Patient Care Unit » Biological Hazards – Infectious Diseases

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 ().

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 workers 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:


Exposure of healthcare employees to blood or other potentially infectious materials (OPIM) while handling patients’ blood or other body fluids.

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.

The biosafety officer or other responsible person must conduct an exposure determination to determine all tasks and procedures in which there is exposure to blood or other potentially infectious material (OPIM) in the patient care unit. [29 CFR 1910.1030(c)(2)(i)].

For a complete explanation, see Hospital-wide Hazards - Bloodborne Pathogens.

OSHA requires employers to:

  • Use engineering and work practice controls
    • Engineering (e.g., engineered safer needle devices and sharps) and work practice controls must be the primary means to eliminate or minimize exposure to bloodborne pathogens. Where engineering controls, including SESIP (Sharps with Engineered Sharps Injury Protection) will eliminate or minimize employee exposure, either by removing or isolating the hazard, they must be used. [29 CFR 1910.1030(d)(2)(i)]
  • Ensure that employees use appropriate personal protective equipment (PPE) (e.g., gloves, gowns, face masks), as required by the standard, when there is anticipated blood or OPIM exposure. [29 CFR 1910.1030(d)(2)(i), 29 CFR 1910.1030(d)(3)(ii)]
  • Ensure that employees discard contaminated needles and other sharp instruments into appropriate containers immediately or as soon as feasible after use. [29 CFR 1910.1030(d)(4)(iii)(A)(1)]
  • Establish a written Exposure Control Plan (ECP). The ECP must contain, among other elements, annual documentation of consideration and implementation of appropriate commercially available and effective safer medical devices designed to eliminate or minimize exposure to blood and OPIM. Solicit input from non-managerial employees responsible for direct patient care who are potentially exposed to injuries from contaminated sharps in the identification, evaluation, and selection of effective engineering and work practice controls. Document the solicitation in the Exposure Control Plan. Any change to the use of engineering controls (and any other change affecting exposure) must also be reflected in the ECP. [29 CFR 1910.1030(c)(1)]
  • Establish Universal Precautions:
    • Universal Precautions: An approach to infection control that treats all human blood and certain human bodily fluids as if they were infectious for HIV and HBV or other bloodborne pathogens. [29 CFR 1910.1030(b)]
    • The requirement to use Universal Precautions in the Bloodborne Pathogens Standard [29 CFR 1910.1030(d)(1)] means implementing the precautions required by the standard (e.g., engineering and work practice controls, appropriate PPE such as gloves, masks, and gowns) whenever there is exposure to blood or OPIM (or in some cases other body fluids).
    • Alternative concepts in infection control are called Body Substance Isolation and Standard Precautions. These alternatives define all body fluids and substances as infectious, and OSHA permits the implementation of these approaches, as an alternative to universal precautions, provided that facilities utilizing them adhere to all other provisions of the Bloodborne Pathogens Standard.
  • Establish and maintain a sharps injury log for recording needlestick/sharps injuries. [29 CFR 1910.1030(h)(5)] The confidentiality of the injured employee must be protected.
  • Make immediately available to an exposed employee a confidential medical evaluation and follow-up, after a report of a needlestick injury or other exposure incident. The initial medical evaluation often occurs in the emergency department. [29 CFR 1910.1030(f)(3)] Provide BBP training to employees at the time of initial assignment where occupational exposure may take place and at least annually thereafter. [29 CFR 1910.1030(g)(2)]

Additional Information


Exposure of staff and patients to Multidrug Resistant Organisms (MDROs) resulting in nosocomial (hospital-acquired) infections. Staff exposure often occurs in the patient care areas, where employees may need to be in direct contact with infected patients.

Common examples of these organisms include:

The CDC provides guidelines and recommends controls for MDRO hazards.

Additional Information

Methicillin-resistant Staphylococcus aureus (MRSA includes VRSA and VISA)


MRSA has emerged as one of the leading pathogens in healthcare-associated infections. Treatment options for MRSA are limited and less effective than options available for susceptible S. aureus infections and results in higher morbidity and mortality.Patient Care Unit staff can be exposed to MRSA through contact with infected individuals (e.g., patients, visitors or staff members) or individuals who may be colonized. Colonization means that the organism is present in or on the body but is not causing illness. MRSA is usually spread by direct contact with an infected wound, body fluids, or from contaminated hands, usually those of healthcare providers. Patients who may carry MRSA, but do not have signs of infection, can spread the bacteria to others and potentially cause an infection. Colonization and infection commonly occur in the patient care areas, where employees care for patients who may have surgical and other open and healing wounds.

Recognized Controls and Work Practices

Additional Information


Exposure of staff to infectious diseases, such as seasonal or pandemic influenza during patient care*.

Healthcare workers, particularly physicians and nurses, are at a higher risk of acquiring influenza than healthy adults working in non-healthcare settings (Kuster et al., 2011).

Influenza can be transmitted by both symptomatic and asymptomatic individuals through infected human respiratory tract secretions, mucus, cough aerosols, and contaminated hands and materials.

Recognized Controls and Work Practices

  • Encourage workers to get vaccinated and make vaccinations available to workers. The Centers for Disease Control and Prevention (CDC), the Advisory Committee on Immunization Practices (ACIP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommend that all U.S. healthcare workers get vaccinated annually against influenza.
  • Modify patient intake, triage, and other service areas to increase space between workers, coworkers, and patients and provide barriers against transmission when applicable (e.g., install sneeze guards or partitions).
  • If available, use airborne infection isolation rooms (AIIRs), for aerosol-generating procedures and limit the number of people present during the procedure.
  • Isolate and group flu patients when possible.
  • Limit patient transport. Conduct exams and procedures at the bedside, instead of transporting the patient to other areas of the facility. Place a surgical mask on the patient, if possible, when they are being transported out of the room.
  • Use closed suctioning systems to suction a patient’s airways and use high quality filters on the expiratory port of ventilators, when available.
  • Limit the staff entering patient isolation rooms to only those necessary for patient care.
  • Restrict visits for patients in isolation.
  • Use proper respiratory and cough etiquette and encourage hand washing by patients and visitors.
  • Follow standard cleaning and disinfection methods.
  • Use a facemask when entering a flu patient's room. A facemask is not a respirator. It will not protect you during aerosol-generating procedures, which may create very fine aerosol sprays. A facemask can only be used to protect workers from contact with the large droplets made by patients when they cough, sneeze, talk or breathe.
  • Use a respirator during aerosol-generating procedures; a fit tested N95 disposable respirator or better is needed.
  • Use gloves, gowns, and eye protection for any tasks that might cause contamination or create splashes.
  • Put on and take off personal protective equipment (PPE) in the correct order to prevent contamination.

* While the recognized control and work practices that protect workers from exposure to seasonal and pandemic influenza are basically the same, consult the CDC’s "Interim Guidance for Infection Control Within Healthcare Settings When Caring for Confirmed Cases, Probable Cases, and Cases Under Investigation for Infection with Novel Influenza A Viruses Associated with Severe Disease," in the event of an influenza pandemic to determine if any higher level precautions should be implemented (i.e., the use of respirators rather than surgical masks when HCWs are engaged in direct patient care).

Additional Information