application of standard precautions

OSHA

occupational safety and health administration, is a division of the department of labor

what is vermont’s division of OSHA

VOSHA

what does OSHA do

is the only agency that has laws regarding infection control practices. Goes based of of CDC recomendations

what is OSHAS role

to protect the employee in the workplace

when did the occupational exposure standard become effective

1992

bloodborne pathogen standard

applies to employees of any type of facility who have the potential for exposure to body fluids

who is the bloodborne pathogen standard monitored by

investigations of facilities by OSHA compliance officers. facility can be inspected without complaint if they employ 11 or more people

what does OSHA require of employers

1. establish and enforce procedures designed to protect employee

2. implement and maintain exposure-incident records for the length of employment plus 30 years

3. provide PPE

OSHA respiratory protection standard

employers must establish and maintain an effective program when employees must wear tight-fitting respirators to protect them from workplace hazards

what are the components of the respiratory protection standard

1. written plan

2. employees must be trained in the use of the device

3. medical evaluations required before being fit for the device

4. employees must be aware of the risk of the job they are asked to perform

5. fit testing-documentation

6. instruction for use, cleaning and storage

who should respirators be approved by

NIOSH

EPA

environmental protection agency, associated with infection control

FDA

Federal drug administration, regulates manufacturing and labeling of medical devices

CDC

centers for disease control, only makes recommendations which many local, state and federal agencies use to formulate laws

OSAP

Office safety and asepsis procedures research foundation, premier infection control education organization in dentistry

ADHA

American dental hygienists association, provides direction on issues that deal with health policy, education, practice standards, research, access to care and legislation

general steps for compliance of OSHA bloodborne pathogen standard

1. review the standard

2. prepare a written exposure control plan

3. train the employees

4. provide employees with everything needed to comply with the standard

5. maintain appropriate records

written exposure control plan of bloodborne pathogen standard

1. exposure determination

2. schedule of implementation

3. evaluation of exposure incidents

exposure control plan- category 1

all tasks involving exposure to blood and OPIM, includes all chair side clinicians

exposure control plan- category 2

includes all work related tasks involving no exposure to blood and OPIM, but may occasionally involve unplanned tasks from category 1. usually includes non clinical persoonnel

exposure control plan- category 3

includes all work-related tasks involving no exposure to blood and OPIM ex-office accountant, tax preparer

what does the hazard communication program include

written hazard communication program, waste and sharps handling and management program, injury and illness prevention program

how does the hazard communication program occur

providing specific info and training on biohazards in the workplace, and uses labels and signs to identify hazards

what vaccine does OSHA require be OFFERED to all employees at risk for occupational exposure (not required)

Hepatitis B vaccine, employer must document and maintain records including employee waiver if chose not to get vaccine

procedure following accidental exposure

1. immediately wash wound with soap and water, rinse well

2. obtain permission for blood testing and arrange for counseling 

3. on same day as exposure test patient and exposed person for HBsAg, Hep C and anti-HIV

4. document route of exposure

5. document circumstances in which incident occurred

6. document source individual

7. evaluation of illness post-accident

8. all documentation is confidential

standard precautions

concept that all human blood and certain human body fluids are treated as if they are infectious for HIV, HBV and other bloodborne pathogens

aseptic technique

all forms of washing, sanitizing, disinfecting and sterilizing items that come into contact with a contaminant or diesease producing pathogen

handwashing

first line of defense, handwashing facilities must be easily accessable

what controls are ideal for handwashing

sink-foot or sensor, same with soap dispenser

what is considered a contaminated sharp

disposable needles, broken instruments, orthodontic wire, scalpels, used anesthetic cartridges

what technique is used for contaminated sharps

one-handed capping technique or recapping devices

safety needles (self-sheathing)

must be used if available in the marketplace and will not jeopardize pt safety or success of procedure. dentistry has not yet mandated use of safety needles yet

gloves

single most important factor in controlling the spread of disease between clinician and patient

procedure of use for gloves

1. pre-gloving wash

2. put eyewear and face mask on first

3. pull gloves up and over cuffs

when to double glove

patient who is severely compromised and needs additional protection, patient with active infectious disease-TB

disposable exam gloves (non-sterile)

single-procedure use, commonly made of latex vinyl or nitrile. Usually ambidextrous

over glove

placed over treatment glove for temporary use, one-time use. not a replacement for latex vinyl or nitrile

sterile gloves

single use during surgical procedures, package pre-sterilized. Sometimes labeled for right and left hands

mitrile utility gloves

multiple use, word during treatment room disinfection-when handling sharps and processing instruments. Household cleaning glove not a substitue

non-allergenic gloves

not the same as hypoallergenic, under glove. Used by HCW with severe allergic reaction to latex or vinyl

what allergies can predispose someone to a latex hypersensitivity

bananas, kiwi, avocado, chestnuts

medical conditions that predispose someone to a latex hypersensitivity

multiple surgeries, spina bifida

how many HCW report some type of dermatitis

1/3

how does latex allergy form

gloves work by HCW, air breathed by HCW, direct exposure (mucosal contact)

etiology

begins with protein harvested from the rubber tree

where does latex allergy originate form

the manufacturing process

what can cause irritant contact dermatitis

acrylates, soaps, disinfectants, metals, lotions, improper hand drying, surgical exam gloves

what gloves are associated with dermatitis

most often caused by residual processing chemicals, powders or hand perspiration inside the glove.

allergic contact dermatitis

Type IV hypersensitivity, almost always limited to area of contact

latex allergy Type 1 hypersensitivity

immediate, allergy to naturally occurring proteins in the latex. must be sensitized by one or more exposures to latex allergens-allergy follows after