Thursday, November 12, 2015

CDC: Emergency Needlestick Information

BLOODBORNE INFECTIOUS DISEASES: HIV/AIDS, HEPATITIS B, HEPATITIS C

Tweet

gloved hand holding blood-stained gauze pad over disposal bag

Emergency Needlestick Information

Workers Please Note

If you experienced a needlestick or sharps injury or were exposed to the blood or other body fluid of a patient during the course of your work, immediately follow these steps:
  • Wash needlesticks and cuts with soap and water
  • Flush splashes to the nose, mouth, or skin with water
  • Irrigate eyes with clean water, saline, or sterile irrigants
  • Report the incident to your supervisor
  • Immediately seek medical treatment

Medical Providers Please Note

If you have questions about appropriate medical treatment for occupational exposures, assistance is available from the Clinicians' Post Exposure Prophylaxis (PEP) Line at
1-888-448-4911.

Wednesday, October 21, 2015

Handling of contaminated laundry in a long-term care facility

February 23, 2011

Mr. C***
Honolulu, Hawaii

Dear Mr. C***:

This is in response to your October 18, 2010, to the Occupational Safety and Health Administration (OSHA) in which you requested an interpretation of the Bloodborne Pathogens Standard, 29 CFR 1910.1030.  This letter constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to any question not delineated within your original correspondence.  Your questions have been paraphrased below followed by our responses.  We apologize for the delay in responding to your inquiry.

Question 1:  Other potentially infectious materials (OPIM) have been defined by the Bloodborne Pathogens Standard to include various body fluids, such as "...all body fluids in situations where it is difficult or impossible to differentiate between body fluids."   29 CFR 1910.1030(b).   Based on this definition, would soiled linen from a nursing home or long-term care facility be treated as OPIM if it consists of urine, or feces or both, without the presence of blood?

Response 1:  The linen itself is not OPIM.  The issue is whether the linen you describe is "contaminated laundry."  In paragraph (b) of the standard "contaminated laundry" is defined as "...laundry which has been soiled with blood or other potentially infectious materials or may contain sharps."  [Emphasis added]. Urine and feces not containing blood are not per se OPIM within the meaning of the standard.

Urine and feces are not the only sources of contamination that may be present on linen generated in nursing homes or other long-term care facilities.  The potential for a variety of medical conditions that may be present in the patient/resident population in these facilities (e.g., surgical wounds, bed sores, etc.) could also be potential sources of blood contamination of linen.  As well, the linen may contain sharps.  As such, it is important that employers in healthcare settings, including nursing homes or other long-term care facilities, evaluate the scope of all possible sources of exposure to housekeeping staff who handle laundry.

Question 2:  If the handling of urine and feces by the nursing staff and the housekeepers in a long-term care facility or a hospital need not be considered handling OPIM unless blood is present, would the requirement to offer the hepatitis B vaccination apply?

Response 2:  The Bloodborne Pathogens Standard requires employers to make the Hepatitis B vaccination available to "...all employees who have occupational exposure..."  [29 CFR 1910.1030(f)(1)(i)].  Determining coverage under the Bloodborne Pathogens Standard must be based on all tasks and possible sources of exposure for a given job function.  Among nursing staff and housekeepers in long-term care facilities and hospitals, a determination of the employees' potential for occupational exposure to blood or OPIM should in no way be limited to exposure to urine and feces.

Nursing staff and housekeepers in these settings perform various tasks that would be considered potential exposure sources.  For example, nursing staff often perform various patient care procedures, such as dressing wounds, which puts them at risk of exposure.  Among housekeepers, the cleaning of blood spills, exposure to exudates from wounds, surgical sites and bed sores, and to syringes or other sharps left in linen or in receptacles following in-room medical treatments are among the exposure scenarios that must be considered.  As such, the nursing staff and housekeepers in long-term care facilities and hospitals are among those who must be offered the hepatitis B vaccination.

Questions 3 & 4:  We note in other interpretations where the discussion of the BBP standard includes laundry a clear distinction between healthcare and non-healthcare settings is made.  For example, in the interpretation issued on September 17, 2004, regarding the handling of laundry in a fitness center the response stated, "...Normally laundry in a non-healthcare setting would not be covered by the bloodborne pathogens standard."  Should we take it to mean that the laundry discussed in questions 1 and 2 above should be treated as OPIM?  Also, would soiled laundry in a patient room in a hospital be considered OPIM? 

Responses 3 & 4: As stated in the response to question 1, the standard's definition of contaminated laundry would apply to the laundry generated in healthcare settings such as hospitals and long-term care facilities.  Consequently, staff members whose duties expose them to contaminated laundry from healthcare settings are considered to have an increased risk for exposure to blood and OPIM.  The Bloodborne Pathogens Standard has special provisions for the handling of contaminated laundry.  For example, employers must assure that contaminated laundry is bagged or containerized at the location where it was used, and are prohibited from allowing the sorting and rinsing of contaminated laundry at the point of use. [29 CFR 1910.1030(d)(4)(iv)(A)(1)].

Additionally, the Centers for Disease Control and Prevention (CDC) has issued infection control guidance recommending careful handling of contaminated laundry in healthcare settings as a measure to enhance patient and healthcare worker protection.  Please refer to Guidelines for Environmental Infection Control in Health-Care Facilities, MMWR 52 (RR10: 1-42; June 6, 2003) for additional information.

The State of Hawaii operates its own occupational safety and health program under a plan approved and monitored by the Federal Occupational Safety and Health Administration (OSHA).  The Hawaii Occupational Safety and Health Division (HIOSH), part of the Hawaii Department of Labor and Industrial Relations (DLIR), adopts and enforces standards and investigates safety and health concerns in workplaces in the State.

HIOSH's Bloodborne Pathogens Standard is identical to OSHA's.  For more information on the standard and HIOSH's enforcement procedures, we suggest that you contact HIOSH directly at the following address:
Hawaii Department of Labor and Industrial Relations
Hawaii Occupational Safety and Health Division
830 Punchbowl Street #425
Honolulu, HI 96813
PH: 808 586-9100
Fax: 808 586-9104
Website: http://hawaii.gov/labor/hiosh

Thursday, October 15, 2015

HBV and Needlesicks in the Textile Industry

February 11, 2015

Mr. Michael J. H***
Asheville, North Carolina 28803

Dear Mr. H***:

Thank you for your September 10, 2014, letter to the Occupational Safety and Health Administration (OSHA). Your letter has been referred to the Directorate of Enforcement Programs for an answer to your specific question. You requested information about possible cases of hepatitis resulting from needlesticks from textile mill equipment. This letter constitutes OSHA's answer to your question and provides an interpretation of the coverage of OSHA's Bloodborne Pathogens (BBP) standard, 29 CFR 1910.1030, and may not be applicable to any other question not delineated within your original correspondence. Your question has been paraphrased, followed by OSHA's response.

Background: You identified a situation where an employee in a textile mill/factory reported daily needlesticks to fingers while operating the equipment. The needles on the machines are reported to be infrequently changed and the equipment is utilized by shift workers.

Question: Have there been any case reports or data related to being infected with hepatitis - in particular - from the equipment being operated and shared with others?

Response: OSHA is unaware of any case reports or data that specifically connect hepatitis infections to employees operating textile equipment. However, the underlying basis of the BBP standard is that all blood and certain body fluids are potentially infectious. [56 FR 64004, 64089 (December 6, 1991)] Thus, the standard applies to "...all occupational exposure to blood or other potentially infectious materials as defined by paragraph (b) of this section." [29 CFR 1910.1030(a)] "Occupational exposure" is defined as "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." [29 CFR 1910.1030(b)] If employees are reasonably expected to get needlesticks from textile equipment contaminated with the blood of others, there is occupational exposure within the meaning of the standard. Employers would thus be required to protect those employees under the provisions of the standard, including, but not limited to, requirements to provide free hepatitis B vaccinations to employees with occupational exposure (paragraph (f)(2)); post-exposure (such as a needlestick) evaluation, follow-up, and post-exposure prophylaxis (where appropriate) (paragraph (f)(3)); and training (paragraph (g)(2)).
In an OSHA memorandum dated August 12, 1994, a similar situation in the garment industry was identified. There, employees sharing label tagging devices were subjected to frequent needlesticks. The issue of concern relating to the BBP standard is that these label tagging devices can retain blood on the needles and on the tool. When the label tagging devices are exchanged between employees, e.g., during shift changes, the result is a potential transmission of bloodborne pathogens.

North Carolina operates its own occupational safety and health program under a plan approved and monitored by OSHA. The North Carolina Department of Labor (NCDOL) adopts and enforces standards and investigates safety and health concerns in workplaces throughout the state, and has jurisdiction over worker safety and health in the state. State plans are required to have standards and enforcement programs that are at least as effective as OSHA's, but may have different or additional requirements. The NCDOL bloodborne pathogens standard for general industry is the same as OSHA's and must be enforced at least as effectively as OSHA enforces the BPS. For specific information regarding North Carolina's requirements for bloodborne pathogens, you may contact North Carolina DOL directly at the following address:

North Carolina Department of Labor
Occupational Safety and Health Division
111 Hillsborough Street
Raleigh, NC 27601-1092
(919) 733-7166
Web: www.nclabor.com/osha/osh.htm

Thursday, October 8, 2015

Clarification of the selection and use of BBP safety devices

May 5, 2008

Dr. H***
Texas A&M University
College Station, TX


Dear Dr. H***:

Thank you for your letter to the Occupational Safety and Health Administration's (OSHA's) Directorate of Enforcement Programs (DEP). Your letter requests OSHA's interpretation of several provisions under 29 CFR 1910.1030, the Bloodborne Pathogens standard. This letter constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to any question not delineated within your original correspondence. For clarification, your specific questions are paraphrased below, followed by OSHA's responses. We apologize for the delay in providing our response.

Question 1: The OSHA Bloodborne Pathogens Standard requires employers to use engineering controls, such as appropriate "safety engineered" sharps. Can an employer select a device that is not expressly labeled by the manufacturer as a safety device and that does not have corresponding safety claims that have been cleared by the Food and Drug Administration (FDA)?

Response 1: As you know, employers are required to use engineering and work practice controls to protect employees [29 CFR 1910.1030(d)(2)(i)]. The standard defines engineering controls as ". . . controls (e.g., sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate or remove the bloodborne pathogens hazard from the workplace." [29 CFR 1910.1030(b)]. With regard to safety-engineered devices used for preventing needlesticks and other sharps injuries, many circumstances would involve the use of safety-engineered devices which are expressly manufactured to replace conventional ones (i.e., sharps with safety engineered sharps injury protections, SESIPs). These devices generally bear a manufacturer's label indicating the type of safety feature along with specific instructions for use. However, the key to preventing needlesticks and other sharps injuries is the isolation or removal of the hazard, and in some circumstances, this may be achieved by completely removing the sharp (needleless technology) or substituting a safer alternative that is not necessarily labeled as such.

As an example, the use of plastic hypodermic syringes has largely replaced the use of glass syringes as an effective safer alternative. Plastic syringes are less prone to accidental breakage and, therefore, offer protection from potential percutaneous injuries from broken contaminated glass. Plastic syringes however, do not necessarily bear a legend of this safety benefit. Another example is the use of alternatives to glass capillary tubes which break easily. In a joint safety advisory on hazards associated with the use of glass capillary tubes, the FDA, NIOSH and OSHA recommended the use of capillary tubes that are not made of glass and glass capillary tubes wrapped in a puncture-resistant film. These alternatives also represent safety-engineered features in that they remove or isolate the sharps hazard.

It is important that employers perform a thorough hazard assessment and fully evaluate the feasibility and appropriateness for use of any engineering control before instituting its use [29 CFR 1910.1030(c)(1)(iv)(B)]. The substitution of a type of device or technology that does not bear a manufacturer's claim of safety must not introduce new hazards nor in itself create a hazard to employees. Additionally, employers should consult device manufacturers prior to making any after-market modifications to medical devices. Unauthorized modifications to medical devices may interfere with their intended use, may violate the FDA's approval of the device, or may create a greater hazard to patients and/or employees. You may wish to contact the FDA directly for additional information on the criteria which manufacturers must meet and the specific labeling requirements for all medical devices, including those with claims of safety-engineering features or capabilities.

Question 2: May an employer make an independent judgment that a device marketed with other claims and for other purposes provides the type of safety-engineered protection anticipated by the standard? If so, what level of documentation or testing is the employer required to have to demonstrate the validity of such judgments?

Response 2: As stated in response #1, the substitution of an alternative device or technology that does not bear a manufacturer's claim of safety must not introduce new hazards nor in itself create a hazard to employees. The requirement for evaluation and selection of a safety device is a performance-oriented provision which depends greatly on the specific medical device and medical procedure(s) in question. Devices must be evaluated for their ability to prevent occupational exposures to blood or other potentially infectious materials (OPIM) in each procedure. The final determination of what safer device is selected for use is a responsibility of the employer; however, when evaluating and selecting safer devices, employers must solicit input from non-managerial employees responsible for direct patient care who are potentially exposed to injuries from contaminated sharps [29 CFR 1910.1030(c)(1)(v)]. The input from affected employees must be factored into the employer's judgment of the appropriateness for use of a particular safety device.

With regard to the documentation needed to justify selection of safety devices, employers are required to have an exposure control plan which includes the initial exposure determination required by 29 CFR 1910.1030(c)(2) as well as the documentation of the methods of compliance, which includes implementation of engineering controls [29 CFR 1910.1030(c)(1)(ii)(A) and 1910.1030(c)(1)(ii)(B)]. The exposure control plan must be reviewed and updated annually to include documentation of the employer's consideration of newer technology [29 CFR 1910.1030(c)(1)(iv)(A) and 1910.1030(c)(1)(iv)(B)]. The standard does not specify the level of detail that must be included in this documentation; however, sufficient information must be provided to substantiate the facility's judgment. As discussed in the preamble of the Final Rule, consideration and implementation of safer medical devices could be documented in the Exposure Control Plan by describing the safer devices identified as candidates for adoption; the method or methods used to evaluate devices and the results of the evaluations; and justification for selection decisions. [See 66 Federal Register 5319, under discussion of paragraph 1910.1030(c)(1)(iv).]

Question 3: OSHA has previously clarified, in the context of Group Purchasing Organizations (GPOs), that price and contractual availability cannot be the sole basis for selecting a safety device. May other contractual requirements provide a basis for selecting a particular device? For example, if a multi-product manufacturer offers a contract that has a cost basis associated with being the employer's exclusive provider of a range of medical devices, and/or offers overall volume discounts that would be impacted by selecting another manufacturer's safety device, is a decision to use the contracting supplier's safety engineering sharps devices on this basis acceptable?

Response 3: 29 CFR 1910.1030 does not address contractual arrangements between employers and device manufacturers. Therefore, the standard does not specifically preclude the use of GPOs as long as the employer is still able to meet the intent of the standard. As stated in the response to question #2, non-managerial employees involved in patient care must be afforded the opportunity to provide feedback in the evaluation and selection of safer devices. If an employer enters into an exclusive contractual arrangement with a manufacturer, the availability and variety of devices may be restricted. As technology advances, it is difficult to determine whether a safer and more appropriate device might become commercially available from a competitor of the exclusive supplier. Employees may be limited in the variety of available safety devices, particularly with regard to equipment that has few available choices. Additionally, each employer must review and update the exposure control plan annually and the annual review must include documentation of the consideration of newer technology [29 CFR 1910.1030(c)(1)(iv)(A)]. Advances in technology might not be captured if an employer is bound by contract to only evaluate devices from a single manufacturer. Finally, 29 CFR 1910.1030(d)(2)(i) requires that employers eliminate or minimize, i.e., reduce to the lowest extent feasible, occupational exposure. Thus, irrespective of the arrangements used in obtaining safety devices, the determination of an employer's compliance will be based on whether the requirements of the standard are being met.

Thursday, October 1, 2015

Protections Provided by OSHA's Bloodborne Pathogens Standard

Bloodborne pathogens are infectious microorganisms present in blood that can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), the virus that causes AIDS. Workers exposed to bloodborne pathogens are at risk for serious or life-threatening illnesses.

All of the requirements of OSHA’s Bloodborne Pathogens standard can be found in Title 29 of theCode of Federal Regulations at 29 CFR 1910.1030. The standard’s requirements state what  employers must do to protect workers who are occupationally exposed to blood or other potentially
infectious materials (OPIM), as defined in the standard. That is, the standard protects workers who
can reasonably be anticipated to come into contact with blood or OPIM as a result of doing their
job duties.

In general, the standard requires employers to:
• Establish an exposure control plan. This is a written plan to eliminate or minimize occupational
exposures. The employer must prepare an exposure determination that contains a list of job  classifications in which all workers have occupational exposure and a list of job classifications in which some workers have occupational exposure, along with a list of the tasks and procedures performed by those workers that result in their exposure.

• Employers must update the plan annually to reflect changes in tasks, procedures, and positions that affect occupational exposure, and also technological changes that eliminate or reduce occupational exposure. In addition, employers must annually document in the plan that they have considered and begun using appropriate, commercially-available effective safer medical devices designed to eliminate or minimize occupational exposure. Employers must also document that they have solicited
input from frontline workers in identifying, evaluating, and selecting effective engineering and work practice controls.

• Implement the use of universal precautions (treating all human blood and OPIM as if known
to be infectious for bloodborne pathogens).

• Identify and use engineering controls. These are devices that isolate or remove the bloodborne
pathogens hazard from the workplace. They include sharps disposal containers, selfsheathing needles, and safer medical devices, such as sharps with engineered sharps-injury protection and needleless systems.

• Identify and ensure the use of work practice controls. These are practices that reduce the possibility of exposure by changing the way a task is performed, such as appropriate practices for handling and disposing of contaminated sharps, handling specimens, handling laundry, and cleaning contaminated surfaces and items.

• Provide personal protective equipment (PPE), such as gloves, gowns, eye protection, and masks. Employers must clean, repair, and replace this equipment as needed. Provision, maintenance, repair and replacement are at no cost to the worker.

Friday, September 25, 2015

Bloodborne Pathogens in Wastewater Treatment Plants

July 30, 2007

Ms. L***
San Juan, PR

Dear Ms. L***:

Thank you for your letter to the Occupational Safety and Health Administration (OSHA). Your letter was forwarded to OSHA's Directorate of Enforcement Programs (DEP) for a response. You requested information regarding the application of OSHA's Bloodborne Pathogens Standard, 29 CFR 1910.1030, to employees in wastewater treatment plants. This letter constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to any question not delineated within your original correspondence. We apologize for the delay in responding to your letter.

Scenario: The Puerto Rico Aqueduct and Sewer Authority, PRASA, currently has a policy of offering hepatitis B vaccination to employees in its wastewater treatment plants. In a Health Hazard Analysis (HHE) conducted by the National Institute of Occupational Safety and Health (NIOSH), it was stated that "...exposure to wastewater or sewage has not been found to be a potential risk factor for hepatitis B infection." Based on this information, we are considering discontinuing the practice of offering hepatitis B vaccination to employees.

Question: Does the Bloodborne Pathogens Standard, 29 CFR 1910.1030 apply to wastewater treatment plant employees?

Reply: As you may know, the Bloodborne Pathogens Standard is applicable to "...all occupational exposure to blood or other potentially infectious materials [OPIM] as defined by paragraph (b) ..." of the standard [29 CFR 1910.1030(a)]. As such, coverage of the standard is not triggered solely by the actual presence of pathogens, but by the presence or reasonably anticipated presence of blood or OPIM. Generally, raw sewage and wastewater do not contain blood. Urine, feces, and other reasonably anticipated biological components comprising human wastes in sewage are not included in the definition of "other potentially infectious materials" unless "...visibly contaminated with blood..." [29 CFR 1910.1030(b)]. Therefore, OSHA, while recognizing that contact with wastewater and raw sewage poses a number of health hazards, does not generally consider that contact with diluted raw sewage not originating directly from a health care facility or other source of bulk blood or OPIM is covered by the Bloodborne Pathogens Standard.

One of the central provisions of the standard is that employers are responsible for determining which job classifications or specific tasks and procedures are reasonably anticipated to result in worker contact with blood or OPIM [29 CFR 1910.1030(c)(2)]. Therefore, your organization is responsible for evaluating all job classifications and tasks to make a determination whether you, indeed, have employees assigned to routine or non-routine tasks which may involve reasonably anticipated exposure to blood or OPIM.

An example of occupational exposure that may occur among wastewater treatment employees is the rendering of first aid or medical services by staff members (e.g., employees working in a first aid station or health clinic). The provisions of 29 CFR 1910.1030(f) on hepatitis B vaccination would fully apply to these employees. Employees who are designated to render first aid as a collateral duty to their normal tasks would also be considered to have occupational exposure. However, they need only be offered the hepatitis B vaccination after rendering assistance in any situation involving blood or OPIM if the employer complies with the protocol set forth in XIII.F.8 (citation policy for first aid providers) of OSHA CPL 2-2.69 — Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens (2001), available at OSHA's webstie. Another example of a job with occupational exposure is one involving potential contact with used hypodermic needles, such as cleaning out drains where the accumulation of used hypodermic syringes/needles is reasonably anticipated; the HBV vaccine provisions fully apply to these employees.

As you probably know, Puerto Rico has a state plan approved by Federal OSHA. It covers private-sector and public-sector employers [29 CFR 1952.380(a)]. Thus, you should contact the Puerto Rico Occupational Safety and Health Administration (PR OSHA), at

Department of Labor, 20th Floor
505 Muñoz Rivera Avenue,
Hato Rey, Puerto Rico 00918
Phone (787) 756-1100, 1106/ (787) 754-2172
Fax (787) 767-6051
PR OSHA standards are the same as those of Federal OSHA [29 CFR 1952.380(a)]. The agency must enforce its standards as effectively as Federal OSHA does [29 U.S.C. 667(c)(2)]. Thus, Federal OSHA's interpretation of the federal Bloodborne Pathogens Standard is relevant to your question, although the Commonwealth may have some different or additional interpretations, especially for the public sector.

Wednesday, May 13, 2015

Compliance with the Bloodborne Pathogens Standard 1910.1030

February 27, 2009

Mr. Joseph K****
East Longmeadow, MA

Dear Mr. K***:

Thank you for your November 24, 2008 letter to the Occupational Safety and Health Administration (OSHA). Your letter was forwarded to the Directorate of Enforcement Programs (DEP) in OSHA's National Office. You had several specific questions regarding compliance with the OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030. This letter constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to any question(s) or scenarios not delineated within your original correspondence. For clarification, your questions have been rephrased below followed by OSHA's responses. We apologize for any delay in responding to your inquiry.

Question 1: Do "universal precautions" apply to the activities of medical and dental facilities (e. g., the handling of masks, goggles, gloves, lab coats or other personal protective equipment (PPE))?

Reply 1: Yes. According to the Bloodborne Pathogens Standard, "Universal precautions" is an approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens." 29 CFR 1910.1030(b). 29 CFR 1910.1030(d)(1) requires that universal precautions be observed to prevent contact with blood or other potentially infectious materials. This would include the handling of PPE that has become contaminated with blood or other potentially infectious materials (OPIM) in medical and/or dental facilities.

Question 2: Would it be a violation of the Bloodborne Pathogens Standard if medical or dental facilities failed to adhere to universal precautions for the handling of blood, OPIM, or items, such as laundry contaminated with blood or OPIM?

Reply 2: Yes. Medical and dental facilities failing to adhere to universal precautions would be in violation of section 29 CFR 1910.1030(d)(1) unless the facility is observing a more stringent set of guidelines. According to the Centers for Disease Control and Prevention's (CDC's) Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007: "Standard precautions combine the major features of Universal Precautions and Body Substance Isolation and are based on the principle that all blood, body fluids, secretions, excretions except sweat, nonintact skin, and mucous membranes may contain transmissible infectious agents. Standard Precautions include a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered. . ."1 These include hand hygiene; use of gloves, gown, mask, eye protection, or face shield, depending on the anticipated exposure; and safe injection practices. Standard precautions are more stringent than universal precautions alone and would be acceptable.

Question 3: Would potential contact of textiles, such as linen or laundry, with unknown body fluids in medical or dental settings where universal precautions are practiced trigger coverage under OSHA's Bloodborne Pathogens Standard at that medical or dental facility? Also, would the contaminated textiles require special handling under the Bloodborne Pathogens Standard?

Reply 3: Pursuant to 29 CFR 1910.1030(a), the Bloodborne Pathogens standard is applicable to all occupational exposure to blood or other potentially infectious material (OPIM), as defined in 29 CFR 1910.1030(b). The definition of OPIM includes saliva in dental procedures, among other things. Occupational exposure is defined as "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." A determination of the duties, tasks, and scope of the employees' work must be done by the employer to assess whether employees have reasonably anticipated exposure to blood or OPIM [29 CFR 1910.1030(c)(2)]. Employers with employees who launder or otherwise handle linen contaminated with blood or OPIM (e.g., housekeeping staff in a healthcare setting; employees in a commercial laundry facility with a contract to launder contaminated linen from medical/dental settings) would be considered to have reasonably anticipated exposure and would be covered by the standard. Blood is often found on linen and laundry in medical facilities, and saliva is often found on such materials in dental offices. With respect to unknown fluids, 29 CFR 1910.1030(d)(1) provides in pertinent part: "Under circumstances in which differentiation between body fluid types is difficult or impossible, all body fluids shall be considered potentially infectious materials." The fact that the contaminated textiles are in a medical or dental facility where universal precautions are practiced would not preclude coverage under the Bloodborne Pathogens Standard.

With regard to the handling of contaminated laundry, 29 CFR 1910.1030(d)(4)(iv) sets forth the requirements for the handling and transport of laundry contaminated with blood or OPIM. For example, 1910.1030(d)(4)(iv)(A) and 1910.1030(d)(4)(iv)(A)(1) - 1910.1030(d)(4)(iv)(A)(3) cover the handling, containerization and transport of contaminated laundry, while sections 1910.1030(d)(4)(iv)(B) and 1910.1030(d)(4)(iv)(C) cover use of PPE while handling contaminated laundry and use of color-coded or labeled bags for transport to off-site facilities that do not use universal precautions in handling all laundry (e.g., transport to an off-site commercial laundry facility). Please refer to these sections of the standard for the specific requirements.

Question 4: Would an off-site facility (e.g., commercial laundry facility) which handles contaminated linen from healthcare settings be required to have a written exposure control plan?

Reply 4: Yes, as stated in the response to question #3, employers with employees who launder or otherwise handle linen contaminated with blood or OPIM (e.g., employees in a commercial laundry facility with a contract to launder contaminated linen from medical or dental settings) would be considered to have reasonably anticipated exposure to blood or OPIM and, thus, would be covered by the Bloodborne Pathogens Standard. Consequently, such employers are required to establish a written exposure control plan designed to eliminate or minimize employee exposure. 29 CFR 1910.1030(c)(1).

Question 5: Does an employer need to also ensure the proper laundering of contaminated linen?

Reply 5: The Bloodborne Pathogens Standard covers the handling and transport of contaminated laundry for the protection of employees; however, OSHA regulations do not have specific requirements for actual laundering procedures for assuring patient-specific infection control. OSHA's authority is limited to the protection of workers. As you noted in your inquiry, there are existing infection control guidelines set by the CDC. In the 2003 Guidelines for Environmental Infection Control in Health-Care Facilities, the CDC provides guidance for the handling, cleaning, and disinfection of contaminated laundry. The document can be found at http://www.osha.gov/pls/oshaweb/owaredirect.html?p_url=http:/www.cdc.gov/mmwr/preview/mmwrhtm/rr5210a1.htm.

Question 6: Is it permissible for employees to launder personal protective equipment like scrubs or other clothing worn next to the skin at home?

Reply 6: In your inquiry, you correctly note that it is unacceptable for contaminated PPE to be laundered at home by employees. However employees' uniforms or scrubs which are usually worn in a manner similar to street clothes are generally not intended to be PPE and are, therefore, not expected to be contaminated with blood or OPIM. These would not need to be handled in the same manner as contaminated laundry or contaminated PPE unless the uniforms or scrubs have not been properly protected and become contaminated.

Question 7: Is an employer in a dental office responsible for implementing an exposure control plan at the establishment if that employer launders the contaminated linen or PPE onsite?

Reply 7: Yes. Again, please see the response to question #3 above. Also, please be aware that dental offices would have other reasonably anticipated exposure scenarios other than the laundering of contaminated PPE that would make it necessary to develop and implement an exposure control plan. The exposure control plan should cover all job classifications and tasks in which employees have occupational exposure.

Question 8: Is that same employer responsible for following the CDC guidelines for laundering contaminated laundry?

Reply 8: The CDC guidelines are not mandatory. They are recommendations written with the intent of enhancing infection control measures in all healthcare facilities, including dental settings.

Question 9: How would OSHA regard an employer in a dental office who does not adhere to the requirements of the Bloodborne Pathogens Standard (e.g., use of universal precautions and establishment of an exposure control plan) and who does not use proper procedures for laundering contaminated laundry?

Reply 9: Again, please see the response to question #3 above. All employers having employees with occupational exposure must comply with the requirements of the Bloodborne Pathogens Standard and would be considered noncompliant for failing to do so. Please see the response to question #8 above with regard to the use of proper procedures for laundering contaminated linen.

Thursday, May 7, 2015

Hospital Preparedness: Current Ebola Treatment Centers

The 55 hospitals with Ebola treatment centers as of 2/18/2015 are:

  • Maricopa Integrated Health Systems; Phoenix, Arizona
  • University of Arizona Health Network; Tucson, Arizona
  • Kaiser Los Angeles Medical Center; Los Angeles, California
  • Kaiser Oakland Medical Center; Oakland, California
  • Kaiser South Sacramento Medical Center; Sacramento, California
  • University of California Davis Medical Center; Sacramento, California
  • University of California Irvine Medical Center; Orange, California
  • University of California Los Angeles Medical Center; Los Angeles, California
  • University of California San Diego Medical Center; San Diego, California
  • University of California San Francisco Medical Center; San Francisco, California
  • Children's Hospital Colorado; Aurora, Colorado
  • Denver Health Medical Center; Denver, Colorado
  • Emory University Hospital; Atlanta, Georgia
  • Grady Memorial Hospital; Atlanta, Georgia
  • Ann & Robert H. Lurie Children’s Hospital of Chicago; Chicago, Illinois
  • Northwestern Memorial Hospital; Chicago, Illinois
  • Rush University Medical Center; Chicago, Illinois
  • University of Chicago Medical Center; Chicago, Illinois
  • Johns Hopkins Hospital; Baltimore, Maryland
  • University of Maryland Medical Center; Baltimore, Maryland
  • National Institutes of Health Clinical Center; Bethesda, Maryland
  • Baystate Medical Center; Springfield, Massachusetts
  • Boston Children's Hospital; Boston, Massachusetts
  • Massachusetts General Hospital; Boston, Massachusetts
  • UMass Memorial Medical Center; Worcester, Massachusetts
  • Allina Health’s Unity Hospital; Fridley, Minnesota
  • Children’s Hospitals and Clinics of Minnesota - Saint Paul campus; St. Paul, Minnesota
  • Mayo Clinic Hospital - Rochester, Saint Marys Campus; Rochester, Minnesota
  • University of Minnesota Medical Center, West Bank campus, Minneapolis, Minnesota
  • Nebraska Medicine - Nebraska Medical Center; Omaha, Nebraska
  • North Shore System LIJ/Glen Cove Hospital; Glen Cove, New York
  • Montefiore Health System; New York City, New York
  • New York-Presbyterian/Allen Hospital; New York City, New York
  • NYC Health and Hospitals Corporation/HHC Bellevue Hospital Center; New York City, New York
  • Robert Wood Johnson University Hospital; New Brunswick, New Jersey
  • The Mount Sinai Hospital; New York City, New York
  • MetroHealth Medical Center; Cleveland, Ohio
  • Children's Hospital of Philadelphia; Philadelphia, Pennsylvania
  • Hospital of the University of Pennsylvania; Philadelphia, Pennsylvania
  • Lehigh Valley Health Network - Muhlenberg Campus; Muhlenberg, Pennsylvania
  • Penn State Milton S. Hershey Medical Center; Hershey, Pennsylvania
  • University of Texas Medical Branch at Galveston; Galveston, Texas
  • Texas Children's Hospital; Houston, Texas
  • University of Virginia Medical Center; Charlottesville, Virginia
  • Virginia Commonwealth University Medical Center; Richmond, Virginia
  • Children’s Hospital of Wisconsin, Milwaukee; Milwaukee, Wisconsin
  • Froedtert & the Medical College of Wisconsin – Froedtert Hospital, Milwaukee; Milwaukee, Wisconsin
  • UW Health – University of Wisconsin Hospital, Madison, and the American Family Children’s Hospital, Madison; Madison, Wisconsin
  • MedStar Washington Hospital Center; Washington, D.C.
  • Children's National Medical Center; Washington, D.C.
  • George Washington University Hospital; Washington, D.C.
  • Harborview Medical Center; Seattle, Washington
  • Seattle Children’s Hospital; Seattle, Washington
  • Providence Sacred Heart Medical Center; Spokane, Washington
  • West Virginia University Hospital; Morgantown, West Virginia

Thursday, April 30, 2015

Hospital Preparedness: Ebola Treatment Centers

Ebola treatment centers are facilities that plan to care for and manage a patient with confirmed EVD for the duration of the patient’s illness. State and local decisions to designate Ebola treatment centers are informed by the results of a CDC site visit conducted by an interdisciplinary team of subject matter experts. Site visits assess the hospitals’ ability to meet the minimum criteria (including infection control capacity, physical infrastructure, staffing resources, PPE supplies, waste management processes, worker safety training, environmental services, and laboratory set up). Staff must be trained in and have practiced putting on and taking off (donning and doffing) PPE for Ebola, as well as providing clinical care using PPE.

Given current PPE shortages, Ebola treatment centers may not be able to procure in advance the amount of PPE needed to care for a patient with EVD. Therefore, at a minimum, to be ready to accept and care for patients with EVD, hospitals will need sufficient PPE for at least 7 days. If hospitalization is anticipated to exceed 7 days, state and local health authorities, in collaboration with CDC, may provide or facilitate the procurement of additional PPE supplies. CDC Ebola Response Teams (CERTs) are ready to deploy to any Ebola treatment center to provide technical assistance for infection control procedures, clinical care, and logistics of managing patients with EVD as soon as the health department or hospital requests assistance.

In addition, CDC is available 24/7 for consultation to hospitals and state and local health departments by calling the CDC Emergency Operations Center (EOC) at 770-488-7100 or via email at eocreport@cdc.gov.

Guidance for Ebola Treatment Centers can be found at http://www.cdc.gov/vhf/ebola/hcp/preparing-ebola-treatment-centers.html.

Interim Guidance for Hospital Preparedness for Evaluation, Testing, and Management of Patients with Possible or Confirmed Ebola Virus Disease (EVD)

Thursday, April 23, 2015

Hospital Preparedness: Ebola Assessment Hospitals

Ebola assessment hospitals are facilities prepared to receive and isolate PUIs and care for the patient until a diagnosis of EVD can be confirmed or ruled out and until discharge or transfer is completed. All states, particularly those not planning to designate Ebola treatment centers, should strongly consider identifying Ebola assessment hospitals to ensure that people with symptoms and exposure history consistent with EVD can be cared for until the diagnosis of EVD is confirmed or ruled out. States should consider selecting enough hospitals to provide adequate geographic coverage across the state and avoid extended transport times of more than 1 to 2 hours from areas in which there are large populations of returning travelers, if possible.

Coordinated public health systems are in place to monitor people potentially exposed to EVD (i.e., active and direct active monitoring). Public health authorities may identify people under monitoring who need testing for EVD if they develop compatible signs or symptoms, and may refer them to Ebola assessment hospitals. These people are likely to have been previously identified as at some level of risk for EVD through airport screening[PDF - 2 pages] and will be actively monitored by public health authorities during the 21 days following travel to an affected country or other potential EVD exposure. Therefore, patients at high risk for EVD should be referred primarily to Ebola assessment hospitals (or treatment centers) rather than frontline healthcare facilities. State and local public health authorities will coordinate closely with facilities when directing patients to a designated Ebola assessment hospital or Ebola treatment center.
  • PUIs are likely to present for evaluation with mild symptoms such as isolated fever. Therefore, initial isolation and evaluation of these minimally symptomatic patients can be performed using PPE according to CDC’s Emergency Department Evaluation and Management for Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD).
  • In addition, Ebola assessment hospitals should be equipped with PPE needed for clinical care of patients with EVD with more severe symptoms and have staff trained in correct PPE use for PUIs who have vomiting, copious diarrhea, or obvious bleeding,
  • Because it may take 72 hours or longer after symptom onset to definitively confirm or rule out an EVD diagnosis (with an additional 12 to 24 hours for specimen transport, testing, and identification of another facility for transfer if needed), Ebola assessment hospitals should be prepared to provide care for PUIs for up to 96 hours. Therefore, Ebola assessment hospitals should have PPE for Ebola sufficient for at least 4 to 5 days of patient care and ensure that staff members involved in or supporting patient care are appropriately trained for their roles. This includes demonstrated proficiency in donning and doffing (putting on and taking off) PPE, proper waste management, infection control practices, and specimen packaging and transport.
  • In collaboration with public health officials, Ebola assessment hospitals also should be prepared to coordinate Ebola testing, which may involve transferring specimens to an LRN laboratory capable of EVD testing. Decisions about when to transport to an Ebola treament center a PUI for EVD or patient with confirmed EVD should be informed by discussions among public health authorities and the referring and receiving physicians on a case-by-case basis. When the decision has been made to transport a patient, preparations should ensure that transport providers are aware of the patient’s status and have appropriate training and PPE to safely transport a patient to a treatment center.
  • Ensure there is no delay in the care of these patients by being prepared to test, manage, and treat alternative etiologies of febrile illness (e.g., malaria in travelers) as clinically indicated.

Friday, April 10, 2015

Hospital Preparedness: Frontline Healthcare Facilities

Most U.S. acute care facilities that are equipped for emergency care (such as hospital-based emergency departments and other emergency care settings including urgent care clinics and critical access hospitals) are in this tier. Frontline healthcare facilities do not include primary care offices and other nonemergent ambulatory care settings. Preparedness guidance for these settings can be found at: Identify, Isolate, Inform: Emergency Department Evaluation and Management of Patients Under Investigation for Ebola Virus Disease[PDF - 1 page].

CDC’s Interim U.S. Guidance for Monitoring and Movement of People with Potential Ebola Virus Disease (EVD) recommends active monitoring by state and local public health agencies for all people who have a recognized potential exposure to EVD within the previous 21 days. These people will be directed to designated facilities for evaluation if they become ill. However, it is also possible that patients with unrecognized EVD will present to a frontline healthcare facility without warning or, rarely, patients may be temporarily referred to frontline healthcare facilities when it is not feasible to refer them to an Ebola assessment or Ebola treatment center, based on distance, bed availability, or other considerations. Therefore, frontline healthcare facilities should be prepared to promptly identify and isolate patients who may have EVD and promptly inform the hospital/facility infection control program and state and local public health agency according to the CDC guidance for emergency departments. In some situations, frontline healthcare facilities may also arrange for Ebola testing at the nearest Laboratory Response Network (LRN) laboratory capable of performing testing for EVD, in accordance with the state’s plan. Frontline healthcare facilities are not expected to provide prolonged care (>12–24 hours) for a severely ill patient.
Specifically, frontline healthcare facilities should, in coordination with local and state health authorities, be able to:
  • Rapidly identify and triage patients with relevant exposure history AND signs or symptoms compatible with EVD as outlined in CDC’s Emergency Department Evaluation and Management for Patients Under Investigation (PUIs) for Ebola Virus Disease(EVD).
  • Immediately isolate any patient with relevant exposure history and signs or symptoms compatible with EVD and take appropriate steps to adequately protect staff caring for the patient, including appropriate use of personal protective equipment (PPE) as outlined in CDC’s Emergency Department Evaluation and Management of Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD).
  • Immediately notify the hospital/facility infection control program, other appropriate facility staff, and the state and local public health agencies that a patient has been identified with relevant exposure AND signs or symptoms compatible with EVD; discuss level of risk, clinical and epidemiologic factors, alternative diagnoses, and plan for EVD testing and further care. Patients who are deemed to have low likelihood of EVD on the basis of clinical and epidemiologic factors and have mild illness, but who nonetheless require EVD testing, may, in some circumstances, remain at the frontline healthcare facility while testing is conducted.
  • Frontline healthcare facilities, in accordance with the state’s plan, should consider immediately transferring patients who have a higher probability of EVD or are more severely ill to either an Ebola assessment hospital or to an Ebola treatment center that can provide Ebola testing and care for the higher risk patients until an EVD diagnosis is either confirmed or ruled out. The state plan may include plans to transfer the patient out of state based on the patient’s risk and severity of illness and the geographic location of Ebola assessment hospitals and Ebola treatment centers. Such plans should ensure that transport providers are aware of the patient’s status and have appropriate training and PPE to safely transport a patient to a treatment center.

Thursday, April 2, 2015

Hospital Preparedness: A Tiered Approach

  • Preparing Frontline Healthcare Facilities
  • Preparing Ebola Assessment Hospitals
  • Preparing Ebola Treatment Centers
  • Current Ebola Treatment Centers

Page Summary

Who this is for: State and local health departments, acute care hospitals, and other emergency care settings, including urgent care clinics.

What this is for: Guidance to assist state and local health departments, acute care hospitals, and other emergency care settings (including urgent care clinics) in developing preparedness plans for patients under investigation (PUIs) for Ebola virus disease (EVD). This guidance does not address Ebola preparedness for primary care offices and other non-emergent ambulatory care settings. Guidance for these settings can be found in Identify, Isolate, Inform: Emergency Department Evaluation and Management of Patients Under Investigation for Ebola Virus Disease[PDF - 1 page].

How this relates to other guidance documents/purpose: This guidance serves as an overarching framework for three other specific CDC guidance documents: Interim Guidance for Preparing Frontline Healthcare Facilities for Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD); Interim Guidance for Preparing Ebola Assessment Hospitals; and Interim Guidance for Preparing Ebola Treatment Centers.

Key Points

  1. Acute healthcare facilities can serve one of three roles:
    • Frontline healthcare facilities
    • Ebola assessment hospitals
    • Ebola treatment centers
  2. To create a coordinated, networked approach, state and local health officials, in collaboration with hospital and healthcare facility executives, may designate healthcare facilities across the state to serve in one of three suggested roles outlined in this guidance document.
  3. Whereas every state is not obligated to adopt a three-tiered approach, all states are strongly encouraged to identify Ebola assessment hospitals that can successfully manage PUIs until an EVD diagnosis is either confirmed or ruled out while awaiting transfer to an Ebola treatment center.
All U.S. acute healthcare facilities have an important role in preparing to identify, isolate, and evaluate PUIs for EVD and promptly informing public health authorities. However, the roles and the preparations required to perform these tasks will differ by facility. Acute healthcare facilities can serve one of three roles: as a frontline healthcare facility, Ebola assessment hospital, or Ebola treatment center (see Figure). In some cases, a hospital may be prepared to serve in more than one role. Some hospitals may serve simultaneously as an Ebola assessment hospital and an Ebola treatment center. State and local health ‎officials, in consultation with healthcare officials in hospitals and urgent/emergency care settings and emergency medical services providers across the state, should develop a concept of operations plan that describes a networked approach to the evaluation, care, and testing of PUIs , including specific plans for the transfer and treatment of patients with confirmed EVD. As part of Ebola hospital preparedness efforts, hospital officials should develop an internal communications plan to ensure that information is shared in a coordinated way if the facility needs to care for PUIs. An external communications plan to effectively communicate with media, partners, and others should also be developed.

To create a coordinated, networked approach, state and local health officials, in collaboration with hospital executives, may identify healthcare facilities across the state to serve in one of three suggested roles outlined in this guidance document. Whereas every state is not obligated to adopt a three-tiered approach, all are strongly encouraged to identify Ebola assessment hospitals that can successfully manage PUIs or confirmed cases of EVD until an EVD diagnosis is ruled out, especially in states where there is not expected to be an Ebola treatment center. This is particularly important in states where there is not expected to be an Ebola treatment center. Designating assessment hospitals helps to ensure that PUIs have in-state access to care while awaiting transfer to an Ebola treatment center.

Wednesday, March 25, 2015

Think Ebola: Early recognition is critical

ISOLATE

If assessment indicates possible Ebola virus infection, take action.

  • Isolate the patient in a private room with a private bathroom or covered, bedside commode and close the door
  • Wear appropriate personal protective equipment (PPE): http://go.usa.gov/szgB
  • Limit the healthcare personnel who enter the room
  • Keep a log of everyone who enters and leaves the patient’s room
  • Consider alternative diagnoses, and evaluate appropriately
  • Only perform necessary tests and procedures
  • Avoid aerosol-generating procedures Follow CDC guidelines for cleaning, disinfecting, and managing waste: http://
    go.usa.gov/szYA

INFORM

Alert others, including public health authorities.

  • Notify your facility’s infection control program and other appropriate staff
  • Contact your state or local public health authorities
  • Consult with state or local public health authorities about testing for Ebola
  • For a list of state and local health department numbers, visit: http://go.usa.gov/f74V

Friday, March 20, 2015

Think Ebola: Early recognition is critical

INITIATE

Think Ebola when you approach a patient. Start the steps for basic infection control before assessing the patient for risks.

  • Always use standard precautions
  • If there are concerns that the patient could meet the criteria for Ebola, immediately separate the patient from others

IDENTIFY

Assess your patient for:

  • Travel to a country with widespread transmission or uncertain control measures (Guinea, Liberia, or Sierra Leone) within the last 21 days
OR
  • Contact with someone with Ebola within the last 21 days
AND
  •  Had a fever at home, or has a current fever
  • Other symptoms:
    • Severe headache
    • Muscle pain
    • Weakness
    • Fatigue
    • Diarrhea
    • Vomiting
    • Abdominal (stomach) pain
    • Unexplained hemorrhage (bleeding or bruising)
  • If the patient has both exposure and symptoms, immediately isolate the patient and inform others (see INFORM -> Coming Soon)

Friday, March 13, 2015

CDC: Ebola Basics

Ebola virus is NOT spread through:

  • Casual contact
  • Air
  • Water
  • Food grown or legally purchased in the U.S.

How do you get the Ebola virus?

  1. Body fluids of a person who is sick with or has died from Ebola. (blood, vomit, urine, feces, sweat, semen, spit, other fluids)
  2. Objects contaminated with the virus. (needles, medical equipment)
  3. Infected fruit bats or pirmates (apes and monkeys)

Early Symptoms

Ebola can only be spread to others after symptoms begin.  Symptoms can appear from 2 to 21 days after exposure.
  • Fever
  • Headache
  • Fatigue
  • Diarrhea
  • Vomiting
  • Stomach pain
  • Unexplained bleeding or bruising
  • Muscle pain

When is someone able to spread the disease to others?

Ebola only spreads when people are sick. A patient must have symptoms to spread the disease to others.
After 21 days, if an exposed person does not develop symptoms, they will not become sick with Ebola.

Friday, February 20, 2015

Ebola: The Standards

This section highlights OSHA standards, preambles to final rules, and directives (instructions for compliance officers) that may be applicable in the event of possible worker exposure to the Ebola virus.

OSHA’s Bloodborne Pathogens standard (29 CFR 1910.1030) covers exposure to Ebola virus. Ebola is among the subset of contact-transmissible diseases to which the Bloodborne Pathogens standard applies, as it is transmitted by blood or other potentially infectious materials as defined in the standard.

In situations where workers may be exposed to bioaerosols containing Ebola virus, employers must also follow OSHA’s Respiratory Protection standard (29 CFR 1910.134).

Other elements of infection control for Ebola, including a number of precautions for contact-transmissible diseases, are covered under OSHA’s Personal Protective Equipment (PPE) standard (29 CFR 1910.132) and Section 5(a)(1) of the Occupational Safety and Health (OSH) Act of 1970, often referred to as the General Duty Clause. Section 5(a)(1) requires employers to "furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees." This section may be used to address hazards for which there are no specific standards (e.g., occupational exposure to Ebola virus).

Under the Bloodborne Pathogens standard, and the PPE and other standards, OSHA has the ability to require employers to fully protect healthcare and other workers who may be exposed to Ebola virus. The best way to determine appropriate protections for workers exposed to Ebola is to consult the CDC guidance, which includes recommendations for PPE and infection control practices from CDC's Ebola web page.

Employers also must protect their workers from exposure to chemicals used for cleaning and disinfection. Employers would likely need to comply with provisions from a combination of OSHA standards and CDC guidance in order to implement a comprehensive worker protection program.

Paragraph 11(c) of the OSH Act prohibits employers from retaliating against workers for raising concerns about safety and health conditions. OSHA encourages workers who suffer such discrimination to submit a complaint to OSHA. Such complaints must be filed within 30 days.

Depending on the specific work task, setting, and exposure to biological or chemical agents, additional OSHA standards, including the following, may also apply:

General Industry (29 CFR 1910)
Preambles to final rules
Directives
Memoranda of Understanding
Additional guidance is available on the Control and Prevention and Additional Information tabs.

Tuesday, February 17, 2015

Ebola: Medical Information

The most common routes of transmission of Ebola viruses are:
  • Contact of the eyes or other mucous membranes with blood or body fluids of a person or animal with Ebola Hemorrhagic Fever (EHF),
  • Contact with contaminated equipment or other objects; and
  • Ingestion of infectious blood or body fluids.
Ebola virus is believed to be viable outside of the body for several days. An evaluation of the persistence of certain Category A select agents in the environment suggests that viruses of the family Filoviridae, of which Ebola viruses are members, may remain stable for 4-5 days in dried blood.2

Though transmission through inhalation of airborne virus is not currently a primary concern during naturally-occurring outbreaks, it may be possible for Ebola virus to be aerosolized under certain conditions. CDC has provided guidance for healthcare workers who must perform aerosol-generating procedures on patients known to have or suspected of having EHF. Pathogenicity (i.e., how the virus acts on the body to cause disease) and symptoms are typically the same regardless of the initial route of infection with Ebola virus
In all settings, avoid using compressed air or water when cleaning surfaces, as it might cause droplets containing infectious material to become airborne (i.e., create a bioaerosol).1

Symptoms of Ebola typically appear within 2-21 days (8-10 days is most common) following infection, and the illness runs its course within 14-21 days of symptom onset. The table below describes the natural history of Ebola:
Exposure Incubation Symptom Onset Illness Recovery or Death
- Exposure to Ebola virus through contact with infectious blood or body fluids, contaminated environmental surfaces, or an infected individual or animal.
- In some instances, exposure may be due to aerosolized viral particles.
- Exposed individuals are not contagious.
- Virus multiplies within the body before symptoms develop.
- Individuals become contagious when symptoms appear.
- Initial symptoms of EHF may include fever, fatigue, muscle pain, headache, and sore throat.
- Symptoms appear similar to other viral illnesses.
- Illness progresses to include nausea, vomiting, diarrhea, impaired organ function, and blood count changes.
- Some cases experience a rash and internal and/or external bleeding (e.g., from skin, eyes, or gums).
- The bodies of individuals who die from EHF remain infectious after death, and must be handled accordingly during death care.
- Individuals who recover from EHF generally are no longer contagious.
Day 0
2-21 days
14-21 days
Up to 49 days
As the infection progresses, patients often experience a rash and severe bleeding as the blood loses its ability to coagulate and blood vessel membranes become more permeable. Lymphocyte counts drop and neutrophils spike. Ebola patients ultimately die from diffuse bleeding and shock.
Medical Management and Countermeasures
There is currently no treatment, antiviral therapy, or approved vaccine for EHF or Ebola virus. Supportive hospital care for patients with EHF (like other viral hemorrhagic fevers) includes fluid and blood replacement, maintaining stable blood pressure, and treating other comorbidities (i.e., other injuries or infections) as appropriate.

Individuals who may have come into contact with Ebola virus may be quarantined at the discretion of public health officials. Isolate suspected and confirmed cases of EHF to prevent transmission of the disease to other individuals. Suspected and confirmed cases of Ebola should be isolated to prevent transmission of the disease to other individuals. If possible, isolating suspected cases separately from confirmed cases also may help prevent transmission.

Healthcare providers have a variety of tools at their disposal to test for Ebola virus infection and diagnose EHF, including blood tests that can detect antibodies to the Ebola virus or the RNA of the virus itself. Cell culture and electron microscopy are also used to identify Ebola virus.

The U.S. Department of Homeland Security has identified EHF as a high-priority threat. The U.S. Department of Health and Human Services is prioritizing the development of vaccines and other medical countermeasures for EHF and Ebola virus accordingly.3 The National Institutes of Health (NIH) has had some success with experimental vaccines in non-human primate models. Ongoing research into recombinant adenoviruses, recombinant vesicular stomatitis viruses (VSVs), and other recombinant vaccine products is underway, but human trials are still needed to demonstrate safety and efficacy.4 Research efforts continue in a number of nations to develop an effective vaccine and other medical countermeasures, such as antibody serum, to prevent or treat EHF and related diseases.