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In May, the United States celebrated National Nurses Week. While many recognize the important work that nurses and other healthcare professionals perform, few consider the unique hazards these workers face on the job.

When the public thinks of hazardous workplaces, they likely think of construction and manufacturing. While those workplaces certainly do have appreciable rates of injuries and illnesses, the Bureau of Labor Statistics has shown that hospital workers face a higher likelihood of injury or illness resulting in days away from work than workers in the construction or manufacturing sectors.

BLS reported that in 2016 there were 552,600 nonfatal injuries and illnesses in the healthcare sector. This topped the list, with manufacturing coming in second at 410,500. Safety efforts in healthcare are challenging due to the diversity of employees and the uniqueness of the hazards they face.

Healthcare services require a broad range of workers, such as physicians, nurses, technicians, clinical laboratory workers, first responders, building maintenance, security and administrative personnel, social workers, food service, housekeeping, and mortuary personnel.

Identifying Healthcare Hazards

Healthcare workers face both traditional workplace safety hazards (for example, slips and falls) and many that are unique to their workplace activities. These unique healthcare hazards can include:

• ​biological hazard exposure, such as bloodborne pathogens and medical waste
• chemical hazard exposure, such as chemotherapy and other drugs, sterilizers and disinfectants (such as ethylene oxide, glutaraldehyde, and formaldehyde), and anesthetic gases
• musculoskeletal hazards, especially related to patient handling
  
• ionizing and non-ionizing radiation (x-rays, nuclear medicine, lasers)

OSHA’s Bloodborne Pathogens Standard

Of the OSHA safety standards impacting hospitals and other healthcare facilities, the bloodborne pathogens standard at 29 CFR 1910.1030 is probably the most recognizable. It’s also one of the most unique.

Infectious diseases can be transmitted in the healthcare setting through direct or indirect contact (for example, skin-to-skin or transfer to patient-care instruments), droplets (from sneezes, coughs, and exhalations), and airborne particles. Hospital safety efforts to reduce the spread of infectious diseases must comply with several workplace safety regulations. OSHA’s bloodborne pathogens standard is designed to protect employees from blood and other potentially infectious materials.

Hospitals and other healthcare facilities where employees may be exposed to bloodborne pathogens must develop a written exposure control plan to describe efforts to eliminate and reduce employee exposure. Simply stated, the bloodborne pathogens standard is implemented through four primary efforts:

1. universal precautions

2. engineering and work practice controls

3. hazard communication

4. ​employee training

Universal Precautions for Infection Control

Universal precautions were originally recommended by the CDC in the 1980s as an approach to infection control to protect workers from HIV, hepatitis B virus, and other bloodborne pathogens in human blood and body fluids.

As stated in 29 CFR 1910.1030(d)(1), under universal precautions, all human blood and certain human body fluids are treated as if they are known to be infectious. Healthcare safety goes beyond universal precautions addressed in this OSHA safety standard. UP are now used in combination with standard precautions and transmission-based precautions.

As with other workplace hazards, employers should seek to eliminate or minimize employee exposure. Engineering controls and work practice controls work in concert to accomplish this goal; see 29 CFR 1910.1030(d)(2).

Hazard Communication in Healthcare

The bloodborne pathogens standard requires employers to communicate the presence of bloodborne pathogens. This may include specific labels and symbols posted on containers, refrigerators, or devices holding potentially infectious materials, including samples of blood and other body fluids and medical waste; see 29 CFR 1910.1030(g)(1)(i).

Safety Training for Healthcare Workers

Healthcare employers must conduct initial and annual training to employees with occupational exposure; see 29 CFR 1910.1030(g)(2). Training, in combination with hospital safety efforts like engineering and work practice controls, is an effective means of ensuring healthcare workers’ hazard exposure is minimized.

Not all bloodborne pathogens or medical waste hazards can be engineered away.

In addition to the bloodborne pathogens standard, healthcare safety professionals will need to comply with OSHA safety standards for personal protective equipment (29 CFR 1910.132) and respiratory protection (29 CFR 1910.134). These standards also contain a training requirement to ensure the employee understands the hazards they face, as well as the proper use and care of the specified equipment, as well as its limitations.

OSHA has more information regarding healthcare safety on its website.