An innovative option to comply with 1992 OSHA guidelines.

Abstract

On March 6, 1992, the Federal Occupational Safety and Health Administration (OSHA) released its much-needed standard for protecting workers from occupational exposure to bloodborne pathogens. According to the US Labor Department, this final standard will protect more than 5.6 million workers. Organisms causing human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are carried in the blood and other bodily fluids, representing a significant risk of infection to healthcare workers. Each year, 5,900 to 7,400 healthcare workers contract hepatitis B, causing the deaths of as many as 300. By May 5, 1992, each institution was required by OSHA to develop its own exposure control plan to implement these standards. The care of ostomies (ie, colostomies and ileostomies) provides potential exposure to healthcare workers. Therefore, ostomy care protocols should be included in the institution's exposure control plan. The following is offered as a suggestion to assist in the implementation of these OSHA standards, for ostomy care. Due to age, deteriorating health, or physical limitations, some ostomy patients in various healthcare settings may not be able to maintain self-care practices. Therefore, the responsiblity for daily emptying of ostomy pouches is transferred to the healthcare staff. Most facilities use one-piece drainable pouches for management of fecal ostomies. In view of the OSHA standards, this traditional management method may not provide optimum exposure protection to the healthcare giver. In fact, emptying, washing, and reusing ostomy pouches can sometimes increase the exposure risk. Not only is the bedside caregiver affected, but so is the housekeeping epartment because housekeeping staff must deal with accidental spillage and stool splash around toilets, trash cans, and bed linens. In many instances, these one-piece pouches are simply removed and replaced daily. Such practices can result in skin-stripping of the patient's peristomal skin. Because these more expensive pouches are not designed for daily removal, this method of management could increase costs to the facility. In most states, Medicare B has limits on the number of drainable pouches covered in a month. A two-piece, closed-end disposable pouching system provides an alternative to a one-piece drainable pouch because it does not require emptying. Sally Matson, of ET Nursing Services, Inc., Jacksonville, Florida, states, With the ongoing need for Universal Precautions regarding all bodily fluids, closed-end pouches allow less exposure to bodily fluids and waste, and therefore reduce the chances of contamination of healthcare personnel. A two-piece, closed-end pouching system consists of a body-side skin-barrier wafer with an integral flange, which allows the closed-end pouch to be removed and discarded according to the institution's exposure control plan. A clean pouch can be reapplied without risking the skin-stripping effects of frequent pouch removal. Matson further states, Closed-end pouches with gas relief filters eliminates the need to 'burp' the pouches to release gas, a procedure necessary with drainable pouches. This decreases the possibility of accidental pouch 'pop-offs' due to overfilling of gas. Any type of stool