Exposure of housekeeping staff to blood or Other Potentially Infectious Materials (OPIM) through contaminated work environments. OPIM is defined in 1901.1030(b).

OSHA requires:

Clean and sanitary work environments to prevent contact with blood or OPIM. Bloodborne Pathogens Standard [1910.1030(d)(4)(i)].

The employer must:

• Determine and implement an appropriate written schedule for cleaning and methods of decontamination.



• This written schedule must be based on the:



• Location within the facility.



• Type of surfaces to be cleaned.



• Type of soil present.



• The tasks or procedures to be performed in the area.

Exposure of housekeeping staff to blood or OPIM by not using an appropriate or approved disinfectant.

Who determines which disinfectants are appropriate?

Appropriate or approved disinfectants are determined by the EPA (U.S. Environmental Protection Agency), which oversees the registration of anti-microbial products. A list is provided by the Office of Pesticide Programs that provides the most recent information available from the EPA on registered anti-microbials.

What disinfectants does OSHA recommend?

• OSHA requires that work surfaces be cleaned with an "appropriate disinfectant." Appropriate disinfectants include a diluted bleach solution and EPA-registered antimicrobial products such as tuberculocides (List B), sterilants (List A), products registered against HIV/HBV (List E), and Sterilants/High Level Disinfectants for equipment sterilization.

	Fresh solutions of diluted household bleach made up every 24 hours are also considered appropriate for disinfection of environmental surfaces and for decontamination of sites. Contact time for bleach is generally considered to be the time it takes the product to air dry.
	NOTE: Products registered by the EPA as HIV effective are not necessarily effective against tuberculosis (tuberculocidal) or against the hepatitis B virus (HBV).

• Any of the above products are considered effective when used according to the manufacturer's instructions, provided the surfaces have not become contaminated with agents or volumes of or concentrations of agents for which higher level disinfection is recommended.
  
  
• It is important to emphasize the EPA-approved label section titled "SPECIAL INSTRUCTIONS FOR CLEANING AND DECONTAMINATION AGAINST HIV-1 AND HBV Of SURFACES\OBJECTS SOILED WITH BLOOD\BODY FLUIDS." On the labels that OSHA has seen, these instructions require: 1) personal protection devices for the worker performing the task; 2) that all the blood must be cleaned thoroughly before applying the disinfectant; 3) that the disposal of the infectious waste is in accordance with federal, state, or local regulations; 4) that the disposal of the infectious waste is in accordance with federal, state, or local regulations; and 5) that the surface is left wet with the disinfectant for 30 seconds for HIV-1 and 10 minutes for HBV. OSHA would expect all such disinfectants to be used in accordance with their EPA-approved label instructions. OSHA Instruction CPL 2-2.69, Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens.
  
  
• OSHA has commented on disinfectants in the following interpretation letters and documents:
  
  
  • Disinfectants claiming efficacy against the Hepatitis B virus. (1997, April 1).
    
    
  • OSHA's policy regarding the use of EPA-registered disinfectants. (1999, July 15).
    
    
  • OSHA's FAQs for Bloodborne Pathogens.

Employee exposure to blood or OPIM through contact with contaminated:

• Equipment and working surfaces



• Protective coverings



• Reusable containers



• Glassware

OSHA requires:

Equipment and working surfaces:

All equipment and environmental and working surfaces shall be cleaned and decontaminated after contact with blood or other potentially infectious materials [1910.1030(d)(4)(ii)].

Contaminated equipment, such as IV poles, require labels or tags in accordance with 1910.1030(g)(1)(i)(H). The labels must also identify which portions of the equipment are contaminated. Some equipment, if grossly contaminated, must be cleaned with a soap and water solution prior to decontamination, as some anti-microbial products will not work in the presence of blood, which interferes with the sterilizing process.

Protective Coverings:

• Protective coverings, such as plastic wrap or aluminum foil, shall be removed and replaced as soon as possible, when they become overtly contaminated, or at the end of a work shift if they may have become contaminated during the shift [1910.1030(d)(4)(ii)(B)].

Reusable Containers:

• All bins, pails, cans, and similar receptacles intended for reuse which have a reasonable likelihood for becoming contaminated with blood or other potentially infectious material shall be inspected and decontaminated on a regularly scheduled basis and cleaned and decontaminated immediately or as soon as feasible upon visible contamination [1910.1030(d)(4)(ii)(C)].

Glassware:

Employee exposure to blood and other potentially infectious agents from handling contaminated laundry during rinsing in utility rooms. Some facilities allow employees to rinse contaminated laundry (i.e., laundry contaminated with blood or Other Potentially Infectious Materials (OPIM) or that might contain sharps, in dirty utility "hopper" rooms, instead of simply containerizing it and then transporting it to the laundry.

The Bloodborne Pathogens Standard requires:

• Bagging and handling of contaminated laundry, with a minimal amount of agitation, at the location where it was used [1910.1030(d)(4)(iv)(A)].



• Contaminated laundry shall not be sorted or rinsed in the location of use [1910.1030(d)(4)(iv)(A)(1)], and must be transported to the laundry for decontamination in bags or containers labeled or color-coded in accordance with 1910.1030(g)(1)(i). When universal precautions are used in the handling of all soiled laundry alternative labeling or color-coding is sufficient if it permits all employees to recognize the containers as requiring compliance with universal precautions.

• Melt away bags for the bagging process. Melt away bags can be thrown directly into washers without having to unload or remove contaminated laundry from bags.



• Rinsing soiled laundry in utility rooms is acceptable, if it is not contaminated with blood, OPIM, or does not contain sharps.
  
  
  • The ergonomic stressors that can occur with lifting, reaching, rinsing, and transporting wet heavy laundry must also be addressed. A lift or transfer device for the lifting of these materials is recommended.
  
  
  
• To avoid punctures from improperly discarded syringes/sharps, do not hold contaminated laundry bags close to the body or squeeze when transporting.

For additional information, see HealthCare Wide Hazards - Laundry Module.

Exposure of housekeeping staff to contaminated sharps and containers from:

• Lack of training in proper procedures and poor handling practices of health care workers.



• Sharps that are not discarded promptly/properly and are left in bedding and accidentally sent to laundry.



• Improper handling or disposal of sharps containers For example:
  
  
  • Allowing containers to overfill, or transporting incorrectly.

Implement work practice and engineering controls to help prevent exposure to sharps.

OSHA requires:

Sharps handling:

• Sharps must be properly disposed of immediately or as soon as feasible into appropriate containers [1910.1030(d)(4)(iii)(A)(1)].

Handling sharps containers:

Contaminated sharps must be properly disposed of immediately or as soon as feasible in containers that are closable, puncture resistant, leak-proof, [1910.1030(d)(4)(iii)(A)(1)], and labeled with the biohazard symbol or color coded in accordance with [1910.1030(g)(1)(i)]. Containers must be replaced routinely and not be allowed to overfill [1910.1030(d)(4)(iii)(A)(2)].

Disposal of Sharps Containers:

Employees should be trained in proper handling/disposal of sharps and containers, such as:

When moving containers of contaminated sharps or Other Regulated Wastes, from the area of use, the containers shall be [1910.1030(d)(4)(iii)(A)(3)]:

• Closed immediately prior to removal or replacement to prevent spillage or protrusion of contents during handling, storage, transport, or shipping.



• Placed in a secondary container, if leakage is possible. The secondary container must meet the requirements of 1910.1030(d)(4)(A)(3)(ii).



• Disposed of in accordance with EPA, state, territorial, and local regulations [1910.1030(d)(4)(iii)(C)].

Reusable sharps containers:

• Shall not be opened, emptied or cleaned manually or in any other manner that would expose employees to the risk of percutaneous injury.

For additional information, see HealthCare Wide Hazards - Needlesticks.

Exposure to hazardous cleaning chemicals found and used in the laundry or housekeeping process.

• Soaps and detergents may cause allergic reactions and dermatitis.



• Broken skin from soap or detergent irritation may provide an avenue for infection or injury if exposed to chemical or biological hazards.



• Mixing cleaning solutions that contain ammonia and chlorine will form a deadly gas.

• The Hazard Communication Standard ensures employee awareness of the hazardous chemicals they are exposed to in the workplace.

Provide appropriate PPE: (e.g., gloves, goggles, splash aprons), when handling hazardous dishwashing detergents and chemicals [1910.132]. For more information see HealthCare Wide Hazards - PPE.

Medical Services and First Aid: Where the eyes or body of any person may be exposed to injurious corrosive materials, suitable facilities for quick drenching or flushing of the eyes and body shall be provided within the work area for immediate emergency use [1910.151(c)].

For additional information, see HealthCare Wide Hazards - Hazardous Chemicals.

Exposure to latex allergy from wearing latex gloves, during housekeeping processes.

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



• Alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided [1910.1030(d)(3)(iii)].


• Eliminate the unnecessary use of latex gloves when no risk of exposure to Blood or Other Potentially Infectious Materials (OPIM) exists.

For additional information, see HealthCare Wide Hazards - Latex Allergy.

Exposure to wet floors, and possible slips, trips, and falls.

	Maintain floors in a clean and, so far as possible, dry condition, and mats provided where practicable. Walking/Working Surfaces Standard [1910.22(a)(2)].
	Provide warning signs for wet floor areas [1910.145(c)(2)].
Other Recommended Good Practices: Implement a program to provide safe, immediate, clean-up of floor spills. Housekeeping procedures such as only cleaning one side of a passageway at a time, providing good lighting for all halls and stairwells can help reduce accidents. Instruct workers to use the handrail on stairs, to avoid undue speed, and to maintain an unobstructed view of the stairs ahead of them-even if that means requesting help to manage a bulky load. Eliminate uneven floor surfaces. For additional information, see HealthCare Wide Hazards - Slips/Trips/Falls.