• Exposure to infectious diseases during physical therapy treatment of patients through exposure to blood or other potentially infectious body fluids (OPIM). OPIM include human body fluids such as semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, and any body fluid that is visibly contaminated with blood.

The Bloodborne Pathogens Standard includes the following when dealing with blood and other potentially infectious materials:
	Universal precautions shall be observed to prevent contact with blood or other potentially infectious materials [1910.1030(d)(1)]. Under circumstances in which differentiation between body fluid types is difficult or impossible, all body fluids shall be considered potentially infectious materials [1910.1030(d)(1)].
	The Physical Therapist shall wear Personal Protective Equipment such as gloves when providing treatment for patients if exposure to blood or OPIM is anticipated, (e.g., wounds or non-intact skin are present that might open up during treatment) [1910.1030(d)(3)(ix)]. Masks, Eye Protection, and Face Shields whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated [1910.1030(d)(3)(x)].

For additional information, see HealthCare Wide Hazards - Bloodborne Pathogens and Universal Precautions

Exposure of physical therapy staff to potential work related musculoskeletal disorders (i.e., strain and sprain injuries to back and shoulders areas) from constant lifting and reaching for patients during treatment procedures and transfers.

	Good work practice recommends employers address ergonomic stressors in the physical therapy department and provide engineering controls and work practice techniques to help minimize stressors such as:
	Emphasize and teach the use of proper lifting techniques using good body mechanics. Take time to stop and think (evaluate the lift). Bend your knees, use arm and leg muscles, keep your back straight. Use smooth and steady lifting motions. Avoid lifting/reaching or working above shoulder height. Avoid awkward postures, such as twisting while lifting. Lift items close to the body. Avoid sitting or standing for long periods of time (take a break). Provide sufficient staff to handle lifts (i.e., get help).
	Use mechanical aids to reduce the need to lift patients. Some examples include the use of: Mechanical Lift Equipment When lifting patients who cannot support their own weight into/out of whirlpools or tubs. Sliding Boards A slick board used under patients to help reduce friction during transfers (e.g., to and from wheelchairs and treatment tables).
	Use adjustable equipment such as tubs and therapy tables. Therapists can then adjust the equipment to fit their individual height and comfort levels.

For additional information, see HealthCare Wide Hazards - Ergonomics.

Exposure to possible hazardous chemicals found and used in the PT area.

• Cleaning chemicals such as glutaraldehyde used to disinfect whirlpools or tubs.
  
  
• Gel used for ultrasound procedures.
  
  
• Prescription medications, creams, or ointments rubbed into skin of patient by therapist during physical therapy treatment.

• Use less-toxic products if feasible and available, or use other processes for sterilization. See the National Anti-Microbial Network for lists of other approved cold sterilization products.
  
  
• Rooms in which glutaraldehyde is to be used should be well ventilated and large enough to ensure adequate dilution of vapor, with a minimum air exchange rate of 10 air changes per hour.
  
  
  • Use increased dilution ventilation in whirlpool rooms and x-ray rooms, along with the careful application of the glutaraldehyde with a long-handled brush rather than a spray applicator.
    
    
• Follow procedures for safe administration of medications and creams. Therapists should wear gloves while applying certain medications to patients (e.g., if skin contact with the medication is indicated only for the patient).
  
  
• Implement a written program that meets the requirements of the Hazard Communication Standard to provide for worker training, warning labels, and access to Material Safety Data Sheets (MSDS) for all hazardous chemicals/medications used by physical therapists.

For additional information, see HealthCare Wide Hazards - Hazardous Chemicals and Glutaraldehyde

Physical Therapists use different types of electrical treatment equipment, such as the hydroculator and ultrasound devices, that could be hazardous:

• If water and electrical energies mix, it may result in a possible shock hazard.
  
  
• If equipment is used improperly, excessive occupational exposure to ultrasound may occur.

	A safety and health program that routinely monitors the condition of equipment and addresses work practices of therapists. Visual inspection of cords; do not use if frayed or damaged. Employee visual inspection of equipment before using. If something doesn't look right, don't use the machine; call for assistance. Ensure that all electrical service near sources of water is properly grounded [1910.304(f)(5)(v)].
Work Practices
	Proper technique must be used when administering ultrasound and electrical stimulation treatments to avoid excessive exposure of therapist's hand. Improper technique could result in hand weakness. Physical therapist should use the handle rather than the head of the ultrasound device when administering treatments.

For additional information, see HealthCare Wide Hazards - Electrical.

Exposure to Legionnaires' Disease by 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.

These are water sources that may provide optimal conditions for growth of the legionella bacteria.

For additional information, see HealthCare Wide Hazards - Legionnaires' Disease.

• Legionnaires' Disease eTool. This eTool was designed to assist industrial hygienists in the assessment of worksites for potential Legionnaires' disease. It provides information on disease recognition, investigation procedures to identify probable water sources, and control strategies.