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Florida Heart CPR*
Intensive Care Unit (ICU) Safety – OSHA
1 hour
Blood, OPIM, Bloodborne Pathogens
Definitions for bloodborne pathogens, other potentially infectious materials (OPIM), and
occupational exposure are found in 1910.1030(b).
Potential Hazard
ICU workers are particularly at risk for exposure to blood, OPIM, and bloodborne
pathogens because of the immediate, life-threatening nature of treatment.
Possible Solutions
The Bloodborne Pathogens Standard requires precautions when dealing with blood and
other potentially infectious materials.

Provide Engineering and Work Practice Controls
o Engineering and work practice controls must be the primary means to
eliminate or minimize exposure to bloodborne pathogens. Where
engineering controls will reduce employee exposure either by removing,
eliminating, or isolating the hazard, they must be used, and changes to the
Exposure Control Plan (ECP) must include these engineering controls
[1910.1030(c)(1)(iv), 1910.1030(d)(2)(i) and OSHA Directive CPL 2-2.69.
Employers must:

Ensure employees wear appropriate personal protective equipment (PPE), (e.g.,
gloves, gowns, face masks), when anticipating blood or OPIM exposure
[1910.1030(d)(3)(i)].

Ensure employees discard contaminated needles and other sharp instruments
immediately or as soon as feasible after use into appropriate containers
[1910.1030(d)(4)(iii)(A)(1)].

Provide in their exposure control plan documentation of consideration and
implementation of appropriate commercially available and effective engineering
controls designed to eliminate or minimize exposure to blood and OPIM. [OSHA
Directive CPL 2-2.69].
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
Practice Universal Precautions: Treat all blood and other potentially infectious
body fluids as if they are infected and take appropriate precautions to avoid
contact with these materials [1910.1030(d)(1)].
o The Bloodborne Pathogens Standard does allow hospitals to practice
acceptable alternatives to Universal Precautions such as Standard
Precautions or Body Substance Isolation.
Working Space
Potential Hazard
Intensive care units (ICU's), particularly neonatal ICU's, may be designed without walls
between patient spaces. This may allow employees to be unknowingly exposed to
aerosolized chemicals and x-ray radiation that escape from neighboring areas.
Possible Solutions

All rooms should have adequate ventilation to remove contaminants.
o If air recirculation is required, then adequate filtering should be installed.

Staff in adjoining patient spaces may need to be warned and removed if
procedures such as x-rays are occurring.

Aerosolized chemicals should be administered in such a fashion as not to expose
staff or patients in the area to the hazard.

OSHA Technical Manual Hospital Investigation Health Hazards: IV Controls and
Prevention.
Slips/Trips/Falls
Potential Hazard
Because of the emergency atmosphere, (i.e., high traffic and compact treatment
spaces) for ICU areas, slips/trips/falls may be a specific concern.
There is a potential slip and fall hazard if water or other fluid is spilled on the floor,
electrical cords run across pathways, or if emergency equipment or supplies block
passage and passageways.
Possible Solutions
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ICU Safety
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Provide safe clean-up of spills and keep walkways free of obstruction.
Latex Allergy
Potential Hazard
Gloves must be worn frequently in the ICU, because of possible occupational exposure
to blood and OPIM. This exposure can potentially lead to latex allergy.
Possible Solutions

Employers must provide appropriate gloves when exposure to blood or other
potentially infectious materials (OPIM) exists [1910.1030(d)(3)(iii)], Bloodborne
Pathogens Standard].
Equipment Hazards
Potential Hazard
Injury may occur to employees from improper training or use of equipment, e.g.,
defibrillators.
Possible Solutions
A program that routinely monitors the status of equipment and proper training of
employees to use equipment safely.
Workplace Violence
Potential Hazard
Workplace violence is an issue in ICU's because of the crowded, emotional situations
that can occur with critical patients.
Possible Solutions
Good work practice recommends a security management program that addresses
workplace violence in the ICU and could include:
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
Trained staff to recognize and diffuse violent situations and patients.
o Be alert for potential violence and suspicious behavior and report it.
o Provide intervention measures including verbal, social, physical,
and pharmacologic interventions.
o Warning Signs of Increasing Anger/Violence include:
 Pacing and/or restlessness
 Clenched fist
 Increasingly loud speech
 Excessive insistence
 Threats
 Cursing
Workplace Stress
Studies suggest work stress may increase a person's risk for cardiovascular disease,
psychological disorders, workplace injury, and other health problems. Early warning
signs may include headaches, sleep disturbances, difficulty concentrating, job
dissatisfaction, and low morale.
Potential Hazard

All hospital employees are exposed to stress, but employees who work in some
areas such as the ICU, or the Emergency Department must deal with additional
stress. They are exposed to critically ill patients and must deal with emotional
life/death situations on a daily basis, increasing their risk for workplace stress,
and job burnout.
Possible Solutions



Educate employees and management about job stress.
Address work-related stressors, such as inadequate work space, unreasonable
work load, lack of readily available resources, inadequate and unsafe equipment.
Establish programs to address workplace stress, such as Employee Assistance
Programs (EAP) or Organizational Change Programs.



An Employee Assistance Program (EAP) can improve the ability of
workers to cope with difficult work situations. Stress management
programs teach workers about the nature and sources of stress, the
effects of stress on health, and personal skills to reduce stress-for
example, time management or relaxation exercises.
EAPs also provide individual counseling for employees for both work and
personal problems.
Organizational Change Programs change hospital policies and
procedures to reduce organizational sources of stress.
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o
This is done by bringing in a consultant to recommend ways to
improve working conditions. This approach is the most direct way to
reduce stress at work. It involves the identification of stressful
aspects of work (e.g., excessive workload, conflicting expectations)
and the design of strategies to reduce or eliminate the identified
stressors. Some strategies include:

Ensure that the workload is in line with workers' capabilities
and resources.

Design jobs to provide meaning, stimulation, and
opportunities for workers to use their skills.

Clearly define workers' roles and responsibilities.

Give workers opportunities to participate in decisions and
actions affecting their jobs.
Additional Information:


Stress at Work DHHS (NIOSH) Publication No. 99-101.
Stress Management in the Work Setting May, 1987.
DHHS (NIOSH) Publication No. 87-111.
Methicillin Resistant Staph Aureus (MRSA)
Potential Hazard

Exposure of staff to nosocominal infections such as MRSA from body fluid
exposure. This is especially common in the ICU area, where employees must
care for patients who have open and healing wounds from recent surgery.
Possible Solutions


Practice Universal Precautions.
The CDC's recommendations for preventing transmission of MRSA in hospitals
consist of Standard Precautions, which should be used for all patient care. In
addition the CDC recommends Contact Precautions in special cases, when the
facility (based on national or local regulations) deems the multi-drug-resistant
microorganism to be of special clinical and epidemiolgic significance. For more
information about the CDC's standard precautions; see:
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ICU Safety
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Florida Heart CPR*
ICU Safety Assessment
1. ICU workers are particularly at risk for exposure to______ because of the
immediate, life-threatening nature of treatment.
a. Blood
b. OPIM
c. Bloodborne pathogens
d. All of the above
2. There is a potential _____ hazard if water or other fluid is spilled on the floor,
electrical cords run across pathways, or if emergency equipment or supplies
block passage and passageways.
a. Needlestick
b. Slip and fall
c. Contaminated air
d. Allergic reaction
3. Early warning signs of this may include headaches, sleep disturbances, difficulty
concentrating, job dissatisfaction, and low morale.
a. High blood pressure
b. Type A personality
c. Work stress
d. Being overworked
4. A strategy to eliminate workplace stressors would be:
a. Ensure that the workload is in line with workers' capabilities and resources.
b. Design jobs to provide meaning, stimulation, and opportunities for workers to
use their skills.
c. Clearly define workers' roles and responsibilities.
d. Any of the above
5. Exposure of staff to_______ such as MRSA from body fluid exposure is
especially common in the ICU area, where employees must care for patients who
have open and healing wounds from recent surgery.
a. Nosocomial infections
b. Opportunistic infections
c. Bacterial infections
d. Viral infections
Florida Heart CPR*
ICU Safety