OSHA issues hazardous exposure guidelines
OSHA issues hazardous exposure guidelines
Guidelines directed at first receivers
Hospital employees, especially those working in and around the emergency department (ED), are at significant risk of occupational exposure to hazardous materials when contaminated patients arrive.
OSHA in January released "OSHA Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances," outlining safety measures that should be in place to protect hospital employees termed "first receivers" who come in contact with patients who have been exposed to (and may be carrying on or in their bodies) hazardous materials.
OSHA’s guidelines assume that first receivers, who are not at the scene of the hazardous substance release or ingestion, are at risk from exposure to the victims’ skin, hair, clothing, or personal effects. The recommendations from OSHA state that preplanning for mass casualty incidents involving hazardous substances is the first line of defense, and that emergency plans should reflect "reasonably predictable worst-case scenarios."
Preparation for mass casualty incidents has been on the forefront of health care, particularly since the terrorist attacks of Sept. 11, 2001, but hospital employees — clinical and nonclinical
— in the high-traffic areas of the ED and main entrances should be prepared for the even more likely risk that just one person carrying a contaminant can create, according to one hospital occupational health expert points out.
OSHA describes first receivers as heath care workers who receive contaminated victims for treatment; they most commonly are physicians, nurses, administrators, security personnel, phlebotomists, respiratory technicians, residents, and X-ray technicians.
According to OSHA, of those first receivers who reported adverse effects stemming from contact with contaminated patients in 2003, none wore personal protective equipment (PPE), respiratory and eye irritation were the most common complaints, and none required hospitalization.
Young patient could be worst case
Incidents of mass casualty, as when hazardous substance releases occur, are obvious risks, but according to one expert in occupational health and safety in the health care setting, the worst-case scenario might be a child arriving in his parent’s arms.
"You have a child who has ingested something, and nobody knows what it is, and just as we find out it’s a hazardous material, he vomits on seven people, and they’re all contaminated," says Jean Randolph, RN, COHN-S/CM, MPA, manager of occupational health for Children’s Healthcare of Atlanta.
Keeping a hospital free from exposure is critical, but as Randolph notes, in the event of a limited exposure, "the hard part can be keeping [exposure victims] out of your ED, because generally they just show up in a car and walk through the door."
"We’ve educated our parking lot attendants," she says. "If someone comes in smelling of gasoline or some other chemical, they need to call security."
The scenario of a parent bringing in a child who has ingested or inhaled a hazardous substance exposes first receivers to two sources of contamination — the parent and child. Randolph says that educating staff to protect themselves and other employees is critical.
Making sure first receivers are initially trained in what protective equipment to use and when to use must be reinforced with enough refresher training to make them comfortable with using it.
"Sometimes people can’t use the respirator specific for tuberculosis, for example, because they can’t stand to be enclosed," she says. "So you have to be sure they’re trained to get past it, and it’s a slow, repetitive process. Generally, they want to get past it and get through the anxiety, because there’s no guarantee they won’t get exposed."
OSHA addresses respirators
The type of personal protective equipment (PPE) that an employee should use is dictated by the hazards the employee might encounter, and his or her role in addressing the hazard, according to the OSHA guide. Despite many hospitals’ strong interest in powered air-purifying respirators (PAPRs) as a practical form of respiratory protection for first receivers in hospital decontamination zones, particularly because they do not require fit-testing, many experts avoid making specific PPE recommendations in favor of pointing out the advantages and disadvantages of the various options.
"However, OSHA believes that the substantial body of recent information on first receivers’ actual experiences and probable exposure levels now allows more definitive guidance," the best-practices guide states. The new guidelines specify PPE that hospitals can use to effectively protect first receivers when the contaminant is unknown, provided the hospital has taken steps to minimize the quantity of substance to which first receivers might be exposed.
The recommended PPE for first receivers includes a PAPR with an assigned protection factor of 1,000; chemical-resistant protective garment; head covering, if not already included in the respirator; a double layer of protective gloves; and chemical-protective boots. Hospitals should then augment the OSHA PPE selections when necessary to provide protection against hazards that might be unique to that facility or location.
Alternatively, if a hazard assessment demonstrates that the specified PPE is not necessary to effectively protect workers from an identified hazard, a hospital would be justified in selecting less protective PPE, as long as the PPE actually selected by the hospital provides effective protection against the hazard, the best practices guide states.
The guidelines in the OSHA best practices report are not mandatory; an employer can choose to perform an independent hazard assessment that is sufficient to identify the hazards
that its employees are reasonably anticipated to encounter, and then select PPE adequate to protect its employees against such hazards.
The Joint Commission on Accreditation of Healthcare Organizations requires accredited hospitals to perform a hazards vulnerability analysis to determine what its risks are in the event of a hazardous materials or mass casualty incident, and to consider the institutions’ roles and coordinate activities with other emergency response agencies and hospitals in their area.
OSHA Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances," January 2005, is available on-line at
www.OSHA.gov.
[For more information, contact:
- Jean Randolph, RN, COHN-S/CM, MPA, Manager, Occupational Health, Children’s Healthcare of Atlanta, GA. Telephone: (404) 250-5437. E-mail: [email protected].]
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