Intensive Care Unit (ICU)
Click on the area for more specific information.
Common safety and health topics:
Blood, OPIM, Bloodborne Pathogens
Definitions for bloodborne pathogens, other potentially infectious materials (OPIM), and occupational exposure are found in 29 CFR 1910.1030(b).
ICU workers are particularly at risk for exposure to blood, OPIM, and bloodborne pathogens because of the immediate, life-threatening nature of
The Bloodborne Pathogens Standard
requires precautions when dealing with blood and other potentially infectious materials. For a complete explanation, see Healthcare Wide Hazards - Bloodborne Pathogens. Some summary
information for this area include:
- Provide Engineering and Work Practice Controls
- Engineering and work practice controls must be the primary means to eliminate or minimize exposure to bloodborne pathogens. Where engineering
controls will reduce employee exposure either by removing, eliminating, or isolating the hazard, they must be used, and changes to the Exposure
Control Plan (ECP) must include these engineering controls
[29 CFR 1910.1030(c)(1)(iv),
29 CFR 1910.1030(d)(2)(i)
and OSHA Directive CPL 2-2.69.
Ensure employees wear appropriate personal protective equipment (PPE), (e.g., gloves, gowns, face masks), when anticipating blood or OPIM exposure
[29 CFR 1910.1030(d)(3)(i)].
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)].
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. [OSHA Directive
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)].
Intensive care units (ICU's), particularly neonatal ICU's, may be designed without walls between patient spaces. This may allow employees to be
unknowingly exposed to aerosolized chemicals and x-ray radiation that escape from neighboring areas.
- All rooms should have adequate ventilation to remove contaminants.
- If air recirculation is required, then adequate filtering should be installed.
- Staff in adjoining patient spaces may need to be warned and removed if procedures such as x-rays are occurring.
- Aerosolized chemicals should be administered in such a fashion as not to expose staff or patients in the area to the hazard.
OSHA Technical Manual Hospital Investigation Health Hazards: IV Controls and Prevention.
Because of the emergency atmosphere, (i.e., high traffic and compact treatment spaces) for ICU areas, slips/trips/falls may be a specific concern.
There is a potential slip and fall hazard if water or other fluid is spilled on the floor, electrical cords run across pathways, or if emergency
equipment or supplies block passage and passageways.
Provide safe clean-up of spills and keep walkways free of obstruction.
For additional information, see Healthcare Wide Hazards -
Gloves must be worn frequently in the ICU, because of possible
exposure to blood and OPIM. This exposure can potentially lead to latex allergy.
- Employers must provide appropriate gloves when exposure to blood or other potentially infectious materials (OPIM) exists
[29 CFR 1910.1030 1910.1030(d)(3)(iii)],
Bloodborne Pathogens Standard].
For additional information see HealthCare Wide Hazards -
Injury may occur to employees from improper training or use of equipment, e.g., defibrillators.
A program that routinely monitors the status of equipment and proper training of employees to use equipment safely.
Workplace violence is an issue in ICU's because of the crowded, emotional situations that can occur with critical patients.
Good work practice recommends a security management program that addresses workplace violence in the ICU 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
For additional information see HealthCare Wide Hazards -
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.
- All hospital employees are exposed to stress, but employees who work in some areas such as the ICU, or the Emergency Department must deal with
additional stress. They are exposed to critically ill patients and must deal with emotional life/death situations on a daily basis, increasing their
risk for workplace stress, and job burnout.
- Educate employees and management about job stress.
- Address work-related stressors, such as inadequate work space, unreasonable work load, lack of readily available resources, inadequate and unsafe
- 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-for
example, 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.
Stress...At Work. US Department of Health and Human Services (DHHS) National Institute for Occupational Safety and Health (NIOSH)
Publication No. 99-101, (1999).
Accessibility Assistance: Contact the OSHA Directorate of Technical Support and Emergency Management at (202) 693-2300 for assistance accessing PDF materials.
*These files are provided for downloading.