Guidelines for Protecting
the Safety and Health
of Health Care Workers

U. S. Department of Health and Human Services
Public Health Service
Centers for Disease Control
National Institute for Occupational Safety and Health
Division of Standards Development and Technology Transfer
September 1988

For sale by the Superintendent of Documents,
US Government Printing Office,
Washington, DC 20302

Disclaimer

Mention of the name of any company or product does not constitute endorsement by the National
Institute for Occupational Safety and Health.

DHHS (NIOSH) Publication No. 88-119

This document is also available in PDF

CONTENTS

Abstract

Abbreviations

Acknowledgments

1. Introduction

1.1 Occupational Injury and Illness Among Hospital Workers
1.2 Growth of Occupational Safety and Health Programs for Hospital Workers
1.3 Health Service Programs and Safety and Health Committees
1.4 References
1.5 Additional Resources

2. Developing Hospital Safety and Health Programs

2.1 Addressing Diverse Needs
2.2 Evaluating Hazards
2.3 Controlling Hazards
2.4 Occupational Safety and Health Agencies and Organizations
2.5 References
2.6 Additional Resources

3. Recommended Guidelines for Controlling Safety Hazards

3.1 Types of Safety Hazards
3.2 Specific Safety Hazards by Hospital Department
3.3 References
3.4 Additional Resources

4. Recommended Guidelines for Controlling Infectious Diseases

5. Recommended Guidelines for Controlling Noninfectious Health Hazards in Hospitals

5.1 Chemical Hazards
5.2 Physical Hazards
5.3 Mutagens and Teratogens
5.4 Dermatological Hazards
5.5 Stress
5.6 References
5.7 Additional Resources

6. Hazardous Waste Disposal

6.1 Infectious Wastes
6.2 Noninfectious Wastes
6.3 References
6.4 Additional Resources

7. Directory of Occupational Safety and Health Information for Hospitals

7.1 Government Agencies and Organizations
7.2 Hospital Associations and Organizations
7.3 Safety and Health Organizations
7.4 Health Professional and Worker
7.5 Manufacturer's Associations
7.6 Publications

Appendices

1. Distribution of Hospital Workers (SIC 806) by Occupation

2. NIOSH Guidelines for Evaluation of Hospital Occupational Health and Safety Programs

3. Occupational Hazards by Location in the Hospital

4. Chemicals Encountered in Selected Hospital Occupations

5. Joint Advisory Notice: Protection Against Occupational Exposure to Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV)

6. Morbidity and Mortality Weekly Reports

7. OSHA Work-Practice Guidelines for Personnel Dealing with Cytotoxic (Antineoplastic) Drugs

8. Reprints of Guidelines for the Prevention and Control of Nosocomial Infections

Preface

The purpose of the Occupational Safety and Health Act of 1970 (Public Law 91596) is to ensure safe and healthful working conditions for every working man and woman in the Nation and to preserve our human resources by providing medical and other criteria that will ensure, insofar as practicable, that no workers will suffer diminished health, functional capacity, or life expectancy as a result of their work experience. The Act authorizes the National Institute for Occupational Safety and Health (NIOSH) to develop and establish recommended occupational safety and health standards, and to conduct the necessary research and experimental programs to develop criteria for new and improved occupational safety and health standards. Although this document does not recommend a new standard, it does present guidelines for reducing the incidence of injury and disease among health care workers. Every effort was made to address all major health and safety hazards that might be encountered in hospitals or other health care centers. The document is not intended to affect patients directly, but implementing the guidelines will generally benefit patient care.

The present document is a major revision of an earlier draft and incorporates the most recent NIOSH recommended standards, the Occupational Safety and Health Administration regulations, and Centers for Disease Control guidelines. Also included is specific information from the Joint Commission on Accreditation of Healthcare Organizations (formerly the Joint Commission on Accreditation of Hospitals), the National Fire Protection Association, the US Environmental Protection Agency, and other agencies. State and local regulations are not addressed, however, and should be consulted where applicable.

Abstract

These guidelines provide information needed to protect the health and safety of health care workers in hospitals and other health care facilities. The document includes an overview of hospital hazards; methods for developing hospital safety and health programs; discussions of safety hazards, infection diseases, and noninfectious health hazards; methods for disposing of hazardous wastes; and a list of occupational safety and health agencies and resource organizations. Because no single set of health and safety regulations applies to all aspects of hospital work or health care delivery, the guidelines presented here were compiled from many sources, including the National Institute for Occupational Safety and Health, the Centers for Disease Control, the Occupational Safety and Health Administration, the US Environmental Protection Agency, the Joint Commission of Accreditation of Healthcare Organizations, and others. Adherence to these guidelines should reduce the risk of injury and disease among health care workers.

Abbreviations

AAMI	Association for the Advancement of Medical Instrumentation
ACGIH	American Conference of Governmental Industrial Hygienists
ACIP	Immunization Practices Advisory Committee of the US Public Health Service
ADA	American Dental Association
AHA	American Hospital Association
AIDS	acquired immunodeficiency syndrome
AIHA	American Industrial Hygiene Association
AMA	American Medical Association
ANSI	American National Standards Institute
BCG	bacille CalmetteGuerin
BLS	Bureau of Labor Statistics
CAP	College of American Pathologists
CAT	computerized axial tomography
cc	cubic centimeter
CDC	Centers for Disease Control
CFR	Code of Federal Regulations
CMV	cytomegalovirus
CPC	chemical protective clothing
CPR	cardiopulmonary resuscitation
dB	decibel
DNA	deoxyribonucleic acid
EDTA	ethylene diaminetetraacetic acid
EEG	electroencephalogram
EPA	U. S. Environmental Protection Agency
f	fiber
FA	fluorescent antibody
FDA	Food and Drug Administration
GFCI	ground fault circuit interrupter
HAV	Hepatitis A virus
HBIG	Hepatitis B immune globulin
HBV	Hepatitis B virus
HBeAg	Hepatitis B "e" antigen
HBsAg	Hepatitis B surface antigen
HHE	health hazard evaluation
HI	hemagglutinationinhibition
hr	hour
HRA	Health Resources Administration
HRSA	Health Resources and Services Administration
HSV	herpes simplex virus
HTLVIII/LAV	human T-lymphotropic virus type III lymphadenopathy-associated virus
Hz	hertz
IAHS	International Association of Healthcare Security
IARC	International Agency for Research on Cancer
ICU	intensive care unit
IDLH	immediately dangerous to life or health
IG	immune globulin
IHSSF	International Healthcare Safety and Security Foundation
in	inch
IR	infrared
ISG	immune serum globulin
JCAH	Joint Commission on Accreditation of Hospitals
kHz	kilohertz
LCM	lymphocytic choriomeningitis
LPG	liquid propane gas
LPN	licensed practical nurse
LVN	licensed vocational nurse
m	meter
MeV	million electron volts
mg/m3	milligram per cubic meter
min	minute
mm	millimeter
MMWR	Morbidity and Mortality Weekly Report
MMR	measles, mumps, and rubella vaccine
mrem	millirem
MSDS	Material Safety Data Sheet
MSHA	Mine Safety and Health Administration
mW	milliwatt
NANB	nonA, nonB viral hepatitis
NCRP	National Council on Radiation Protection and Measurements
NEC	National Electrical Code
NFPA	National Fire Protection Association
NICU	neonatal intensive care unit
NIH	National Institutes of Health
NIOSH	National Institute for Occupational Safety and Health
nm	nanometer
NMR	nuclear magnetic resonance
NOHS	National Occupational Health Survey
NRC	Nuclear Regulatory Commission
NSC	National Safety Council
NTP	National Toxicology Program
OSHA	Occupational Safety and Health Administration
pa	posterior and anterior view
(Pa	micropascal
PAA	peracetic acid
PEL	permissible exposure limit
PMR	proportionate mortality ratio
PPD	purified protein derivative
PPDS	purified protein derivativestandard
ppm	part per million
psi(a)	pound per square inch (absolute)
ptAP	paratertiary amylphenol
ptBP	paratertiary butylphenol
QNFT	quantitative fit testing
RAD	radiation absorbed dose
RDL	respirator decision logic
REL	recommended exposure limit
rem	roentgen equivalent man
RF	radiofrequency
RN	registered nurse
RSV	respiratory syncytial virus
RTECS	Registry of Toxic Effects of Chemical Substances
SCE	sister chromatid exchange
SI	Systeme International d’Unites
STEL	shortterm exposure limit
TB	tuberculosis
TLD	thermoluminescent dosimeter
TLV (r)	threshold limit value
TLVC	threshold limit value – ceiling
TLV – skin	threshold limit value – skin adsorption
TLVSTEL	threshold limit value – shortterm exposure limit
TU	tuberculin unit
TWA	timeweighted average
UV	ultraviolet
V	volt
VDT	video display terminal
VZV	varicella zoster virus
W	microwatt
WBGT	wet bulb globe temperature

ACKNOWLEDGMENTS

Subsequently, the following DSDTT staff members were primarily responsible for completing this document:

Contributions by other NIOSH staff members are also gratefully acknowledged:

Thanks are due to the following reviewers:

Pierre Belanger, National Institute for Occupational Safety and Health
Linda H. Brooks, American Hospital Association
Marianne Brown, M.P.H., American Cancer Society
Kate Christianson, M.D., Kaiser Hospital, Los Angeles
David E. Clapp, Ph.D.,National Institute for Occupational Safety and Health
Linda Hawes Clever, M.D., Pacific Medical Center, San Francisco
Julia Garner, Centers for Disease Control
Gail Grynbaum, R.N., M.P.H., San Francisco General Hospital
Bobby J. Gunter, Ph.D., National Institute for Occupational Safety and Health
Douglas Kenyon, Pacific Medical Center, San Francisco
Richard A. Lemen, National Institute for Occupational Safety and Health
Frank Mitchell, D.O., Agency for Toxic Substances and Disease Registry
Melvin T. Okawa, National Institute for Occupational Safety and Health
Sharon Morris, University of Washington, Seattle
Linda Morse, M.D., San Francisco General Hospital
Lloyd B. Tepper, M.D., Air Products and Chemicals, Inc.
Walter W. Williams, M.D., M.P.H., Centers for Disease Control

We also appreciate the contributions of the following individuals and organizations, who provided the final review of this document:

The American Federation of Government Employees
The Association of Hospital Employee Health Professionals
Molly Coye, M.D., M.P.H., Commissioner of Health, State of New Jersey
The Joint Commission on Accreditation of Healthcare Organizations
Donna Richardson, American Nurses Association
Charles Whitcher, M.D., Professor of Anesthesia, Department of Anesthesia, Stanford University School of Medicine