Surgical Suite » 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:

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) places employees at risk of infection, such as Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Human Immunodeficiency Virus (HIV) and Viral Hemorrhagic Fevers (e.g. Ebola).

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

OSHA requires employers to:

  • Provide and ensure the use of 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)]
      • Some engineering and work practice controls used in the surgical suite include:
        • Safer needle/other sharps devices
        • Blunt-tip suture needles
        • Needleless IV connectors
        • Proper containers for sharps
        • "No Pass Zone" (also known as neutral zone) for surgical instruments
        • Method for passing equipment safely between surgeon and assistants
  • Ensure that employees use appropriate personal protective equipment (PPE), 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)]
    • PPE will be considered appropriate under the standard only if it does not permit blood or OPIM to pass through to or reach the employee's work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time it will be used.
    • Appropriate PPE may include, but is not limited to, gloves, gowns, face shields or masks, and shoe covers. The types of PPE required to be used depends on the anticipated exposure and the requirements in the Bloodborne Pathogens and other standards. For example:
      • Gloves must be worn when potential hand contact with blood, mucous membranes, OPIM, or non-intact skin is reasonably anticipated; or when handling or touching contaminated items or surfaces; or, generally, when performing vascular access procedures. [29 CFR 1910.1030(d)(3)(ix)]
        • Double gloving has been shown to be an effective method to reduce the potential for contact with bodily fluids during invasive surgical procedures where punctures in gloves often occur without the healthcare worker's knowledge.
      • Masks, in combination with eye protection devices, must be worn whenever splashes, spray, splatter or droplets of blood or OPIM may be generated and eye, nose, or mouth contamination can be reasonably anticipated. [29 CFR 1910.1030(d)(3)(x)]
  • 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)]
  • Ensure that sharps containers are easily accessible and located as close as is feasible to the immediate area where sharps are used or can be reasonably anticipated to be found. [29 CFR 1910.1030(d)(4)(iii)(A)(2)(i)]
  • 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)-(2)]
  • Ensure that contaminated needles and other contaminated sharps are not bent, recapped, or removed except as noted in 29 CFR 1910.1030(d)(2)(vii)(A) and (d)(2)(vii)(B). Shearing or breaking contaminated needles is prohibited. [29 CFR 1910.1030(d)(2)(vii)]
  • 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. [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 surgical suite staff to patients with active tuberculosis during surgical procedures. Exposure may also occur after surgical procedures are completed, from treatment rooms not properly ventilated during or after occupation by a patient who has active tuberculosis (TB).

Recognized Controls and Work Practices

The CDC discusses three types of controls for TB infection in healthcare settings:

  1. Administrative controls to minimize the number of areas where exposure to TB can occur
  2. Environmental controls to reduce the concentration of TB
  3. The use of respiratory protection in situations that pose a high risk for exposure

Recognized controls and work practices include:

  • Providing an area in the surgical suite that is ventilated separately for TB patients (i.e., patients with suspected or confirmed TB) in facilities in which TB patients are frequently treated. If this is not possible, ensuring that TB patients wear surgical masks, stay in the surgical suite the minimum amount of time possible, and be returned promptly to their isolation rooms.
  • Healthcare facilities serving populations that have a high prevalence of TB may need to supplement the general ventilation or use additional engineering controls in general-use areas where TB patients are likely to go (e.g., waiting-room areas, emergency departments, and radiology suites). These engineering controls include:
    • A single-pass, non-recirculating system that exhausts air directly to the outside.
    • A recirculation system that passes air through HEPA (High Efficiency Particulate Air) filters before re-circulating it to the general ventilation system.

Requirements under OSHA's Respiratory Protection Standard, 29 CFR 1910.134

Employers must comply with applicable provisions of OSHA’s Respiratory Protection standard, 29 CFR 1910.134, for using respirators if TB hazards are present.

Additional Information