Engineering and Work Practice Controls

Engineering controls are devices and tools designed to isolate and remove contaminated equipment from the workplace. Work practice controls are alterations in how a workplace task is completed to reduce the likelihood of exposure. When combined, these controls effectively eliminate or reduce the risk of exposure and transmission of infectious disease. Examples include handwashing facilities or antiseptic hand cleanser, proper use of personal protective equipment (PPE), needle safety devices, puncture-resistant, closeable, and leakproof sharp containers, and the proper handling, storage, and disposal of potentially hazardous materials.

PPE protects employees from exposure by creating a barrier against bloodborne pathogens. Employers must conduct a risk assessment of the worksite hazards, identify potential exposures and assign PPE accordingly. Basic PPE, including fitted gloves, masks, and gowns, should be readily available and worn whenever there is potential for contact with bodily fluids and contaminated equipment. PPE does not eliminate the hazard, and proper fit is critically important. For example, the surgical gown must provide adequate coverage in the critical primary protection zones. PPE that is too large or loose may minimize tactile sensitivity and has the potential to be a hazard. Properly fitted PPE has greater user satisfaction and is, therefore, more likely to be consistently worn. In addition to basic equipment, for procedures posing an additional exposure risk such as wound irrigation, additional protective equipment such as a face shield will provide a barrier to the back spray and should be readily available. Employers are responsible for the risk assessment, accessibility, proper use, cleaning, disposal, repair, and replacement of PPE.

Since the bloodborne pathogens standard was published, many different engineering controls and medical devices have been developed to reduce exposure risk. For example, contaminated PPE and equipment should be placed in appropriately labeled bags or containers for safe disposal. A warning label that includes the universal biohazard symbol must be displayed and readily observable on all bags and containers with contaminated items. The availability and use of engineering controls, including sharps disposal containers and self-sheathing needles, for removing contaminated pathogens is another important step in the safe removal of hazardous waste.

Along with PPE, proper hand hygiene is one of the most effective means of infection control and preventing disease transmission. All employees caring for patients must perform hand hygiene. Current CDC guidelines recommend using alcohol-based hand rub with at least 60% alcohol (60% ethanol or 70% isopropyl alcohol) or handwashing with soap and water for at least 20 seconds before and after touching a patient or performing an aseptic procedure. Hand hygiene should also be practiced when moving from a soiled to a clean body site, after touching a patient, contacting blood, body fluids, contaminated surfaces. Proper hand hygiene is necessary immediately before donning and immediately after doffing PPE.