Medical Assistant Exam: Clinical Procedures - Infection Control

Clinical procedures are essential in a medical office. This guide will review clinical procedures including infection control, procedures relating to the treatment area, patient preparation and assisting the physician, the patient history interview, diagnostic testing and collecting and processing specimens, preparing and administering medications, emergencies, first aid, and nutrition.

Infection Control
Infectious diseases, also called communicable diseases, are caused by microorganisms that may be transmitted directly or indirectly between individuals, causing infection. Infection control is an integral part of medical practice settings.

Key Principles Of Infection Control
- hand washing before and after contact with patients
- separation of infected patients from the uninfected
- safe handling of needles and other sharp medical objects
- use of personal protection such as gloves
- sterilization and disinfection procedures

Infectious Disease
An infectious disease is caused by the presence of an organism in the body—specifically, a pathogenic microorganism, such as bacteria, viruses, parasites, or fungi—that grows and multiplies. Microorganisms are tiny living plants or animals that cannot be seen with the naked eye. Many different types of microorganisms exist in the environment; however, not all are connected to disease. Pathogens are microorganisms that are harmful to the body and cause disease; nonpathogens are harmless microoganisms and carry no risk of causing disease. Bacteria, viruses, fungi, and protozoa can act as both pathogens and nonpathogens.
Microorganisms that are considered nonpathogenic live normally on and in the human body and are known as normal flora or resident flora. A healthy balance of these microorganisms normally exists and provides protection from those microorganisms that are not part of the body’s normal flora.
Normal flora exist in all places that are not sterile, including the mouth, throat, intestines, and vagina. As long as these microorganisms stay in the area of origin, they do not cause disease; they are nonpathogenic. The term normal flora refers to the microorganisms that are present even in the state of normal health. Such microorganisms are always present in the human body, and their number far exceeds the number of body cells. Normal flora perform many useful functions in the body, such as protection from highly pathogenic microorganisms, help in providing vitamins, and help in eliminating toxins. When normal flora are transmitted to an area of the body in which they are not normally found, they are called transient flora; they have become pathogens.
For example, a person may have the bacteria Escherichia coli growing in his or her gut. This bacteria is part of a person’s necessary flora, because such bacteria provides an individual with vitamins that he or she needs to survive. But if E. coli gets into a person’s urinary tract, then the person will end up with an infection. Women tend to get urinary tract infections more frequently than men because of the closeness of the anus to the urethra in the female body.
To grow and thrive, most pathogens require nutrients, moisture, warmth, and a suitable (usually neutral) pH environment. Some parts of the human body tend to provide a more hospitable environment for pathogenic growth than others do. Some pathogens, called aerobic pathogens, require oxygen for growth; those that must have an oxygen-free environment to thrive are called anaerobic pathogens. Eliminating the conditions required for growth is one way of reducing the transmission of the pathogens. For example, aerobic infections such as Mycobacterium tuberculosis require oxygen to multiply. Anaerobic infections usually happen in deep wounds; because of the decrease in capillaries, the level of oxygen is lowered in these wounds, making the environment friendly to the anaerobic pathogen.

Types of Pathogenic Microorganisms

Bacteria
Bacteria are single-celled microorganisms that reproduce via cell division, in which a mother cell divides into two identical daughter cells. Bacteria are able to live and grow outside a living host. Bacteria reproduce by cell division. Many bacteria produce spores to protect themselves under adverse conditions. A spore is a dormant type of bacteria that has formed a thick capsule around itself; it is highly resistant to heat or chemicals.
Except for spirochetes, bacterial infections are diagnosed by culture. A microbiological, or microbial, culture, allows microorganisms to reproduce in a controlled environment—a biological culture medium—in order to allow for the identification of the microbe.

Bacteria are unicellular and each type has its own characteristics. A characteristic of bacteria is that they grow into various shapes. When stained and viewed under the microscope, these shapes are used to identify the organism.
- A coccus is round or spherical in shape. They include staphylococci, streptococci, and diplococci. Cocci can arrange themselves in various ways such as in clusters, chains, or pairs. The prefix of the bacteria’s name tells the arrangement.

Staphylococci arrange in round clusters on skin and on mucous membranes. Staphylococcus epidermidis is usually nonpathogic; however, a cut, abrasion, or other break in the skin can allow invasion of the tissues by the organism, resulting in a mild infection. Species of staphylococci can cause sore throat, scarlet fever, rheumatic fever, and many types of pneumonia.

Diplococci are round bacteria that grow in pairs. Pneumonia, gonorrhea, and meningitis are infectious diseases caused by diplococci.
- A bacillus is rod shaped and causes tuberculosis, tetanus, and otitis externia. Bacilli are usually aerobic, like Bacillus anthracis and Yersinia pestis. Diseases caused by bacilli include botulism, tetanus, gas gangrene, gastroenteritis produced by salmonella food poisoning, typhoid fever, pertussis, bacillary dysentery, diphtheria, tuberculosis, leprosy, and plague. Escherichia coli is a species of bacillus that is found among the normal flora of the large intestine.
- Spirochetes are long, spiral, flexible bacteria. They cause diseases such as syphilis, caused by the bacteria Treponema pallidum; Lyme disease, caused by the bacteria Borrelia burgdorferi; and cholera, caused by Vibrio cholerae.
- Antibiotics are used to fight bacterial infections; they either kill the bacteria or prevent it from reproducing.
- Rickettsia and Chlamydia are genera of bacteria known as parasites, which are organisms that must live inside another living organism in order to survive. Rickettsia spread to humans via a vector, which is a disease carrier that transmits a disease from an infected person to a noninfected person. Common vectors are insects such as ticks, fleas, mites, and lice. Examples of diseases transmitted by rickettsia are typhus and Rocky Mountain spotted fever. Chlamydia cause lymphogranuloma, a sexually transmitted disease.

Viruses
A virus is a pathogen that can grow and reproduce only after infecting a host cell. Viruses are non-living organisms consisting of either DNA or RNA, surrounded by a protein coat. Viruses reproduce by taking over cells and directing the cell to produce copies of the virus in the infected cell. A virus uses the host cells’ RNA and DNA (genetic material) to reproduce. Viruses are difficult to treat because of the protein in their outer cell membrane. Antivirals are used to treat viruses by inhibiting their growth. Viruses require a living host for survival and replication. The most definitive way to determine the presence of a virus is to test the blood for antibodies to the virus. Viruses cause such diseases as the common cold, hepatitis, chicken pox (varicella), measles (rubeola), and AIDS.

Fungus
A fungus is a simple, single-celled organism, such as yeast, or a multicellular colony, such as mold and mushrooms. Fungi can grow outside a living host on organic material. For example, athlete’s foot (tinea pedis) is caused by fungus that grows in warm, moist environments and likes to live in the outer layers of human skin. However, for short periods of time, this fungus can live in warm puddles on tile floor.
Usually fungi do not cause disease, but they can become pathogenic in certain circumstances. When the normal balance in the body’s chemistry changes, through infection, disease, medication, and the like, fungi that normally live in the body may no longer be kept in check and, therefore, may become pathogenic.
Fungi are opportunistic and usually become pathogenic when the host’s normal flora cannot offset the colony’s growth. Examples of the diseases they cause in humans include tinea infections (such as athlete’s foot and ringworm) and yeast infections (such as candidiasis).

Protozoa
Single-celled parasites are called protozoa, another type of pathogenic microorganism. Parasites vary from single-celled organisms to more complex creatures such as worms and insects. They commonly infect persons with low immunity. Protozoan infections are spread through the fecal-oral route, when one ingests contaminated food or water, or these infections are transmitted by mosquitoes or other insects carrying the infection. Examples of common protozoan infections are malaria, giardiasis, and a vaginal infection called trichomoniasis.

Prion
Prions, the smallest pathogens, result in damage to the tissue of the brain. The best-known infections caused by prions are bovine spongiform encephalopathy (BSE, or mad cow disease) in cows and Creutzfeldt-Jakob disease in humans. Diseases caused by prions are fatal.

Hand Washing
Hand washing has been the backbone of infection control for more than a century. Hand washing protects the patient from cross contamination and also protects the medical assistant. Go to http://cdc.gov/handhygiene and read the fact sheet on hand hygiene.

Chain of Infection
For a pathogen to survive and produce disease, a continuous cycle, known as the chain of infection, must be followed. If the cycle is broken at any point, the pathogen dies.
The chain begins with the infectious agent, which invades the reservoir host, and is transmitted through a portal of exit from the host to a new host, through a port of entry. Infection cannot occur if the infectious microorganism is not introduced at the beginning of the cycle.
The first link of the chain of infection is the reservoir host, which is the person infected with the microorganisms. Although this person may not show signs of an infection, his or her body serves as a source of nutrients and an incubator in which the pathogen can grow and reproduce. These persons are also called carriers or reservoirs of the disease.

Reservoir Host
A reservoir host becomes infected with the pathogen and serves as a source of transfer of the pathogen. The host provides nourishment for the pathogenic organism, providing a hospitable environment in which the pathogen can grow. Living infected hosts may be symptomatic (having noticeable signs of the disease) or may be asymptomatic (free of noticeable symptoms). The reservoir host is considered contagious (a carrier of the pathogen) and can spread the disease to others.

Means of Exit
The pathogen may exit the reservoir host through contact with mucous membranes, through a break in the skin, or through the mouth, nose, throat, ears, eyes, intestinal tract, urinary tract, reproductive tract, and open wounds.

Mode of Transmission
A pathogen can be transmitted to another person by direct or indirect contact with an infected person or discharge. Modes of indirect transfer include range of situations, such as coughing and sneezing, contamination of objects touched by infected individuals, and contaminated food. Examples of direct-contact transmission include transmission through skin-to-skin contact (such as hand shaking or kissing) or the exchange of bodily fluids (such as through needle sharing or sexual contact). Pathogens can be transmitted via indirect contact with inanimate objects: when an object is capable of harboring a pathogen, it is called a fomite.

Means of Entry
Pathogens gain entry to the body in much the same way as they exit it, usually through contact with mucous membranes, through a break in the skin, or through the mouth, nose, throat, ears, eyes, intestinal tract, urinary tract, reproductive tract, and open wounds. Therefore, potential entry sites include the eyes, nose, mouth, throat, vagina, and rectum, as well as any wounds to the skin.

Susceptible Host
A susceptible host is capable of being infected by the pathogen. Common examples of susceptible hosts include those with poor hygiene, poor nutrition, unusual levels of stress, and other underlying diseases or disorders. Other factors causing susceptibility include some medications, age (very young and very old), and self-destructive behaviors such as tobacco use, excessive alcohol intake, and use of illicit drugs.
An infection may be localized, which means that it is confined to one site, and can exhibit heat, redness (erythema), swelling (edema), and pain. Or an infection can be systemic, which means that it involves the whole body, and the symptoms can include fever, fatigue, and headache, and so on. The susceptible host can become the reservoir host, and the infection cycle begins again.

Types of Infection
Acute infections, such as the common cold, typically have a quick onset and short duration. A clear prodromal phase, in which symptoms are generally nonspecific (examples of nonspecific symptoms include body aches, rash, and fever) may or may not occur. The duration is usually one to three weeks.
Chronic infections, such as hepatitis C, last for a long time—sometimes for years or even a lifetime. The patient may be asymptomatic, or the patient’s symptoms may fluctuate.
Latent infections are those in which patients experience alternating periods of being symptomatic (relapse) and periods of being symptom-free (remission). The infecting organism, usually a virus, never leaves the body, but lies dormant between relapses. A common example of a latent infection is the herpes viruses, which can cause intermittent outbreaks of oral lesions, genital lesions, and shingles.

Principles of Asepsis
Medical asepsis, a condition free of pathogens, and infection control are crucial in preventing the spread of disease. The medical assistant should practice good medical aseptic techniques to provide a safe and healthy environment in the medical office.
The Occupational Safety and Health Administration, a federal agency responsible for the safety of all workers, issued the blood-borne pathogen standard in 1992. This standard is required by the federal government to reduce the exposure of healthcare employees to infectious diseases. The Centers for Disease Control (CDC) also recommend that standard precautions procedures be used to reduce the chance of transmitting infectious microorganism. More information on Biohazardous Material and Standard Precautions follows.

Medical Asepsis
Medical asepsis, also called clean technique, involves removing pathogens and reducing transfer of microorganisms by cleaning any body part or surface that has been exposed to them.
Hand washing is the first line of defense in the practice of medical asepsis and the single most important means of preventing the spread of infection.
Soap and the friction of rubbing the hands together loosens dirt so that it can be rinsed away with water. Standard precautions state that medical assistants and other medical professionals should clean their hands with soap and warm water or with an antiseptic agent (an agent that kills or inhibits the growth of microorganisms) prior to and immediately after any direct contact with patients and after any potential contact with pathogenic organisms. Medical assistants should avoid wearing jewelry or rings when performing procedures, because microorganisms often remain in crevices of the jewelry even after the hands are washed.
Microorganisms on the hands are classified into the following categories: resident flora and transient flora. Resident flora (also known as normal flora) normally reside and grow in the epidermis and in the deeper layers of the skin known as the dermis; they are generally harmless.
Transient flora live and grow on the superficial skin layers, or epidermis, and are transferred in a range of ways, such as through contact with contaminated equipment or infected patients. They can be pathogenic, but since they live on the surface layer of the skin, they can be killed by washing and scrubbing with an antiseptic.
Antiseptic hand washing cleans and sterilizes the hands through the physical scrubbing action and through the action of the antimicrobial soap contained in the antiseptic.

The medical assistant should wash his or her hands at the following times and under the following conditions:
- before and after every patient
- before and after breaks and lunch
- at the end of the day
- after coughing, sneezing, or blowing his or her nose
- after contact with contaminated material
- after using the restroom
- before and after wearing gloves

The medical assistant should always assume that everyone’s blood and body fluids are contaminated with pathogens. Although gloves help to protect against contamination from these pathogens, wearing them does not replace hand washing, because bacteria can multiply in the moist environments inside gloves.
Medical assistants should always wear gloves whenever they risk exposure, such as when touching or handling biohazardous containers or when drawing blood or assisting in surgical procedures. Wearing gloves protects both the medical assistant and the patient from transmission of pathogens.

Levels of Asepsis
There are three levels involved in asepsis: sanitization, disinfection, and sterilization.

Sanitization
Sanitization is the removal of microorganisms using chemicals, heat, or ionizing radiation. The single most effective standard precaution that breaks the chain of infection and protects everyone is consistent, proper hand hygiene and sanitization.
To sanitize an instrument, the medical assistant will usually rinse it under cold water and scrub it with an enzymatic detergent. In some cases, the medical assistant may use an ultrasonic bath where sound waves cause vibrations to loosen debris from instruments. In addition to equipment, the medical assistant must sanitize the environment of the medical office, including surfaces such as countertops and examination tables. A solution of ten parts water to one part household bleach is inexpensive, easy to use, and effective. Regardless of the product used, the medical assistant should always take time to read the labels, follow the directions, and note the information on material safety data sheets (MSDSs), which provide data about ingredients, information on how to handle or work with specific substances, and measures to take in the event of an exposure or spill.

Disinfection
Disinfection typically involves the application of a substance to equipment, surfaces, or other items to kill pathogenic microorganisms. In order to effectively disinfect an object, the medical assistant must sanitize it before the disinfection process.
Chemical disinfecting agents appropriate for instruments, surfaces, furniture, and equipment include chlorine, iodine, 70 percent isopropyl alcohol, hydrogen peroxide, or a one-to-ten solution of household bleach and water.

Sterilization
Sterilization eliminates all microorganisms from a surface or instrument through exposure to chemicals, ionizing radiation, dry heat, gas, or steam. Prior to sterilization, instruments must have been sanitized and disinfected. Some pathogens are easily destroyed; others, such as spores, are very resistant to temperature extremes and are difficult to destroy. The sterilization process, as a final stage, helps to eliminate these types of pathogens. The autoclave is used to sterilize surgical instruments and supplies. An autoclave subjects items to high-pressure steam at 121° C typically for 15 to 20 minutes, depending on the size of the load and the contents.

Surgical Asepsis
Surgical asepsis is the practice of destroying all pathogenic organisms before they enter the body. More specifically, the surgical aseptic technique is a method of performing invasive procedures so that patients are protected from pathogenic microorganisms. Examples of some procedures that require surgical asepsis include injections, urinary catheterization, wound care, tissue biopsy, and repair and suturing of lacerations.

Surgical Scrub
Surgical scrub is a style of hand washing that is much more thorough than regular hand washing and follows specific steps. Although the human skin can never be fully sterilized, the surgical scrub is designed to reduce the number of pathogenic microorganisms on the hands and forearms to the greatest extent possible.
A surgical scrub requires surgical soap, a nail file, and a sterile brush. In a surgical scrub, your hands are kept upright to avoid having the water run from the unscrubbed area of your arm onto your hands. The scrubbing process should take five minutes for each hand, covering all four sides of the fingers. Arms and forearms should be rinsed, starting with your fingertips, wrists, then forearms, always holding the fingers upward, without touching the faucet. The faucet should be turned off with the foot, knee, or elbow and hands should be dried with a sterile towel.

Gowning and Gloving
Gowns and gloves are worn to protect the skin and prevent contamination of clothing during activities that may generate splashes or sprays of blood and other bodily fluids. Sterile gowns are worn when assisting in surgical procedures, and nonsterile gowns are worn for routine procedures.
Sterile gloves are used when assisting in surgical procedures, removing sutures or staples, or changing dressings, to prevent infectious material from entering the body.

Maintaining a Sterile Field
The instruments and supplies for surgery must be set on a sterile field. The medical assistant may set up the sterile tray either before or after preparing the patient’s skin. The sterile tray setup must not become contaminated. If the medical assistant must turn away from the sterile tray or leave the room after setting up, a sterile towel must be placed over the tray to maintain sterility.
A common method for setting up a sterile tray is to use prepackaged sterile setups wrapped in disposable sterilization paper or muslin that are prepared by the medical office through autoclave sterilization. These packs are labeled according to use and contain most of the instruments and supplies required for the minor office surgery indicated on the label. The medical assistant opens the wrapped package on a flat surface, such as a Mayo stand, a broad, flat metal tray placed on a stand and used to hold sterile and nonsterile instruments and supplies. Several additional articles not contained in the prepackaged setup (such as an antiseptic, sterile gauze, disposable syringe and needle, or sutures) may need to be added to the sterile field when the package is opened.
To maintain sterility, the medical assistant should use only sterile objects to touch other sterile objects. The medical assistant should keep sterile objects in his or her field of vision. If the medical assistant cannot see an object, he or she must assume it is no longer sterile. Only the area above the waist is sterile. If a medical assistant lowers his or her hands or a sterile instrument below the waist, they are no longer sterile. The outside inch of the sterile field on all sides is considered nonsterile. The medical assistant should avoid passing nonsterile objects over the sterile field. He or she should also avoid coughing or sneezing over the sterile field. When one is wearing a sterile gown, the sterile field comprises the area above the waist, the front of gown, the gloves, and the sterile Mayo stand except the outer inch and any part that hangs below the table. The lower limit of a sterile surgical field is the waist.
If an antiseptic solution is poured into a basin on the sterile field, the medical assistant should read the label, check the expiration date, recheck the label, place the palm of his or her hand over the label, and place the cap on a flat surface with the open end up. Rinse the lip of the bottle by pouring a small amount of solution into a separate container. Pour the solution into a sterile container at a height of approximately six inches. The cap should be replaced and the label checked a third time.

Autoclave Sterilization
An autoclave, a sterilization device commonly used in a clinical setting, sterilizes items using steam under pressure. For sterilization to occur the temperature must reach 250°F to 270°F (120°C to 130°C) with 15 pounds of pressure for a specific amount of time, usually 15 to 20 minutes depending on the contents being sterilized. Subjecting items to steam under pressure causes the proteins in microorganisms to coagulate and the bacterial spores to be destroyed. When the chamber cools, the condensation of the steam causes the explosion of the microorganism cells, ensuring their complete destruction.

Operation of the Autoclave
Quality control methods must be maintained when operating an autoclave to ensure that proper sterilization has been achieved. Various indicators are used to check that sterilization has occurred. The two most common are color changes and culture tests.

Color change: Sterilization tape is all one color before sterilization. During sterilization, brown stripes appear. Sterilization pouches have arrows that turn from pink to brown during steam sterilization and from blue to yellow during gas sterilization.
Culture tests: Various types of culture tests for bacterial spores are also placed inside packs for quality control purposes. These strips or ampules contain bacterial spores. They are autoclaved with the equipment to be sterilized and then placed in an incubator or sent to a lab to see if any spores have survived.

Preparing Items for Autoclave
To prepare instruments for the autoclave, the medical assistant must open all hinged instruments. The medical assistant must pack items so that they do not touch each other and so that all parts of the instrument are exposed to the steam and pressure. Instruments can be placed in muslin cloth or in polypropylene autoclave bags. The medical assistant must wrap sharp instruments with gauze on the tips to prevent puncturing the bag. The medical assistant should also label packs using permanent marker with the contents, the date, and his or her initials.
Wrapping the equipment keeps it sterile after sterilization. The wrap is sterilized along with the item. After sterilization, the inside of the package remains sterile, while the outside can be touched.

Chemical Sterilization
Chemical sterilization is used when the instrument or equipment cannot withstand the high temperature of the autoclave. The medical assistant should carefully follow the instructions for mixing the solution, immersion time, rinsing, and storage of sterilized equipment. Chemical sterilization liquids like glutaraldehyde and formaldehyde are mixed according to the instructions on the bottle. The solution must be marked with the date of preparation and the expiration date. Materials must be submerged in this solution with a closed lid for eight hours or more. Items should be removed with sterile forceps and must be rinsed with sterile water to remove all traces of the chemical before the items are used on a patient.

The Medical Assistant’s Role in Aseptic Surgery
Medical asepsis—critical in any medical setting—is a clean technique that aims to reduce the number and prevent the spread of microorganisms. Surgical asepsis goes several steps further: it is a sterile technique that aims to ensure that all microorganisms are eliminated from an environment in which an invasive procedure will be performed.
Assisting with minor office surgery requires a thorough knowledge of the instruments and supplies for each tray setup and the type of assistance required by the physician during the surgery. Of particular concern for the medical assistant is maintaining asepsis in the surgical environment.

Standard Precautions
The term standard precautions relates to a system—a set of principles and practices—used in all medical facilities to prevent the transmission of infectious materials and reduce the occurrence of nosocomial infections—that is, infections that develop in hospitals or healthcare settings. The system protects medical staff members who might be exposed to infectious agents when handling or coming into contact with blood, secretions, excretions, and other bodily fluid and tissues.

Standard precautions include various protective measures, such as:
- Hand hygiene: Following any patient contact, the medical assistant should wash his or her hands. Hand hygiene is often considered the most important means of defense against transmission of nosocomial infections.
- Gloves: Clean, nonsterile gloves should be worn when coming into contact with blood, body fluids, secretions, or excretions. The medical assistant should put gloves on just before coming into contact with potentially contaminated fluids, remove and discard gloves immediately after use, in order not to contaminate other items or surfaces, and then wash his or her hands.
- Gowns: Gowns should be worn during any activity that may result in splashing or spraying blood, bodily fluids, secretions, or excretions. The fabric should be resistant to fluids and nonsterile.
- Mask, face shield, and eye protection: These components protect the eyes, nose, mouth, and mucous membranes from spraying or splashing blood, body fluids, secretions, and excretions. They also protect from pathogens that are airborne.
- Cleaning and disinfection: All non-disposable equipment, including examination table, countertops, and chairs, should be cleaned or disinfected before treating another patient. Routine cleaning should be done after each patient has left the exam room. If a surface in the exam room appears to have been contaminated—for instance, through exposure to blood or other bodily fluids—it should be disinfected immediately, with a tuberculocidal disinfectant or diluted bleach solution.
- Personal protective equipment (PPE): Specialized garments, such as gowns and masks, that are critical in protecting against the transmission of infectious agents.
- Puncture-resistant sharps containers: These containers should be readily available in areas where wastes such as needles, syringes, or broken glass may be generated. Sharps are objects that have acute rigid corners, edges, or projections capable of cutting or piercing and can be reasonably anticipated to penetrate the skin or any other part of the body. Placing sharps in puncture-resistant containers prevents injury and the potential spread of pathogens.

Disposing of Infectious Waste
The Environmental Protection Agency (EPA) and OSHA have created federal policies and guidelines for proper disposal of hazardous materials. Each state determines its own policy based on the federal guidelines. The policies can vary from state to state, but general guidelines include:
- Red leakproof bags are used for contaminated supplies such as gloves, gauze, bandages, gowns, and linens.
- OSHA’s blood-borne pathogens standard requires that containers and appliances containing biohazardous materials be labeled with a biohazard warning label.
- The biohazard warning label must be fluorescent orange or orange-red and contain the biohazard symbol and the word BIOHAZARD in a contrasting color.

OSHA requires that the medical office have policies and procedures in place for preventing employee exposure to biohazardous materials. OSHA requires that all personnel who will be exposed to blood or other possible infectious material must have training in the blood-borne pathogens standard. According to OSHA, the medical office must provide hepatitis B immunization at no charge and provide healthcare workers with access to personal protective equipment, including face shields and gloves. In addition, OSHA requires medical offices to have an exposure control plan if the office has ten or more employees. This exposure control plan dictates what should happen if an employee or visitor is exposed to a biohazardous material.
Most medical offices enter into contracts with infectious waste disposal services. This service supplies the office with biowaste containers and regularly picks up the filled containers. The service disposes of the waste according to EPA and OSHA standards. The service also maintains a tracking mechanism recording the type of waste, weight, and disposal destination on a three-part manifest. The generator of the biomedical waste keeps one part of the form; the service keeps the other two parts. Once the waste has been destroyed, the service returns one part of the form to the generator as proof of disposal. The medical office maintains these records for three years.