1. Occupational Health Issues Associated With Long Term Care Facilities n Bloodborne pathogens n Tuberculosis n Latex allergies n Hazard communication n Indoor air quality

2. Bloodborne Pathogens in Nursing Homes

3. Exposure Control Plan n Exposure Determination - List of job classifications (all employees exposed, some exposed) - List of tasks and procedures where exposure may occur (without regard to use of ppe) n Methods of Compliance - Universal Precautions - Engineering Controls - Work Practice Controls - Personal Protective Equipment

4. Universal Precautions Treat all blood samples and potentially infected materials as if infected.. n Use proper personal protective equipment n Immediate washing of hands and other skin surfaces if contact with materials n Wash hands immediately after glove removal n Management of sharps n Exposure incident reporting and follow-up n Spill response

5. Engineering and Work Practice Controls n Handwashing facilities and procedures n Contaminated needles handling (no bending, recapping) n Placement of used sharps in special containers (puncture resistant, labeled, leakproof, color coded) n No eating, drinking, smoking, hangling contacts, use of cosmetics in exposure areas n No storage of food where blood is present n Minimize splashing, spraying, spattering n No mouth pipetting n Placement of blood in leakproof containers ( labeled, color coded) n De-contamination of equipment

6. Personal Protective Equipment n Must be provided, cleaned, laundered, disposed of, replaced, and used properly. n Gloves, gowns, face shields, masks, resusitation bags, eye protection, aprons, and caps n Consider possibility of soiling (aprons when changing dressing), and spattering (eyewear during mouth examinations) n Cleaning and disposal n Removal before leaving workplace n Stored in containers after use

7. Housekeeping n Keep written schedules and methods of cleaning and decontaminating surfaces and equipment n Maintain clean and sanitary worksite n De-contaminate work surfaces n Use protective coverings n Cleaning of receptacles, pails, bins n No hand contact with broken contaminated glassware n Handling of re-usable sharps

8. Discarding of contaminated sharps n Container must be closable, puncture resistant, leakproof, labeled and color coded n Keep closed n Secondary containment if leak occurs n Disposal according to Federal, State, local requirements

9. Handling of contaminated laundry n Bag and containerize where used (no rinsing or sorting) n Bags labeled and color coded and leakproof n Protective gloves used when handling laundry

10. Employee training n Available hepatitis B vaccine, post exposure evaluation, and follow-up to employees who had incident n Training at initial assignment and annually n OSHA standard n Explanation of HIV and hepatitis B diseases n Modes of transmission n Exposure identification n Tasks which involve exposure n Methods used to prevent exposure n Personal protective equipment use n Decontamination procedures n Emergency procedures n Exposure incident procedures

11. Labels and signs n “BIOHAZARD” n Use of red bags and containers in stead of labels

12. Recordkeeping n Vaccination and other medical records n Training records

13. Medical Waste Handling - State and local laws (44 states require disposal and tracking) and RCRA Subtitle J Medical Waste Tracking Act Demonstration Program - Council of State Govenors - Model State Plans for Medical Waste - Identify waste - Packaging and lable - Segregation - Destruction of waste - Disposal - most require treatment before disposal - Recordkeeping and tracking - Training employees - Incineration, steam autoclave, microwave, grinding and chemical treatment - Transporter and disposal site permitting and insurance concerns

14. Tuberculosis n Drug resistant strains n Homeless population n HIV n 14% increase since 1985 (recent decline due to greater awareness) n Outbreaks in hospitals, homeless shelters, nursing homes, and AIDS residential care centers n TB is an inhalable airborne infectious disease

15. OSHA Enforcement Policy n In response to employee complaints, or n Part of regular IH inspection for CDC identified workplaces - Health care facilities, homeless shelters, LTC facilities, correctional institutions, and drug treatment centers n Inspect if confirmed or suspected TB in passed 6 months n Based on 1994 CDC revised guidelines n Use of general duty clause 5(a)(1) - “...workplace free of recognized hazards...” n Infection control plan n Proposed standard in 1997?

16. Infection Control Plan n Early detection through skin tests n Training and information - signs and symptoms - medical surveillance and therapy - Site procedures - Use of controls n Medical screening and re-test every 6 months ( 3 months for high risk and 12 months for low risk) n Management and restriction of infected individuals n Isolation rooms under negative pressure and warning signs n PPE - HEPA respirators

17. Latex Allergies n Rise in latex glove use as result of OSHA bloodborne pathogen standard and CDC recommendations for universal precautions n Affects about 8% to 10% of health care workers n Direct skin contact with latex or airborne powders from inside n Severity and hypersensitivity grows with exposure n Symptoms include contact dermatitis, anaphylactic shock, respiratory failure n Can be confirmed through patch skin testing n Cornstarch powder can carry latex protein and become airborne - air sampling can be done to assess exposure n Control through education, substitution, low powder/low allergy gloves, manufacturing rinse processes, complete avoidance, and medical history and screening n New non-powdered gloves, low allergen gloves, non-latex gloves, establishment of safe zones for sensitized

18. Hazard Communication Plan n OSHA 29CFR1910.1200 n Written plan n Labeling of hazardous materials n MSDSs obtained and available n Employee training - Health effects - Signs and symptoms of exposure - Controls - OSHA requirements

19. Indoor Air Quality/Sick Building Syndrome n Sensitive elderly population n Investigation techniques - Questionnaire - Air sampling (specific contaminants or indicator gasses) - Ventilation evaluation - Heat/humidity evaluation n Sources (chemical, biological, inside, outside, chemicals, off-gassing of furnishings) n Controls (low emmission furnishings, HVAC maintenance, chemical control, local ventilation of sources, moisture control, fresh air volume and mixing) n Standards (chemical levels, CO, ventilation)