Workers in hospital settings may be exposed to a variety of common and emerging infectious disease hazards, particularly if proper infection prevention and control measures are not implemented in the workplace. Examples of infectious disease hazards include seasonal and pandemic influenza; norovirus; Ebola; Middle East Respiratory Syndrome (MERS), tuberculosis, methicillin-resistant Staphylococcus aureus (MRSA), and other potentially drug-resistant organisms.
Infectious diseases are caused by agents that are transmissible through one or more different routes, including the contact, droplet, airborne, and bloodborne routes. The transmission of infectious agents through the bloodborne route—a specific subset of contact transmission—is defined in the Bloodborne Pathogens (BBP) standard, 29 CFR 1910.1030 (See the Bloodborne Pathogens section below).
An effective infection control program normally relies upon a multi-layered and overlapping strategy of engineering, administrative and work practice controls, and PPE. It is OSHA’s intent in this eTool to highlight some – not all – of the controls that would be necessary to the development and implementation of an effective program. Implementing the controls highlighted here alone will not typically protect workers from infection hazards.
Follow standard and transmission-based precautions to prevent worker infections (see also the OSHA page: Worker protections against occupational exposure to infectious diseases). Early identification and isolation of sources of infectious agents (including sick patients), proper hand hygiene, worker training, effective engineering and administrative controls, safer work practices, and appropriate personal protective equipment (PPE), among other controls, help reduce the risk of transmission of infectious agents to workers.
Employers must comply with the BBP standard to the extent that there is "occupational exposure" (i.e., to the extent employers should reasonably anticipate contact with blood or other potentially infectious materials (OPIM) that may result from the performance of duties). Employers must also comply with the PPE Standard, 29 CFR 1910 Subpart I, and the OSH Act’s General Duty Clause, 29 U.S.C. 654(a)(1), to protect their workers from infectious disease hazards. The General Duty Clause requires each employer to "furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees."
OSHA provides agent-specific guidance for a variety of pathogens that workers in hospital settings may encounter. See OSHA's Safety and Health Topics Pages for Biological Agents and Bloodborne Pathogens and Needlestick Prevention for additional information.
In this module, OSHA provides additional guidance specifically for:
Bloodborne pathogens are pathogenic microorganisms present in human blood that can cause disease in humans. These pathogens include, but are not limited to, Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Human Immunodeficiency Virus (HIV) and Viral Hemorrhagic Fevers (e.g. Ebola). [29 CFR 1910.1030(b)]
Occupational exposure to blood or other potentially infectious materials (OPIM) can occur in central sterile supply when employees sort bloody and/or contaminated surgical instruments, sharps, reprocess medical equipment and decontaminate surfaces.
Requirements under OSHA's Bloodborne Pathogens Standard, 29 CFR 1910.1030
The Bloodborne Pathogens Standard requires precautions when there is occupational exposure to blood or OPIM (as defined by the standard). Under the standard, OPIM means (1) the following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; (2) any unfixed tissue or organ (other than intact skin) from a human (living or dead); and (3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.
OSHA requires employers to ensure that the biosafety officer or other responsible person conducts an exposure determination to determine the exposure of workers to blood or OPIM throughout the hospital setting. [29 CFR 1910.1030(c)(2)(i)].
For more information, see Hospital-wide Hazards - Bloodborne Pathogens.
Exposure of Central Sterile Supply workers to Multidrug Resistant Organisms (MDROs) from contaminated medical supplies or equipment.
Common examples of these organisms include:
- Carbapenem-resistant Enterobacteriaceae (CRE) are a family of germs that can become carbapenem-resistant, including Klebsiella pneumoniae and Escherichia coli (E. coli).
- Clostridium difficile (C. Diff). Clostridium difficile is a spore-forming, Gram-positive anaerobic bacillus. It is a common cause of antibiotic-associated diarrhea.
- Extended-spectrum beta-lactamases (ESBLs). ESBLs of concern are resistant to cephalosporins and monobactams.
- Methicillin/Oxacillin-resistant Staphylococcus aureus (MRSA), which includes Vancomycin-intermediate Staphylococcus aureus (VISA) and Vancomycin-resistant Staphylococcus aureus (VRSA) is addressed below and also in Hospital Wide Hazards – MRSA.
- Multidrug-resistant Acinetobacter baumannii (MDR-Ab) is a gram-negative bacterium that can colonize the skin of infected patients.
- Multi-drug-resistant Tuberculosis (MDR-TB) is addressed in Hospital-Wide Hazards – Tuberculosis.
- Penicillin-resistant Streptococcus pneumoniae (PRSP). Pneumococcal disease is an infection caused by Streptococcus pneumoniae bacteria, sometimes referred to as pneumococcus. Pneumococcus can cause many types of illnesses, including ear infections and meningitis.
- Vancomycin-resistant enterococci (VRE). Enterococci are bacteria that can live in the human intestines and female genital tract without causing disease or infection (often called colonization). However, enterococci can cause infections of the urinary tract, the bloodstream, or of wounds associated with catheters or surgical procedures. Vancomycin is usually the drug of choice for treating these bacteria. However, VRE are resistant to Vancomycin.
The CDC provides guidelines and recommends controls for MDRO hazards.
- Management of Multidrug-Resistant Organisms in Healthcare Settings. Centers for Disease Control and Prevention (CDC).
- Healthcare: Infectious Disease. OSHA Safety and Health Topics Page.
- Healthcare-associated Infections (HAI). Centers for Disease Control and Prevention (CDC).
- Antibiotic / Antimicrobial Resistance. Centers for Disease Control and Prevention (CDC).
- Understanding Antimicrobial (Drug) Resistance. National Institute of Allergy and Infectious Diseases (NIAID).
- Methicillin-resistant Staphylococcus aureus (MRSA includes VRSA and VISA)
Most MRSA infections occur in people who have been in hospitals or other healthcare settings, such as nursing homes and dialysis centers. Central Sterile Supply workers can become colonized or infected through contact with contaminated medical supplies or equipment. These staff may then become carriers who can infect other staff members or patients. As MRSA becomes more resistant to antibiotics, such as methicillin and potentially vancomycin, MRSA will become more difficult to treat.
Exposure of staff to MRSA infections from operating room instruments, sterile trays, and other equipment and supplies used in the care of patients with MRSA. Staff can become infected and then become carriers who can infect other staff members or patients.
Recognized Controls and Work PracticesInfection control is the key to preventing the spread of MRSA. Ensure the availability of adequate facilities and supplies that encourage workers to practice good hygiene. Ensure that contaminated surfaces and equipment in the Central Sterile Supply area are disinfected and sterilized with the appropriate EPA-registered disinfectants and sterilants.
Also see Hospital-wide Hazards - MDRO - Multidrug-Resistant Organisms and Infection.
For more information, see Hospital-wide Hazards - Methicillin-resistant Staphylococcus aureus (MRSA). Provides links with general information, answers specific questions for employers and employees, and offers resources for a variety of workplace settings and activities, including healthcare, schools, athletics, and childcare.