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
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
2. Developing Hospital Safety and Health Programs
3. Recommended Guidelines for Controlling Safety Hazards
4. Recommended Guidelines for Controlling Infectious Diseases
5. Recommended Guidelines for Controlling Noninfectious Health Hazards in Hospitals
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
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
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
1. Distribution of Hospital Workers (SIC 806) by
Occupation
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.
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.
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 dUnites |
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 |
Sandra E. Bonzo§
Division of Standards Development and Technology Transfer (DSDTT)
Subsequently, the following DSDTT staff members were primarily responsible for completing this document:
Diane M. Manning
Docket Office Coordinator
Lawrence F. Mazzuckelli
Associate Director for Policy Development
Contributions by other NIOSH staff members are also gratefully acknowledged:
Bryan D. Hardin, Ph.D., Chief
Kern Anderson
| Public Health Advisor Ruth E.
Grubbs | Writer/Editor Vanessa L. Becks | Editorial Assistant Denise
Hill | Secretary Michael A. Brown | Industrial Hygienist Howard A.
Ludwig | Industrial Hygienist Carolyn A.
Browning | Writer/Editor Dannie C.
Middleton,
M.D. | Medical Officer Crystal L. Ellison | Industrial Hygienist Mary A. Newman,
Ph.D. | Industrial Hygienist Vivian K. Morgan, Chief
Madonna Allen | Library Technician Tammy K.
Lykins | Clerk-Typist Lawrence Q.
Foster | Librarian Lucy
Schoolfield | Library Technician Hattie Frei | Secretary Linda
Smith | Library Aide Leslie Karlin, R.N. | Special Assignment from DSHEFS Suzette
Yeager | Secretary Lisa Kingery | Secretary
Thomas Ziegler | Library Technician Richard A. Lemen, Director Richard W. Niemeier, Ph.D., Deputy Director
Sandra L. Clark | Secretary
Jennifer A.
Huxford | Clerk-Typist B. JoAnne Hamons
| Secretary Laurence D.
Reed | Senior Reviewer, Engineering Donald Millar, M.D., D.T.P.H., Director
David Bayse, Ph.D. | Chief Science Advisor Hugh Hansen,
Ph.D. | Assistant Science Advisor Writer/Editor
| |
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