Health Devices. 1993 Feb;22(2):35-92.
Just over a year ago, the Occupational Safety and Health Administration (OSHA) issued the final bloodborne pathogens standard, "Occupational Exposure to Bloodborne Pathogens; Final Rule," which requires healthcare institutions to protect their employees from all occupational exposure to bloodborne pathogens." According to OSHA, the only criterion for applying the standard is the likelihood of exposure to blood and other potentially infectious materials (OPIMs). Thus, the standard is designed to protect all vulnerable personnel, from the clinical engineers who service contaminated equipment to the staff in clinical laboratories, patient care or treatment areas, and housekeeping and laundry services--any location where the nature of the work poses the risk of exposure to bloodborne pathogens. All department heads and employees must have access to the standard and should carefully review our analysis of the regulations and recommendations for implementing them, as presented in this special issue of Health Devices. The standard is aimed at protecting employees from occupational exposure to all bloodborne pathogens and, especially, to the human immunodeficiency virus (HIV) and the hepatitis B virus (HBV)--the most infamous pathogens transmitted through occupational exposure to blood and body fluids. Other bloodborne diseases referenced by OSHA in the preamble to the standard include arboviral infections, babesiosis, brucellosis, Creutzfeldt-Jakob disease, hepatitis C, human T-lymphotropic virus type I, leptospirosis, malaria, relapsing fever, syphilis, and viral hemorrhagic fever. In this issue, we provide a clinical overview of HIV and HBV and the diseases they cause, as well as a brief discussion of other bloodborne pathogens; an analysis of the most significant regulations affecting hospitals; and our recommendations for compliance. The recommendations presented in this article do not exhaust the possibilities for reducing exposure and complying with the standard. We invite you to communicate your ideas and practices regarding compliance issues to the ECRI-sponsored Center for Healthcare Environmental Management (CHEM) for possible inclusion in a future update to its loose-leaf reference publication, the Healthcare Environmental Management System. We wish to acknowledge CHEM's contribution in developing this special report, which was reviewed by the Centers for Disease Control and Prevention (CDC), the National Institute for Occupational Safety and Health (NIOSH), and OSHA. Also see "CDC's Recommendations for Hepatitis B Vaccination and Postexposure Follow-up" and "A Minimal Training Syllabus" in this issue.
就在一年多以前，职业安全与健康管理局（OSHA）发布了最终的血源性病原体标准《职业性接触血源性病原体；最终规则》，该标准要求医疗机构保护其员工免受一切职业性血源性病原体接触。根据OSHA的说法，适用该标准的唯一标准是接触血液和其他潜在传染性物质（OPIM）的可能性。因此，该标准旨在保护所有易受伤害的人员，从维修受污染设备的临床工程师到临床实验室、患者护理或治疗区域以及家政和洗衣服务部门的工作人员——任何因工作性质而存在接触血源性病原体风险的场所。所有部门主管和员工都必须能够获取该标准，并应仔细研读我们在本期《健康设备》中对相关法规的分析以及实施建议。该标准旨在保护员工免受职业性接触所有血源性病原体，尤其是人类免疫缺陷病毒（HIV）和乙型肝炎病毒（HBV）——通过职业性接触血液和体液传播的最臭名昭著的病原体。OSHA在该标准前言中提及的其他血源性病包括虫媒病毒感染、巴贝斯虫病、布鲁氏菌病、克雅氏病、丙型肝炎、人类嗜T淋巴细胞病毒I型、钩端螺旋体病、疟疾、回归热、梅毒和病毒性出血热。在本期中，我们提供了HIV和HBV及其所引发疾病的临床概述，以及对其他血源性病原体的简要讨论；对影响医院的最重要法规的分析；以及我们的合规建议。本文中提出的建议并未穷尽减少接触和符合标准的所有可能性。我们邀请您就合规问题将您的想法和做法告知由ECRI赞助的医疗保健环境管理中心（CHEM），以便有可能纳入其活页参考出版物《医疗保健环境管理系统》的未来更新版本中。我们谨此感谢CHEM在编写本特别报告过程中的贡献，该报告经过了疾病控制与预防中心（CDC）、国家职业安全与健康研究所（NIOSH）和OSHA的审核。另请参阅本期中的“CDC关于乙肝疫苗接种及暴露后随访的建议”和“最低培训大纲”。
