Safety Manual:
Hazard Assessment and
Personal Protective Equipment (PPE)

The purpose of this plan is to comply with 29 CFR 1910.132. In compliance, a hazard assessment has been completed at each work site of the NKY Health. Based on this assessment, a list has been compiled consisting of the following:

• Hazards potentially present

• The proper personal protective equipment for potentially hazardous tasks

• The appropriate staff for which these potential hazards exist in the performance of their duties

This plan applies primarily to staff identified as needing personal protective equipment based on the hazards associated with their job duties or work location when a hazard assessment of each site was conducted. Other staff desiring the use of personal protective equipment may use it.

The staff whose job duties require the use of personal protective equipment will be trained at the time of entry into the job and any time the plan changes.

Training for the staff involved will consist of the following:

•  When personal protective equipment is necessary

• What personal protective equipment is necessary

• How to properly don, doff, and utilize personal protective equipment

• Limitations of personal protective equipment

• The proper care, maintenance, useful life and disposal of personal protective equipment

 Demonstration of the staff’s understanding of the above topics will be accomplished by a written test. Results of the tests will be retained in the training files.

Initial general training is in the form of self-paced modules and training records are maintained in a learning management system and/or personnel files. Specific training is the responsibility of the immediate supervisor.

 Contact the Employee Health Nurse with questions/concerns about this plan.

The NKY Health will conduct an assessment to determine whether various physical hazards are present in the work place. As part of the assessment, the NKY Health will also determine whether various health hazards are present in staff work areas.

The NKY Health will correct any actual hazards found; the NKY Health will institute engineering controls and infection control practices as well as ensure the availability of personal protective equipment (PPE) for potential hazards identified.  PPE is designed to create a barrier between an employee and a workplace hazard.

Physical hazards include:

• Sources of motion

• Sources of high and low temperatures

• Sources of light radiation

• Sources of falling objects

• Sources of sharp objects

• Sources of rolling or pinching objects

• Sources of electric hazards

• Floor conditions

Health hazards include:

• Exposure to blood and other bodily fluids

• Exposure to airborne transmissible diseases

• Exposure to droplet transmissible diseases

• Contact with:

  • Sources of pathogens

  • Sources of harmful chemicals

  • Sources of harmful dusts

  • Sources of nuclear radiation

  • Sources of biological agents

 PPE alone should not be relied on to provide protection against hazards, but should be used in conjunction with guards, engineering controls and infection control practices. Defective or damaged PPE equipment shall not be used.

The following tasks and procedures or groups of closely related tasks and procedures may have occupational exposure to physical and/or health hazards:

• The performance of venipuncture, heelsticks or fingersticks.

• The performance of intravenous, intramuscular, subcutaneous or intradermal administration of vaccine or medications.

• The use and handling of needles, sharp instruments, scalpels or similar devices during routine clinical procedures or diagnostic examinations. The cleaning of used instruments, and the disposal of needles, blades, and other sharps.

• The collection and handling of all smears, cultures and specimens  of all bodily fluids (whether or not they contain visible blood).

• The physical examination of the pelvis, rectum, and genitalia; contact with all mucous membranes, including the nose and mouth.

• The performance of invasive procedures.

• The manipulation, cutting or removal of any oral tissue including tooth structure in which bleeding occurs; the handling of intra-oral devices.

• Contraceptive implant and insertion.

• The performance or assistance in vaginal delivery.

• The performance of wound care.

• The performance of communicable disease investigation and case management.

• The performance of tasks associated with any off-site visit.

• The collection or preparation of samples or specimens for testing or analysis.

• The investigation of environmental complaints that involve the potential exposure to health or safety hazards.

• Routine cleaning of surfaces in laboratories, examination rooms, and restrooms.

• Decontamination and clean-up of blood or bodily fluid.

• Handling of visibly contaminated waste or waste containers.

• Use of any power tool.

• Clearing obstructions in drainage systems.

Professional judgment must be used in all situations to determine the level of protection required.

Positions are classified into three categories according for potential to occupational exposure. See the section "Determining Occupational Exposure" the Bloodborne Pathogen (BBP) Exposure Control Plan of this Safety Manual for an assessment of classifications.

General requirements

• Each potentially affected staff shall use appropriate eye or face protection when exposed to eye or face hazards from flying particles, molten metal, chemicals, acids or caustic liquids, chemical gases or vapors, or potentially injurious light, radiation or biological agents.

• Each potentially affected staff shall use eye protection that provides side protection when there is a hazard from flying objects or splashing.

• Each potentially affected staff who wears prescription lenses while engaged in operations that involve eye hazards shall wear eye protection that incorporates the prescription in its design, or shall wear eye protection that can be worn over the proper position of the prescription lenses without disturbing the proper position of the prescription lenses or the protective lenses.

Staff requirements

• Clean eye protection equipment with mild soap and water or special wipes that are designed for cleaning protective eye equipment. Never use abrasive soaps, rough paper or cloth towels. These items will scratch and damage the equipment.

• Always keep eye protection equipment in good working condition. If it is damaged, have it repaired or replaced.

Needs

• Safety glasses

• Goggles

• Face shields

• Masks

General requirements

• Each potentially affected staff shall wear protective helmets when working in areas where there is potential for injury to the head from falling objects.

• Each potentially affected staff shall wear protective helmets designed to reduce electrical shock hazard when near exposed electrical conductors which could contact the head.

• Each potentially affected staff shall wear surgical hoods designed to cover the head and neck when the threat of a Viral Hemorraghic Fever, such as Ebola, exists.

Needs

• Hard hats

• Surgical hoods

General requirements

Employers shall select and require staff to use appropriate hand and skin protection when staff's hands and skin are exposed to hazards such as those from blood borne pathogens, skin absorption of harmful substances, severe cuts or lacerations, severe abrasions, punctures, chemical burns, thermal burns, harmful temperature extremes and biological agents.

Staff requirements

• Select and use the right kind of glove for the task to be performed.

• Select gloves that fit.

• Inspect gloves before use. Look for holes and cracks that might leak.

• Remove any rings, watches or bracelets that might cut or tear gloves.

• Wash hands Perform hand hygiene before and after wearing gloves.

• Wear footwear covers appropriate for the task to be performed.

• Wear clothing appropriate for the task to be performed.

Needs

• Latex exam gloves (powder free)

• Non-latex exam gloves

• Standard and extended cuffed gloves

• Utility gloves

• Gowns

• Aprons

• Footwear Covers

General requirements

Employers shall require staff to wear protective footwear when working in areas where there is a danger of foot injuries due to falling and rolling objects, or objects piercing the sole, and where such staff's feet are exposed to electrical hazards. 

 Staff requirements

• Select footwear that fit.

• Wear shoes that cover heels and toes in a clinic setting to minimize exposure of feet to sharp objects and/or spills.

• Wear shoes that are secured by backs or back straps in all settings to avoid “walking out” of shoes.

• Avoid footwear made of leather or cloth if working around acids or caustics. These chemicals quickly eat through the leather or cloth and can injure feet.

• Replace worn or torn footwear.

Needs

• Footwear appropriate to the task.

Standards and recommendations

The OSHA occupational exposure limit for noise is 90 decibels as an eight-hour total weight average (29 CFR 1910.95). Because the noise exposure limit is time-weighted, the amount of time workers are permitted to spend in a noise exposure area varies according to the noise level as follows:

Hours of exposure per work day Permissible noise level (dBA)

                         8                                                                  90                         

                                6                                                                  92      

                                4                                                                  95

                                3                                                                  97       

                                2                                                            100 

                                1                                                            105 

                                0.5                                                         110 

                                0.25                                                       115

Engineering controls

The goal of the hearing conservation program should be to develop engineering controls to reduce noise exposure. Engineering controls could include enclosure of noisy equipment, acoustical treatment of walls to reduce noise reflection, vibration damping of noisy machines and replacement of metal-to-metal contact with synthetic material-to-metal contact. Administrative controls can also be used to limit a worker's exposure time to excessive noise.

Hearing protection devices

If engineering or administrative controls are not feasible, or if they are in the process of being implemented, hearing protection is required. Many forms of hearing protection are available, including earmuffs and earplugs. Some are more effective than others depending on the noise level, frequency and individual fit of the device. Protection must be effective but reasonably comfortable.

Needs

• Earplugs

• Earmuffs

Standard PPE is always provided.  However, when the threat of a Viral Hemorraghic Fever, such as Ebola, exists, additional PPE will be provided.  The additional PPE is marked with an “*E*” in this section. 

Disposable, single-use surgical or examination gloves (latex or non-latex) are available to staff. Surgical gloves are available when appropriate to the task. These gloves are to be discarded after each procedure or discarded and replaced during a procedure if torn, punctured or no longer providing a barrier. *E* Gloves with a standard cuff and an extended cuff are available. 

Multi-use utility gloves must be discarded if the integrity of the glove is compromised (i.e. cracked, peeling, torn, punctured or no longer providing a barrier.) 

• Masks: Provides a covering to the mouth and nose.

• Goggles: Must have a solid side shield and fit over prescription glasses worn by staff.

• Face shields: Covers the face and extends to chin.

• *E* Surgical hoods: Covers the head and neck.

• Gowns: Disposable, fluid resistant with long sleeves and elastic cuffs. Ties in the back at the neck and waist.  *E* Impermeable gowns.

• *E*: Disposable scrubs, single use, worn, under disposable gown.

• Aprons: Disposable, plastic.

• Limitations: Except for Viral Hemorrhagic situations, gowns are water resistant, not waterproof.

Disposable, single-use shoe covers are available to staff. 

*E* Disposable, single-use boot covers.

N-95 Respirators and PAPRs: Provide protection from airborne particles. 

See the "Respirators" subsection of the “Proper Use of PPE” section 

When the threat of a Viral Hemorrhagic Fever, such as Ebola, exists all PPE utilized to isolate, observe, and examine a suspect case is to be discarded immediately after use in a designated Class A waste container.  When this threat does not exist, the normal procedures outlined in this section may be followed.

• Examination gloves: Discard after use

• Utility gloves:

  • Reusable

  • Inspect before using for cracks, tears and holes; discard if found

  • Rinse with water after use; if heavily soiled, use soap and water to clean; hang to dry

  • If soiled with blood, use EPA-registered disinfectant labeled as effective against HIV and HBV

  • Discard during task if torn, cracked or hole develops

Masks 

• Discard after each use

Goggles

• Reusable

• Inspect for breaks or cracks before use

• Clean with soap and water

• Clean with EPA-registered disinfectant labeled as effective against HIV and HBV for blood splatters

Face shields

• Reusable

• Inspect before use for cracks or holes, discard if found

• Clean with soap and water for soil

• Clean with EPA-registered disinfectant labeled effective against HIV and HBV for blood splatters

Eye protection

• Clean eye protection equipment with mild soap and water or special wipes that are designed for cleaning protective eye equipment. Never use abrasive soaps, rough paper or cloth towels. These items will scratch and damage the equipment.

• Always keep eye protection equipment in good working condition. If it is damaged, have it replaced.

Discard after each use.

Discard after each use.

After reading this section, staff who have additional questions about proper use of PPE should consult their supervisor, especially when the threat of a Viral Hemorrhagic Fever, such as Ebola, exists.

All employees who will be using N-95 respirators must be fit tested and approved for N-95 respirator use. Contact the Employee Health Nurse to arrange a fit test.

See the Prevention of Tuberculosis (TB) Transmission Plan section of this Safety Manual for information about proper use of N-95 respirators.

All employees who will be using a PAPR must be approved and trained in proper PAPR use. Contact the Employee Health Nurse for details.

See See the Prevention of Tuberculosis (TB) Transmission Plan section of this Safety Manual for information  about the proper use of respirators.

See professional protocols and standards relating to professional practice concerning when and how to use PPE. In the absence of professional protocols, employees must consult their supervisor regarding the proper use of PPE.