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Bloodborne Pathogens Prevention for Emergency Response PersonnelEmergency Personnel
In the intensity of responding to a serious medical emergency, first responders may not immediately think of protecting themselves but rather those they “protect and serve.” Emphasis must be placed on employee safety even in emergency situations. Officers and emergency personnel, carrying the wounded to safety while their uniforms are soaked with blood and other bodily fluids, are common images of any catastrophic event on the news. Tragedies such as Columbine, the Grundy Law School, and the more recent Virginia Tech shootings demonstrate the need to ensure that emergency response personnel are appropriately protected from BBP exposures through training, adequate and appropriate personal protective equipment (PPE), and decontamination. Preparation Employees responsible for responding during emergency situations should be thoroughly trained and drills should be conducted frequently. Because every emergency situation is different, the importance of conducting on-site hazard assessments to determine the appropriate level of protection and response should be emphasized during the training phase. The BBP program should be reviewed after the drills to determine its effectiveness and identify any needed improvements. Personal Protective Equipment Healthcare professionals and first responders with emergency medical training (Emergency Medical Technicians, law enforcement officers, emergency response team members, etc.) should always utilize universal precautions as the first line of defense when handling patients, especially when bodily fluids are involved. If latex gloves are not available, some type of barrier (rags, bags, work gloves) should be placed between the person giving assistance and bodily fluid. A good rule of thumb: Emergency responders without appropriate training should utilize the same precautions and only act as the primary responder if a trained emergency medical responder is not available. Written PPE hazard assessments should be conducted according to OSHA/VOSH 29 CFR 1910.132. These assessments should identify the appropriate types of PPE to be worn by employees for various BBP exposures. According to a 1993 OSHA Letter of Interpretation Cleaning of police uniforms as specified by bloodborne pathogens standard, “PPE will be considered ‘appropriate’ only if it does not allow blood or other potentially infectious materials (OPIM) to pass through or reach employee’s work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use for the duration of time when the protective equipment will be used.”1 Some types of PPE to consider for employees include (but are not limited to):
The employer should make sure employees have enough PPE in a variety of sizes and the means to immediately replace and replenish damaged or used materials. If PPE kits are available to employees, the contents should be periodically inspected to ensure availability and to ensure the equipment maintains its integrity.
Once the PPE has been selected, employees need to understand how to appropriately put on, take off, and clean or dispose of the PPE to prevent further exposure or contamination. Additionally, the limitations of each type of PPE should be discussed with employees. Overprotecting employees may also expose them to physical dangers such as heat stress or may create situational dangers by hindering their ability to conceal themselves in hostile situations. Coverage by using long-sleeved shirts and long pants may be more feasible than white Tyvek® suits in some immediately dangerous situations. Caution should also be exercised to ensure the PPE does not contribute to or worsen existing hazards. Decontamination Contaminated PPE, if not reusable, should be properly discarded in a biohazard materials container. Techniques for properly removing and discarding disposable items should be reviewed with the employees. If a uniform also serves as PPE, it should not be worn home and must remain in the workplace in an area designated for storage, decontamination, washing, or disposal. Clothing used as a uniform should be removed, bagged, and laundered by an approved vendor unless there is an on-site laundering facility equipped to handle the BBP contaminated clothing. According to the Centers for Disease Control, dry cleaning the clothing is acceptable because “the solvents and heat used in the dry cleaning process are sufficient to destroy bloodborne pathogens.”2 While PPE protects workers from potentially infectious materials, good personal hygiene is also important to prevent transmission and to ensure complete decontamination. Employee training should emphasize the importance of washing hands, even when gloves are worn. Depending on the level of exposure, the employee may need to shower immediately after removing and decontaminating or disposing of soiled garments. OSHA/VOSH BBP Standard OSHA/VOSH requires employers to comply with the intent of the standard by:
The Preventing BBP Exposures article provides additional BBP exposure prevention information and techniques to consider. Remember, employees responsible for protecting the welfare and safety of others must also be protected. An effective BBP program helps ensure these heroes will be able to perform their duties safely for many years to come. 1Occupational Safety and Health Administration. (April 19, 1993). Standard Interpretations: Cleaning of police uniforms as specified by bloodborne pathogens standard. Retrieved November 19, 2007 from, http://www.osha.gov/pls/oshaweb/owadisp.show_document? 2Ibid. References Commonwealth of Virginia Workers’ Compensation Program. (April 2004). Preventing Bloodborne Pathogen Exposures. Retrieved November 26, 2007 from, http://www.covwc.com/lcarticles/archives/000071.php. Division of Healthcare Quality Promotion-National Center for Preparedness, Detection, and Control of Infectious Diseases. (November 18, 2000). Laundry: Washing Infected Material. Retrieved November 26, 2007 from, http://www.cdc.gov/ncidod/dhqp/bp_laundry.html. McPherson, Donna. (September 1, 2007). Fusing Form & Function: Selecting Protective Apparel for Comfort and Protection. Retrieved November 19, 2007 from, http://www.occupationalhazards.com/Issue/Article/72035/ Occupational Safety and Health Administration. (April 19, 1993). Standard Interpretations: Cleaning of police uniforms as specified by bloodborne pathogens standard. Retrieved November 19, 2007 from, http://www.osha.gov/pls/oshaweb/owadisp.show_document? Occupational Health and Safety Division-International Association of Fire Fighters. (October 13, 2003). Project Heroes: Homeland Emergency Response Operational and Equipment Systems. Task 1: A Review of Modern Fire Service Hazards and Protection Needs. Retrieved November 20, 2007 from http://www.cdc.gov/niosh/npptl/pdfs/ProjectHEROES.pdf. Torres, Katherine. (August 1, 2007). After Disaster Strikes: Lessons Learned from the Gulf Coast. Retrieved November 19, 2007 from, http://www.occupationalhazards.com/Issue/Article/70127/
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