Housekeeping » Biological Hazards – Infectious Diseases

Workers in hospital settings may be exposed to infectious disease hazards, especially if proper measures to prevent infection are not taken. Examples of infectious disease hazards include seasonal and pandemic influenza; norovirus; Ebola; Middle East Respiratory Syndrome (MERS), tuberculosis, methicillin-resistant Staphylococcus Aureus (MRSA), among others.

Infectious diseases are caused by agents that can enter the body through one or more different routes, including through the air and through blood. The transmission of infectious agents through the bloodborne route—a specific subset of contact transmission—is defined in the Bloodborne Pathogens (BBP) standard, 29 CFR 1910.1030 (See the Bloodborne Pathogens section below).

See OSHA's Safety and Health Topics Pages for Biological Agents and Bloodborne Pathogens and Needlestick Prevention for more information.

Some of the proper measures to prevent infection might include, for example, using PPE, such as gloves, AND washing hands AND cleaning work surfaces AND properly disposing of sharps. This eTool discusses only some of the proper measures that are necessary to protect workers. Implementing the controls highlighted here alone will not typically protect workers from infection hazards

Employers must comply with the BBP standard to the extent that there is "occupational exposure" (i.e., to the extent workers should reasonably anticipate contact with blood or other potentially infectious materials (OPIM) that may result from the performance of duties). Employers must also comply with the PPE Standard, 29 CFR 1910 Subpart I, and the OSH Act's General Duty Clause, 29 U.S.C. 654(a)(1), to protect their workers from infectious disease hazards. The General Duty Clause requires each employer to "furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees."

In this module, OSHA provides additional guidance specifically for bloodborne pathogens.

Bloodborne pathogens are pathogenic microorganisms present in human blood that can cause disease in humans. These pathogens include, but are not limited to, Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Human Immunodeficiency Virus (HIV) and Viral Hemorrhagic Fevers (e.g. Ebola). [29 CFR 1910.1030(b)]

Hazard

Exposure of housekeeping staff to work environments contaminated with blood or other potentially infectious materials (OPIM).

Requirements under OSHA's Bloodborne Pathogens Standard, 29 CFR 1910.1030

The Bloodborne Pathogens Standard requires precautions when there is occupational exposure to blood or OPIM (as defined by the standard).

OSHA requires employers to ensure that the biosafety officer or other responsible person conducts an exposure determination to determine the exposure of workers to blood or OPIM throughout the hospital setting. [29 CFR 1910.1030(c)(2)(i)].

Recognized Controls and Work Practices

  • Develop and implement an appropriate written schedule for cleaning and methods of decontamination for each hospital area to be cleaned.
  • This written schedule must be based on the:
    • Location within the facility.
    • Type of surfaces to be cleaned.
    • Amount of contamination.
    • The tasks or procedures to be performed in the area.

For more information, see Hospital-wide Hazards - Bloodborne Pathogens

Appropriate disinfectants

OSHA Requirements

  • Work surfaces are to be cleaned with an "appropriate disinfectant." [29 CFR 1910.1030(d)(4)(ii)(A)].
    • "Appropriate disinfectants" under the standard include a diluted bleach solution and U.S. Environmental Protection Agency (EPA)-registered antimicrobial products such as tuberculocides (List B), sterilants registered by EPA (List A), products registered against HIV/HBV (List E), and Sterilants/High Level Disinfectants cleared by the Food and Drug Administration (FDA).

    • The EPA oversees the registration of anti-microbial products. A list maintained by the Office of Pesticide Programs provides the most recent information available from the EPA on registered anti-microbials.

      NOTE: Products are registered by the EPA as effective against individual, or a combination of, agents, such as the Human-HIV Virus, Mycobacterium tuberculosis, and Hepatitis B virus (HBV). Thus, products registered by the EPA as HIV-effective are not necessarily effective against tuberculosis (tuberculocidal) or against the hepatitis B virus (HBV).
    • The sterilants and high level disinfectants cleared by FDA can be found here.
    • Any of the above products are considered effective for their listed purpose when used according to the manufacturer's instructions, provided surfaces have not become contaminated with agents or volumes of or concentrations of agents for which higher level disinfection is recommended.
  • Bleach is generally considered to be an effective disinfectant once the product air dries.
  • It is important to emphasize the EPA-approved label section titled "SPECIAL INSTRUCTIONS FOR CLEANING AND DECONTAMINATION AGAINST HIV-1 AND HBV OF SURFACES\OBJECTS SOILED WITH BLOOD\BODY FLUIDS".
    • On the labels OSHA has seen, these instructions require: (1) personal protection devices for the worker performing the task; (2) that all the blood must be cleaned thoroughly before applying the disinfectant; (3) that the disposal of the infectious waste is in accordance with federal, state, or local regulations; and (4) that the surface is left wet with the disinfectant for 30 seconds for HIV-1 and 10 minutes for HBV. Use all such disinfectants in accordance with their EPA-approved label instructions.

Additional Information

Contaminated equipment

Hazard

Exposure to contaminated equipment is prevalent in housekeeping. Contaminated equipment can include working surfaces, protective coverings, reusable containers, and glassware.

Requirements under OSHA's Bloodborne Pathogens Standard, 29 CFR 1910.1030

OSHA requires:

Equipment and working surfaces:

  • All equipment and environmental and working surfaces shall be cleaned and decontaminated after contact with blood or other potentially infectious materials. [29 CFR 1910.1030(d)(4)(ii)]

  • Labels required by the standard for contaminated equipment shall be in accordance with 29 CFR 1910.1030(g)(1) and shall also state which portions of the equipment remain contaminated. [29 CFR 1910.1030(g)(1)(i)(H)].

    Note: Some equipment, if grossly contaminated, must be cleaned with a soap and water solution prior to decontamination, as some anti-microbial products will not work in the presence of blood, which interferes with the sterilizing process (CDC, 2008).

Protective coverings:

  • Protective coverings, such as plastic wrap or aluminum foil used to cover equipment and environmental surfaces, shall be removed and replaced as soon as feasible when they become overtly contaminated or at the end of a work shift if they may have become contaminated during the shift. [29 CFR 1910.1030(d)(4)(ii)(B)]

Reusable containers:

  • All bins, pails, cans, and similar receptacles intended for reuse which have a reasonable likelihood for becoming contaminated with blood or other potentially infectious materials shall be inspected and decontaminated on a regularly scheduled basis and cleaned and decontaminated immediately or as soon as feasible upon visible contamination. [29 CFR 1910.1030(d)(4)(ii)(C)]

Glassware:

  • Broken glassware which may be contaminated shall not be picked up directly with hands; use mechanical means, such as a brush and dustpan, tongs or forceps. [29 CFR 1910.1030(d)(4)(ii)(D)]

OSHA requires employers to ensure that the biosafety officer or other responsible person conducts an exposure determination to determine the exposure of workers to blood or OPIM throughout the hospital setting. [29 CFR 1910.1030(c)(2)(i)].

Additional Information

Contaminated laundry

Contaminated laundry is defined in the Bloodborne Pathogen Standard as laundry which has been soiled with blood or other potentially infectious materials (OPIM) or may contain sharps. [29 CFR 1910.1030(b)]

Hazards

Employee exposure to blood and other potentially infectious agents can occur from handling contaminated laundry.

Requirements under OSHA's Bloodborne Pathogens Standard, 29 CFR 1910.1030

The Bloodborne Pathogens Standard requires under 29 CFR 1910.1030(d)(4)(iv)(A) that contaminated laundry:

  • Be handled as little as possible;
  • Be bagged or containerized at the location where it was used;
  • Not be sorted or rinsed in the location of use; and
  • Be placed and transported (e.g., to the laundry for decontamination) in bags or containers labeled or color-coded in accordance with 29 CFR 1910.1030(g)(1)(i).
    • When universal precautions are used in the handling of all soiled laundry, alternative labeling or color-coding is sufficient if it permits all employees to recognize the containers as requiring compliance with universal precautions.

OSHA requires employers to ensure that the biosafety officer or other responsible person conducts an exposure determination to determine the exposure of workers to blood or OPIM throughout the hospital setting. [29 CFR 1910.1030(c)(2)(i)].

Recognized Controls and Work Practices

  • Use melt-away bags for the bagging process. Melt-away bags can be thrown directly into washers without having to unload or remove contaminated laundry from bags.
  • The ergonomic stressors that can occur with lifting, reaching, rinsing, and transporting wet heavy laundry must also be addressed. A lift or transfer device for the lifting of these materials is recommended.
  • To avoid punctures from improperly discarded syringes/sharps, do not hold contaminated laundry bags close to the body or squeeze them when transporting.

Additional Information

Sharps and containers

Hazard

Exposure of housekeeping staff to contaminated sharps and containers from:

  • Sharps that are not discarded promptly/properly and are left in bedding and accidentally sent to the laundry.
  • Improper handling or disposal of sharps containers (e.g., allowing containers to overfill, or transporting them incorrectly).

Requirements under OSHA's Bloodborne Pathogens Standard, 29 CFR 1910.1030

Implement work practice and engineering controls to help prevent sharps injuries. Train employees in proper handling/disposal of sharps and sharps containers.

OSHA requires:

Sharps Disposal:

  • Contaminated sharps must be properly disposed of immediately or as soon as feasible into appropriate containers that are in accordance with the Bloodborne Pathogens standard. [29 CFR 1910.1030(d)(4)(iii)(A)(1)]

Handling and Replacement of sharps containers:

Moving and Disposal of sharps containers:

  • When moving containers of contaminated sharps from the area of use, the containers shall be:
  • Dispose of all regulated waste (see definition in Bloodborne Pathogens Standard) in accordance with applicable U.S. regulations (e.g., EPA regulations), as well as applicable State, Territorial, and local regulations. [29 CFR 1910.1030(d)(4)(iii)(C)]

Reusable containers:

  • Reusable containers shall not be opened, emptied or cleaned manually or in any other manner that would expose employees to the risk of percutaneous injury.

OSHA requires employers to ensure that the biosafety officer or other responsible person conducts an exposure determination to determine the exposure of workers to blood or OPIM throughout the hospital setting. [29 CFR 1910.1030(c)(2)(i)].

Additional Information