California issues tightest set of Ebola protocols yet


The California Occupational Safety and Health Administration (OSHA) announced on Friday a new group of Ebola-protection guidelines that meet and surpass the voluntary protocols recommended by the CDC. The new regulations come in the wake of a massive strike/protest held by thousands of Californian nurses and organized by National Nurses United (NNU). “The governor and OSHA have really inspired nurses with their dedication to this,” NNU spokesman Chuck Idelson said. “They’ve shown an absolute commitment to protecting patients and nurses.” The guidelines – are mandatory and entail penalties for hospitals that neglect to meet them – addresses one of health workers’ chief concerns: personal protective equipment (PPE).

Protection of body, hands, eyes, nose, and mouth

·         Body covering must be used so as to not allow fluids to penetrate. Employees working in a patient’s room must wear a coverall.

·         Head and neck must be protected, including covering for the eyes, mouth, nose, and skin. Hair must be fully enclosed.

·         Two or more pairs of gloves must be used to protect the hands (the CDC recommends two pairs of disposable nitrile exam gloves with extended cuffs on the outer pair).

·         Fluid-resistant boots or feet and lower leg coverings must be used. Undersocks or underboots integrated into the coverall – or equivalent protection – must be provided to offer continual fluid protection.

According to the Cal/OSHA protocols, not only should employees who are in contact with patients wear fully protective PPE, but the employees who help those employees put on and take off PPE should also wear head-to-toe protection. Hospitals must provide staff with PPE that complies with the following:

·         Bodily fluids cannot pass through the PPE and each the employee’s work or street clothes, undergarments, skin, eyes, mouth, or other mucous membranes.

·         Design, strength, fit, and durability of PPE should offer sufficient protection. Seams, zippers, and other fastenings protect against fluid passage.

·         PPE is comfortable enough and does not hinder the employee’s freedom of movement.

·         Each piece must be compatible with the rest of the gear during use, removal, and decontamination.

Additionally, hospitals must provide written plans to reduce or eliminate Ebola exposure including:

·         Identification of all operation areas, tasks, and job classifications where staff is at risk of exposure to Ebola patients or contaminated materials.

·         Engineering controls, for instance separate rooms for patients, plastic barriers, decontamination facilities, hygiene facilities, and when applicable special isolation rooms with dedicated ventilation systems.

·         Work practice controls that affect how tasks and operations are performed in all stages of workflow.

·         Personal protective equipment including respirators, and methods to determine the respiratory protection level required.

·         Medical services and continuation of a worker’s pay if the employee must be isolated after workplace exposure.

·         Training on the risks covered by the protocols and the employer’s methods for preventing exposure, with an opportunity for Q&A.

The last one is important because the guidelines stress active employee involvement, including meetings with staff in affected units, and establishing a committee of non-management and management employees to review the exposure control plan and any concerns posited by staff. Employees should be at liberty to express their concerns without fear of repercussions, while hospitals must inform staff that their concerns are being looked into and provide the results of an investigation. “Hospitals will continue to work closely with Cal/OSHA officials as hands-on training sessions continue for those employees who are most likely to provide care to patients with Ebola,” spokeswoman for the California Hospital Association Jan Emerson-Shea said. 

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CDC: Guidelines for Ebola personal protection gear