6): 

• Create an exposure plan and update it annually 
• Initial and annual education for workers 
• Hepatitis B vaccines available upon employment 
• Universal precautions standard implemented 
• Engineering controls to reduce exposure and risk 
• Use of work practice controls 
• Warning labels and signs are posted correctly 
• Provide appropriate Personal Protective Equipment (P.P.E.) 
• Develop and implement post-exposure evaluation and follow-up plans 
• Maintain employee medical and training records 

Healthcare Worker Precautions  

Healthcare workers should take necessary precautions to protect themselves from bloodborne pathogens. These precautions include using Personal Protective Equipment (P.P.E.), proper sharps handling, and caution with bodily fluids (6). 

Personal Protective Equipment includes gloves, gown, mask, and eye protection and indicated (see the “Personal Protective Equipment” section later in this course for additional information). 

Proper sharps handling includes adequate precautions to prevent needle sticks. Healthcare workers should not recap, bend, or break needles. They should utilize safety devices and dispose of used sharps in designated sharps containers (6). 

Precautions should be taken when handling bodily fluids. Healthcare professionals may handle common body fluids, including blood, saliva, phlegm, bile, urine, feces, breast milk, vomit, sweat, nasal secretions, and earwax. Less common bodily fluids include cerebrospinal, pericardial, pleural, and peritoneal fluid. All bodily fluids should be handled carefully, especially if blood is visible (6).

Ionizing Radiation Standard 

O.S.H.A.’s Ionizing Radiation Standard outlines standards and precautions for healthcare departments that utilize radiation. This may impact departments, including radiology, nuclear medicine, radiation oncology, interventional fluoroscopy or radiology, and cardiac angiography. Employers are responsible for ensuring radiation dose limits are not exceeded, radiation hazard precautions are followed, and appropriate monitoring devices are provided to employees. Employers must also post caution signs, provide proper training, and post safe operating procedures (4). 

Exposure Limits 

• Adults > 18 years old 
  • Whole body: 1.25 rem per quarter* 
  • Hands and forearms: 18.75 rem per quarter 
  • Skin: 7.5 rem per quarter 

*rem = unit to measure radiation (includes radiation exposure and absorbed radiation dose) 

Exit Routes Standard  

The Exit Route Standard focuses on three elements to ensure the safe exiting of buildings in emergencies. These three elements include exit access, exit, and exit discharge. Exit access refers to the route to the exit. The exit is separated from other hospital areas and provides a protected way of exiting the building. The exit discharge is a route that leads directly outside. To remain O.S.H.A. compliant, the Exit Route Standard requirements must be met (7). 

Exit Route Standard Requirements 

Exit Route Standard Requipments include (7): 

• Design and construction requirements for the Exit Route Standard include having permanent exit routes with fire-resistant materials. 
• The exit must be separated from other parts of the workplace, where the exit reaches the point of exit discharge.  
• The doors must be self-closing and must trigger the fire alarm when exited.  
• The exit must lead directly outside, and doors should hinge and wing outward.  
• The doors must always remain unlocked from the inside when employees are present.  
• If the exit route includes stairs that continue past the exit discharge level, signage and interruption to stairs should be present to direct exiting individuals in emergencies appropriately.  
• Outdoor exit routes must include guardrails and be enclosed if fall risks exist.  
• The outdoor exit route must be covered if snow or ice is possible.  
• The exit must also be reasonably straight, smooth, and level.  
• Exit routes must meet height and width requirements of 7.5 feet tall and 28 inches wide.

Electrical Standard  

O.S.H.A.’s Electrical Standard dictates safety precautions for a range of electrical sources. These can range significantly from outlets to massive generators. Electrical safety is essential for healthcare organizations, as it can impact patients, visitors, and healthcare professionals. Improper use of electrical sources can increase the risk of electrical injury, damage to equipment, and fire safety concerns (15).  

Employee Safety Practices 

• Healthcare professionals should practice examination of outlets and electronic cords before using them.  
• Both should appear in good working condition, without fraying, missing pieces, or broken.  
• Healthcare professionals should take caution when using electrical sources when near water. This will reduce the increased risk of electrical shock or electrocution. 
• Patients should be instructed and encouraged to follow the same electrical risk precautions. 

Emergency Action Plan Standard 

O.S.H.A. developed the Emergency Action Plan Standard to aid hospitals and other healthcare organizations in disaster preparation. This standard includes emergency evacuation procedures that outline evacuation and escape routes. The standard also outlines identifying personnel to perform critical operations before evacuation, accounting for all employees during and after an evacuation by name and employee job title, continuing emergency services during evacuation, and adequately reporting emergencies (10). 

Fire Safety Standard 

The Fire Safety Standard has overlapping requirements with the Exit Route Standard. The Fire Safety Standard requires an adequate number of exits to safely reroute all working employees and patients directly outside. The Fire Safety Standard also requires exits to be well-lit with appropriate signage. When employees are present, the fire exits must remain unobstructed and unlocked from the inside. If construction is being carried out, the organization must have a safe alternative exit that meets all the previously outlined requirements (16). 

Fire Safety Acronyms 

In addition to safe exits, healthcare professionals are responsible for assisting in safely evacuating their patients and coworkers. To ensure safety during a fire, healthcare workers should be trained to apply two fire safety acronyms if the situation presents itself (1): 

• RACER 
  • Remove occupants from the building 
  • Alert/Alarm 
  • Confine/Contain fire 
  • Extinguish 
  • Relocate 
• PASS 
  • Pull the pin of the fire extinguisher 
  • Aim the nozzle at the fire’s base 
  • Squeeze the handle 
  • Sweep the extinguisher from side to side

Medical and First Aid Standard  

O.S.H.A.’s Medical and First Aid Standard outlines that healthcare organizations must provide medical and first aid supplies for employees and patients. The Medical and First Aid Standard identifies two classifications. Class A has a broad range of first aid supplies for most common injuries, while Class B targets more populated, complex, or high-risk environments (3).  

Minimum Requirements 

The minimum requirements for workplace first aid kits include various supplies. Class A has basic supplies to meet general medical and first aid needs, while class B has additional items to meet the higher acuity level. These supplies include (3): 

• Class A 
  • Adhesive bandages 
  • Adhesive tape 
  • Antibiotic 
  • Antiseptic 
  • Burn dressing 
  • Burn treatment 
  • Cold pack 
  • C.P.R. breathing barrier 
  • Eye covering 
  • Eye/skin wash 
  • First aid guide 
  • Foil blanket 
  • Hand sanitizer 
  • Medical exam gloves 
  • Roller bandage 
  • Scissors 
  • Sterile pad 
  • Trauma pad 
  • Triangular bandage 
• Class B 
  • All of class A  
  • Plus tourniquet 
• Additional considerations 
  • Adhesive bandages of various sizes 
  • Analgesics 
  • Antihistamine 
  • Aspirin, low dose 
  • Electrolyte replacement 
  • Face-mask 
  • Hemostatic agent/dressing 
  • Hydrocortisone 
  • Splinter remover 
  • Surface disinfecting wipes 
  • Thermometers 
  • Bleeding control kits 
    • Chest seal 
    • Compression bandage 
    • Hemostatic bandage 
    • Thermal blanket 
    • Tourniquet 
    • Gloves 
    • Permanent marker 
    • Shears 

Access to Medical Attention 

In addition to providing first-aid equipment, O.S.H.A. requires employers to provide employees with medical attention, including treatment and consultation, in the event of an occupational injury or illness (8). The organization has two options: onsite services and resources or offsite medical resources. Most healthcare organizations will provide onsite services, but some smaller organizations may rely on offsite resources, such as small clinics or rural hospitals.  

• Onsite services and resources (8) 
  • Eye wash stations, where exposure to corrosive materials  
  • Ensure access to first aid supplies 
  • Ensure at least one person is adequately trained to render first aid 
• Offsite medical resources (8) 
  • Within 2-4 minutes 
    • Suffocation, severe bleeding, or other life-threatening injury or illness is expected 
  • 15 minutes 
    • Where life-threatening injury is unlikely 

Personal Protective Equipment Standard 

The Personal Protective Equipment (P.P.E.) is regulated by the Centers for Disease Control and Prevention (CDC) and O.S.H.A. This standard dictates healthcare organizations’ availability, application, and disposal of P.P.E. This standard is essential for healthcare systems to protect patients and employees accordingly (9). 

Types of P.P.E 

Various types of P.P.E. include (9): 

• Gown 
• Gloves 
• Masks 
• Respirators 
• Face shields (or goggles) 

Types of Precautions 

Four types of precautions exist, including Standard, Contact, Droplet, and Airborne Precautions (9). Standard precautions should apply to all patients, while additional steps are necessary for contact, droplet, and airborne precautions. Table 1 identifies examples of illness and suggested precautions therein.   

• Standard (used as a baseline standard for all patients) 
  • Proper hand hygiene 
  • Use of appropriate P.P.E.  
  • Ensure appropriate patient placement 
  • Right respiratory/cough etiquette principles 
  • Proper disinfection of equipment  
  • Handle textiles and laundry carefully 
  • Follow safe injection practices 
  • Proper sharps handling 
• Contact 
  • Gown 
  • Gloves 
• Droplet 
  • Gown 
  • Gloves 
  • Eye protection 
  • Mask 
• Airborne 
  • Gown 
  • Gloves 
  • Eye protection 
  • Mask (N-95 or higher-level respirator) 
  • Special air handling and ventilation systems 

Table 1. Table of Clinical Presentations and Recommended Precautions (9)  

Application and Removal of P.P.E. 

The application (donning) and removal (doffing) of Personal Protective Equipment (P.P.E.) must be completed in a specific order to reduce the spread of pathogens and infectious diseases (9): 

• Donning of P.P.E. should take place outside of the patient’s room: 

1. Gown 
2. Mask or respirator 
3. Eye protection 
4. Gloves 

• Doffing of P.P.E. should take place outside of the patient’s room: 

1. Gloves 
2. Eye protection 
3. Gown 
4. Mask or respirator 

Chemical and Nuclear P.P.E. 

Beyond the traditional Personal Protective Equipment (P.P.E.), there is also chemical and nuclear P.P.E. This would be utilized for exceptional circumstances where hazardous chemicals or nuclear exposure is possible (9). The HAZMAT equipment has four different types, categorized by level of exposure. Depending on the level identified, the HAZMAT equipment will change to protect the individual accordingly: 

• HAZMAT equipment (9): 
  • Level A:  
    • Positive pressure full face-piece self-containing breathing apparatus (S.C.B.A.) 
    • Encapsulating covering chemical protective suit 
    • Chemical-resistant outer gloves 
    • Chemical-resistant inner gloves 
    • Chemical-resistant boots with steel toe 
    • Disposable protective suit/gloves/boots 
  • Level B:  
    • Positive pressure full face-piece S.C.B.A. 
    • Chemical-resistant clothes with a hood 
    • Chemical-resistant outer gloves 
    • Chemical-resistant inner gloves 
    • Chemical-resistant boots with steel toe 
  • Level C:  
    • Air purifying respirator 
    • Chemical-resistant clothes with a hood 
    • Chemical-resistant outer gloves 
    • Chemical-resistant inner gloves 
    • Chemical-resistant boots with steel toe 
  • Level D: 
    • Gloves 
    • Coveralls 
    • Chemical-resistant boots/shoes with steel toe 
    • Safety glasses or chemical splash goggles

Conclusion

The Occupational Safety and Health Administration (O.S.H.A.) department has developed specific regulations, recommendations, and support for all occupations. However, nine standards apply to healthcare. These include Hazard Communication Standards, Bloodborne Pathogen Standards, Ionizing Radiation Standards, Exit Routes Standards, Electrical Standards, Emergency Action Plan Standards, Fire Safety Standards, Medical and First Aid Standards, and Personal Protective Equipment. As a healthcare worker, implementing the standards reviewed herein ensures workplace safety for the healthcare worker, the patient, and the healthcare organization in which they reside.

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