ICU workers are particularly at risk for exposure to blood, OPIM, and bloodborne pathogens because of the immediate, life-threatening nature of treatment.

The Bloodborne Pathogens Standard requires precautions when dealing with blood and other potentially infectious materials. For a complete explanation see HealthCare Wide Hazards - Bloodborne Pathogens. Some summary information for this area include:

• Provide Engineering and Work Practice Controls
  
  
  • Engineering and work practice controls must be the primary means to eliminate or minimize exposure to bloodborne pathogens. Where engineering controls will reduce employee exposure either by removing, eliminating, or isolating the hazard, they must be used, and changes to the Exposure Control Plan (ECP) must include these engineering controls [1910.1030(c)(1)(iv), 1910.1030(d)(2)(i) and OSHA Directive CPL 2-2.69.
    
  Employers must:

	Ensure employees wear appropriate personal protective equipment (PPE), (e.g., gloves, gowns, face masks), when anticipating blood or OPIM exposure [1910.1030(d)(3)(i)].
	Ensure employees discard contaminated needles and other sharp instruments immediately or as soon as feasible after use into appropriate containers [1910.1030(d)(4)(iii)(A)(1)].
	Provide in their exposure control plan documentation of consideration and implementation of appropriate commercially available and effective engineering controls designed to eliminate or minimize exposure to blood and OPIM. [OSHA Directive CPL 2-2.69].
	Practice Universal Precautions: Treat all blood and other potentially infectious body fluids as if they are infected and take appropriate precautions to avoid contact with these materials [1910.1030(d)(1)]. The Bloodborne Pathogens Standard does allow hospitals to practice acceptable alternatives to Universal Precautions such as Standard Precautions or Body Substance Isolation.

Intensive care units (ICU's), particularly neonatal ICU's, may be designed without walls between patient spaces. This may allow employees to be unknowingly exposed to aerosolized chemicals and x-ray radiation that escape from neighboring areas.

• All rooms should have adequate ventilation to remove contaminants.
  
  
  • If air recirculation is required, then adequate filtering should be installed.
  
  
• Staff in adjoining patient spaces may need to be warned and removed if procedures such as x-rays are occurring.
  
  
• Aerosolized chemicals should be administered in such a fashion as not to expose staff or patients in the area to the hazard.
  
  
• OSHA Technical Manual Hospital Investigation Health Hazards: IV Controls and Prevention.

Because of the emergency atmosphere, (i.e., high traffic and compact treatment spaces) for ICU areas, slips/trips/falls may be a specific concern. There is a potential slip and fall hazard if water or other fluid is spilled on the floor, electrical cords run across pathways, or if emergency equipment or supplies block passage and passageways.

Provide safe clean-up of spills and keep walkways free of obstruction.

For additional information see HealthCare Wide Hazards - Slips/Trips/Falls.

Gloves must be worn frequently in the ICU, because of possible occupational exposure to blood and OPIM. This exposure can potentially lead to latex allergy.

Employers must provide appropriate gloves when exposure to blood or other potentially infectious materials (OPIM) exists [1910.1030(d)(3)(iii)], Bloodborne Pathogens Standard].

For additional information see HealthCare Wide Hazards - Latex Allergy.

Injury may occur to employees from improper training or use of equipment, e.g., defibrillators.

A program that routinely monitors the status of equipment and proper training of employees to use equipment safely.

Workplace violence is an issue in ICU's because of the crowded, emotional situations that can occur with critical patients.

Good work practice recommends a security management program that addresses workplace violence in the ICU and could include:

• Trained staff to recognize and diffuse violent situations and patients.
  
  • Be alert for potential violence and suspicious behavior and report it.
    
    
  • Provide intervention measures including verbal, social, physical, and pharmacological interventions.
    
    
  • Warning Signs of Increasing Anger/Violence include:
    
    
    • Pacing and/or restlessness
      
      
    • Clenched fist
      
      
    • Increasingly loud speech
      
      
    • Excessive insistence
      
      
    • Threats
      
      
    • Cursing

For additional information see HealthCare Wide Hazards - Workplace Violence.

• All hospital employees are exposed to stress, but employees who work in some areas such as the ICU, or the Emergency Department must deal with additional stress. They are exposed to critically ill patients and must deal with emotional life/death situations on a daily basis, increasing their risk for workplace stress, and job burnout.

• Educate employees and management about job stress.
  
  
• Address work-related stressors, such as inadequate work space, unreasonable work load, lack of readily available resources, inadequate and unsafe equipment.
  
  
• Establish programs to address workplace stress, such as Employee Assistance Programs (EAP) or Organizational Change Programs.

• An Employee Assistance Program (EAP) can improve the ability of workers to cope with difficult work situations. Stress management programs teach workers about the nature and sources of stress, the effects of stress on health, and personal skills to reduce stress-for example, time management or relaxation exercises.
  
  
• EAPs also provide individual counseling for employees for both work and personal problems.
  
  
• Organizational Change Programs change hospital policies and procedures to reduce organizational sources of stress.
  
  
  • This is done by bringing in a consultant to recommend ways to improve working conditions. This approach is the most direct way to reduce stress at work. It involves the identification of stressful aspects of work (e.g., excessive workload, conflicting expectations) and the design of strategies to reduce or eliminate the identified stressors. Some strategies include:
    
    
    • Ensure that the workload is in line with workers' capabilities and resources.
      
      
    • Design jobs to provide meaning, stimulation, and opportunities for workers to use their skills.
      
      
    • Clearly define workers' roles and responsibilities.
      
      
    • Give workers opportunities to participate in decisions and actions affecting their jobs.

• Stress at Work DHHS (NIOSH) Publication No. 99-101.
• Stress Management in the Work Setting May, 1987. DHHS (NIOSH) Publication No. 87-111.

• Exposure of staff to nosocominal infections such as MRSA from body fluid exposure. This is especially common in the ICU area, where employees must care for patients who have open and healing wounds from recent surgery.

• Practice Universal Precautions.
  
  
• The CDC's recommendations for preventing transmission of MRSA in hospitals consist of Standard Precautions, which should be used for all patient care. In addition the CDC recommends Contact Precautions in special cases, when the facility (based on national or local regulations) deems the multi-drug-resistant microorganism to be of special clinical and epidemiological significance. For more information about the CDC's standard precautions; see:
  
  
  • Guideline for Isolation Precautions in Hospitals. CDC, 1996.

For additional information see HealthCare Wide Hazards - Multi-Resistant Organisms (MRO), and Universal Precautions.