Water spills that can lead to falls and injuries. Continually wet surfaces can also create a health hazard by promoting the growth of molds and bacteria that can cause infections or allergic reactions in employees.

• Floors shall be kept clean and dry [29 CFR 1910.22(a)(2)]. 
• Non-slip mats and other dry standing places should be provided where practicable [29 CFR 1910.22(a)(2)]. In addition to being a slip hazard continually wet surfaces promote the growth of mold, fungi, and bacteria which can cause infections.  
• The OSHA Walking/ Working Surfaces Standard requires that all places of employment shall be kept clean and orderly and in a sanitary condition [29 CFR 1910.22(a)(1)].
• The OSHA Sanitation Standard requires: 
  • Where wet processes are used, drainage shall be
    maintained and false floors, platforms, mats, or other dry
    standing places shall be provided, where practicable, or
    appropriate waterproof footgear shall be provided [29 CFR 1910.141(a)(3)(ii)]. 

• Ensure spills are reported and cleaned up immediately. 
• Use no skid waxes and surfaces coated with grit or waterproof footgear, may also help decrease slip/fall hazards. 

• 29 CFR 1910.22, General requirements  
• Small Business Handbook. OSHA Publication 2209-02R, (2005). Also available as a 260 KB PDF, 56 pages.
  • Walkways
• Walking/Working Surfaces. OSHA Safety and Health Topics Page.

Exposure to blood or other potentially infectious materials (OPIM) 

• While physical therapists provide therapy to patients with bed sores or other open wounds.
• While nursing staff are showering residents and must stand in water that may have blood or fecal matter in it.

Bloodborne Pathogens Standard 29 CFR 1910.1030 requires:

• Exposure control plan in place to help reduce the risk of occupational exposure to bloodborne pathogens:
  • Communicate possible hazards to Physical Therapist.
  • Educate and train all employees with occupational exposure to blood or OPIM to recognize hazards.
  • Provide personal protective equipment (PPE), such as gloves and gowns. 
  • Use safe work practices and engineering controls.
  • Provide Hepatitis B Vaccination.

• Provide "Shower Boots" for nursing staff to wear to protect their feet from exposure to water, fecal matter and blood that may be present when they shower residents [29 CFR 1910.132(a)].

For more information see the Bloodborne Pathogens Module.

• Bloodborne Pathogens. OSHA Safety and Health Topics Page.
  

Exposure to Legionnaires' Disease through:

• Breathing aerosolized water that contains the legionella bacteria. This could occur in the shower or whirlpool area, or areas that have a spray nozzle. Cooling towers, evaporative condensers, fluid coolers, and domestic hot-water systems are water sources that frequently provide optimal conditions for growth of the legionella bacteria.

Good work practice includes appropriate maintenance of water systems, as recommended by the OSHA Technical Manual Legionnaires' Disease Chapter 7 Section III Chapter 7 - Controls:

• Domestic hot-water systems:
  • Store hot water at 140 degrees F. To avoid scalding problems install appropriate, fail-safe scald protection equipment, such as preset thermostatic mixing valves.
  • Where building cannot be retrofitted, periodically increasing the temperature to at least 158 degrees F or chlorination followed by flushing should be considered.
  • Systems should be inspected annually to ensure equipment is functioning properly.
    
    
• Domestic cold-water systems:
  • Maintain cold-water lines below 68 degrees F.
  • Water tanks that allow water to remain uncirculated for long periods should be eliminated or designed to reduce storage time to a day or less. They should also be covered and protected from temperature extremes.
  • Cross-contamination of the domestic cold water system with other systems shall be prevented.
  • If the cold-water lines have significant contamination, hyper chlorination can eradicate legionella.
    
    
• Cooling towers should be cleaned and disinfected at least twice a year: 
  • Periodic use of biocides is recommended to control bacteria growth.
  • Provide visual inspection and periodic maintenance of the system, to prevent buildup of scale and sediment and bio-fouling, which support legionella growth.

The OSHA Technical Manual also provides recommendations for Source Identification of Legionnaires' disease and a employee awareness program.

• Employee awareness program: The purpose of an employee awareness program is to inform employees of any potential outbreak, to educate about the disease, and provide early recognition of the disease. Sample forms and questions and answers about Legionnaires' disease are provided in the technical chapter.

The Engineering Module also addresses Legionnaires' Disease.