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Hospital eTool
Emergency Department (ED) Module
Click on the area for more specific information.
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Common Safety and health issues:
Definitions for bloodborne pathogens, other potentially infectious materials (OPIM), and occupational exposure are found in
29 CFR 1910.1030(b).
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Potential Hazard
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Emergency Department (ED) workers are at particular risk for exposure to blood, OPIM, and bloodborne pathogens because of the immediate,
life-threatening nature of emergency treatment.
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Possible Solutions
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The Bloodborne Pathogens
Standard requires precautions when dealing with blood and other potentially infectious materials. For a complete explanation, see the
HealthCare Wide Hazards section for Bloodborne Pathogens.
Some summary information for this area includes: |
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- Provide Engineering and Work Practice Controls
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Employers: |
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- Ensure employees wear appropriate personal protective equipment (PPE), gloves, gowns, face masks, when anticipating blood or OPIM
exposure [29
CFR 1910.1030(d)(3)(i)].
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- Ensure employees discard contaminated needles and other sharp instruments
immediately or as soon as feasible after use into appropriate containers [29
CFR 1910.1030(d)(4)(iii)(A)(1)].
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- Provide in their exposure control plan documentation of consideration and implementation of appropriate commercially available and
effective engineering controls designed to eliminate or minimize exposure to blood and OPIM
[Enforcement
Procedures for the Occupational Exposure to Bloodborne Pathogens. OSHA
Directive CPL 02-02-069 [CPL 2-2.69], (2001, November 27)].
- Practice Universal Precautions: Treat all blood and other potentially
infectious body fluids as if they are infected and take appropriate precautions
to avoid contact with these materials [29
CFR 1910.1030(d)(1)].
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- The Revised Bloodborne Pathogen Standard requires
needlestick/sharps injuries be recorded on a Sharps Injury Log
29 CFR 1910.1030(h)(5).
The sharps injury log must be established and maintained and the confidentiality of the injured employee must be protected.
- Follow-up area for needlestick injuries and/or exposure incidents: The Bloodborne
Pathogens Standard
29 CFR 1910.1030(f)(3)
requires the employer to make immediately available a confidential medical evaluation and follow-up to an employee reporting an exposure
incident. This follow-up often occurs in the emergency department.
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- Additional follow-up information is provided in:
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Hazardous Chemicals
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Potential Hazard
Employee exposure to hazardous chemicals (e.g., while decontaminating ED patients after a chemical spill) or exposure to hazardous drugs
(e.g., during administration).
Possible Solutions
- A program in place to maximize employee safety during decontamination of patients.
- A program in place to maximize employee safety during administration, disposal, and preparation of hazardous drugs.
For additional information see HealthCare Wide Hazards -
Hazardous Chemicals, and
Hospital Pharmacy Module.
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Slips/Trips/Falls
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Potential Hazard
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Because of the emergency atmosphere, (i.e., high traffic and compact treatment spaces) slips/trips/falls may be a specific concern for ED areas.
There is a potential slip and fall hazard if water is spilled on the floor accidentally, electrical cords run across pathways, and/or if
emergency equipment or supplies block passageways.
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Possible Solutions
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Provide safe clean-up of spills, and keep walkways free of obstruction.
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For additional information see HealthCare Wide Hazards -
Slips/Trips/Falls.
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Latex Allergy |
Potential Hazard
Gloves must be worn frequently in the ED, because of
occupational exposure to blood and OPIM, creating a potential for employees to develop latex allergy from wearing latex gloves.
Possible Solutions
- Employers must provide appropriate gloves when exposure to blood or other potentially infectious materials (OPIM) exists
[29
CFR 1910.1030 Bloodborne Pathogens Standard].
- Alternatives shall be readily accessible to those employees who are allergic
to the gloves normally provided [29
CFR 1910.1030(d)(3)(iii)].
For additional information see HealthCare Wide Hazards -
Latex Allergy.
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Equipment Hazards
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Potential Hazard
Injury may occur to employees from improper training or use of equipment (e.g., defibrillators). Electric shock may also occur as a result of lack
of maintenance or misuse of equipment and/or its controls. Oxygen-enriched atmospheres and water may contribute to hazardous
conditions.
Possible Solutions
A program that routinely monitors the status of equipment and proper training of employees to use equipment safely.
For additional information see HealthCare Wide Hazards -
Electrical.
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Workplace Violence
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Potential Hazard
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Workplace violence is an issue in EDs because of the crowded and emotional situations that can occur with emergencies. In addition, ED
patients could be involved with crimes, weapons, or violence from other people that could put the ED employee at an increased risk of
workplace violence.
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Possible Solutions
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Good work practice recommends a security management program that addresses workplace violence in the ED and could include:
- Trained staff to recognize and diffuse violent situations and patients.
- Be alert for potential violence and suspicious behavior and report it.
- Provide intervention measures including verbal, social, physical, and pharmacological interventions.
- Warning Signs of Increasing Anger/Violence include:
- Pacing and/or restlessness
- Clenched fist
- Increasingly loud speech
- Excessive insistence
- Threats
- Cursing
- Adequate staffing levels, with experienced clinicians on each shift.
- Counseling and treatment for employees who have experienced workplace violence.
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- The use of appropriate engineering controls to provide security such as:
- Install concealed panic buttons in the ED, on staff, and at the check-in area, that can be pushed for emergency help. These buttons
could notify hospital security as well as directly reach the local Police Department.
- Improve lighting and video surveillance.
- Use an escort or buddy system.
- Limit access to ED area and personnel, by implementing:
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- A waiting room area with controlled access to ED area. Patients must be buzzed in by receptionist from a secure door.
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- ED exits that exit out only, so people off the streets can't access the ED unless they enter through the waiting room area.
- The use of metal detectors.
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- Provide a "secure" room for patients identified to be violent. This room could include controls such as:
- Video camera surveillance
- Visual surveillance: provide a window
- Door locks on patient rooms
- Bed with tie down straps
- Locked cabinets
- Attach furniture and equipment to the floor so patients can't throw them at employees.
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Tuberculosis
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Potential Hazard
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Exposure to Tuberculosis and other infectious agents from patients in waiting room and treatment areas. Staff may be treating an emergency
and be unaware of other pre-existing infectious conditions.
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Possible Solutions
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- Provide and practice early
patient
screening in the ED to identify potentially infectious patients, and provide isolation to prevent
employee exposures. Consistent with CDC guidelines: ED employees should treat
patients as having suspected infectious TB if they have both a persistent
cough lasting at least three weeks, and at least two of the following
additional symptoms: bloody sputum, night sweats, weight loss, fever, and
anorexia.
- Provide engineering, work practice, and administrative procedures to reduce the risk of exposure. For example:
- Patients with a productive cough could be asked to wear a mask to prevent the spread of infection.
- Post waiting rooms signs that state, "If you are coughing you may be asked to wear a mask."
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- Isolate patient until verification testing is negative.
- Some EDs provide an isolation room to safely isolate potentially infectious patients. Others can designate an isolation
area for infectious patients. Isolation rooms must be respiratory acid-fast bacilli (AFB) rooms that are maintained under negative pressure. AFB isolation refers to a negative-pressure room or an area that exhausts room air directly outside or through HEPA filters if
re-circulation is unavoidable.[Enforcement
Procedures and Scheduling for Occupational Exposure to Tuberculosis. OSHA
Directive CPL 02-11-106 [2.106], (1996, February 9)].
- Protect employees from exposure to the exhaled air of an individual with
suspected or confirmed TB [29
CFR 1910.134(a)(2)].
- Isolate patients who have suspected or confirmed TB
[Enforcement
Procedures and Scheduling for Occupational Exposure to Tuberculosis. OSHA
Directive CPL 02-11-106 [2.106], (1996, February 9)].
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- Post a warning sign outside the ED respiratory isolation room
29 CFR 1910.145(a)(1) to prevent accidental entry.
29 CFR 1910.145(f)(4)
Requires that that a signal word (i.e. "STOP", "HALT", or "NO ADMITTANCE") or biological hazard symbol be
presented as well as a major message (e.g., "Special respiratory isolation," "Respiratory isolation," or "AFB
isolation"). An example of a description of necessary precautions is "Respirators must be donned before entering."
- Employers must provide suitable respirators when such equipment is necessary
to protect the health of the employee [29
CFR 1910.134(d)(1)(i)].
The minimally acceptable level of respiratory protection for TB is the Type N95 Respirator.
- Establish and maintain a respiratory protective program which includes the
requirements outlined in [29
CFR 1910.134(c)].
- Worker education:
Enforcement Procedures and Scheduling for Occupational Exposure to Tuberculosis.
OSHA Directive CPL 02-11-106 [2.106], (1996, February 9)
requires worker education and training to ensure employee knowledge of TB including: signs, symptoms, transmission, controls, and
post-exposure protocols.
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For more information see HealthCare Wide Hazards -
Tuberculosis.
Additional Information:
- Tuberculosis
and Respiratory Protection. OSHA Standard Interpretation, (2004, July 30). Defines the new enforcement policy for tuberculosis under
29
CFR 1910.134. Effective
July 2, 2004. Covered establishments must comply with
29
CFR 1910.134 when using
respirators for protection from tuberculosis (TB).
- Comparison of Respiratory Protection (29 CFR
1910.139) with (29 CFR 1910.134). 132 KB
PDF,
29 pages. Most of the requirements in
29
CFR 1910.134 and the former 29 CFR 1910.139 are
basically the same, however five areas now have more detailed
requirements.
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Accessibility Assistance: Contact the OSHA Directorate of Science,
Technology and Medicine
at 202-693-2300 for assistance accessing OSHA PDF materials.
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Studies suggest work stress may increase a person's risk for cardiovascular disease, psychological disorders, workplace injury, and other
health problems. Early warning signs may include headaches, sleep disturbances, difficulty concentrating, job dissatisfaction, and low
morale.
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Potential Hazard
All hospital employees, especially ED employees, are exposed to many stressors at work that can cause workplace stress, and burnout, due to
factors such as shift work, long hours, fatigue, and intense emotional situations, (e.g., the suffering and death of patients).
Possible Solutions
- Educate employees and management about job stress.
- Establish programs to address workplace stress, such as: Employee Assistance Programs (EAP) or Organizational Change Programs.
- An Employee Assistance Program (EAP) can improve the ability of workers to cope with difficult work situations.
Stress management programs teach workers about the nature and sources of stress, the effects of stress on health, and personal skills to
reduce stress (e.g., time management or relaxation exercises).
- EAPs also provide individual counseling for employees for both work and personal problems.
- Organizational Change Programs change hospital policies and procedures to reduce organizational sources of stress.
- This is done by bringing in a consultant to recommend ways to improve working conditions. This approach is the most direct way to reduce
stress at work. It involves the identification of stressful aspects of work (e.g., excessive workload, conflicting expectations) and the
design of strategies to reduce or eliminate the identified stressors. Some strategies include:
- Ensure that the workload is in line with workers' capabilities and resources.
- Design jobs to provide meaning, stimulation, and opportunities for workers to use their skills.
- Clearly define workers' roles and responsibilities.
- Give workers opportunities to participate in decisions and actions affecting their jobs.
Additional Information:
- US Department of Health and Human Services (DHHS), National Institute of
Occupational Safety and Health
(NIOSH)
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Methicillin Resistance Staph Aureus (MRSA)
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Potential Hazard
- Exposure of ED staff to MRSA infections from environmental sources (e.g., homeless patients or IV drug abuse patients). Staff can become
infected and then become carriers who can infect other staff members or patients. As MRSA becomes more resistant to antibiotics such as
methicillin and potentially vancomycin, it will become more difficult to treat.
Possible Solutions
- Hospitals in different geographical locations will need to establish their own local MRSA data and provide treatment information to
clinicians.
- Recommendations for vancomycin use as initial empiric therapy for suspected staphylococcal infection for health-care workers exposed to
MRSA.
- Practice Universal Precautions to help protect
employees from infection.
- The CDC's recommendations for preventing transmission of MRSA in hospitals consist of
Standard Precautions, which should be used for
all patient care. In addition the CDC recommends Contact
Precautions in special cases, when the facility (based on national or local regulations) deems the multi-drug-resistant microorganism to
be of special clinical and epidemiological significance. For more information about the CDC's standard precautions:
For additional information see HealthCare Wide Hazards -
MRSA,
and Infection.
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Terrorism
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Potential Hazard
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Exposure of ED staff and other hospitals workers to patients exposed to biological agents, chemical agents, and mass causalities as a result
of terrorist attacks or events.
Possible Solutions
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Provide and plan for emergency response for health care employers and emergency responders. The Department of Health and Human Services
(DHHS), Centers for Disease Prevention and Control (CDC), the American Hospital Association (AHA), Department of Defense, and OSHA have several resources about how hospitals can plan and
prepare for terrorist events:
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Emergency
Preparedness and Response. OSHA Safety and Health Topics Page.
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Chemical Terrorism Wall Chart. University of North Carolina, Chapel Hill,
(2002). Provides a wall chart on chemical terrorism agents.
- Hospital Preparedness for Mass Casualties.
American Hospital Association (AHA) and US Department of Health and Human
Services (DHHS), Office of Emergency Preparedness, (2000, August), 195 KB
PDF, 62 pages.
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Hospitals and Community Emergency Response - What You Need to Know. OSHA Publication 3152, (1997).
- Anthrax:
- Anthrax in the Workplace. OSHA.
Radiological Dispersal Devices (RDD)/Dirty Bombs. OSHA Safety and Health Topics
Page.
Accessibility Assistance: Contact the OSHA Directorate of Science,
Technology and Medicine
at 202-693-2300 for assistance accessing PDF materials.
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