MDWF 2010 3.6 Guidelines for Universal Precautions & OSHA Compliance Revised August 10th, 2019
Infection control procedures in an out-of-hospital (OOH) midwifery practice:
1. Handwashing a. Indications: prior to the application of gloves, after using gloves, prior to performing any sterile technique, before and after contact with the skin of a client or baby, or any body fluids, after using the restroom, after contact with soiled or potentially contaminated equipment, when hands are visibly soiled, and prior to handling food. 2. Handling & Disposal of Sharps a. Contaminated sharps are to be disposed of in an appropriately labeled/color coded, puncture- resistant & leakproof (on sides & bottom) container; all sharps needles and any disposable equipment are to be placed in the appropriate waste container after use; containers must be kept in the immediate area and away from the reach of children (United States Department of Labor, 1910.1030 - Bloodborne pathogens, 2012). 3. Use of Personal Protective Equipment (PPE) a. Barrier precautions are used to help prevent the exposure of skin or mucous membranes to any bodily fluids such as blood, amniotic fluid, breast milk, vaginal secretions, or seminal fluid. b. PPE includes: gloves (client contact, blood and culture collection, vaginal exams, delivery of the newborn, handling soiled linens or consumables), waterproof aprons or gowns, masks, protective eyewear, mouthpiece; used for resuscitation (Davis, 2012). 4. Disposal of Single-Use Items a. Single-use disposable gloves must be replaced as soon as practical when contaminated, and as soon as possible when torn or punctured; disposable gloves must never be washed or decontaminated for re-use. 5. Disinfection of Environmental Surface and Reusable Equipment a. Clean doppler, stethoscopes, blood pressure cuffs, etc. with germicidal soap or wipes after contamination or client contact (after appointment/birth); wash and disinfect all reusable instruments and store in an appropriate container until they are able to be sterilized (United States Department of Labor, 1910.1030 - Bloodborne pathogens, 2012, p. 10). 6. Handling of Soiled Linens a. Take care when handling soiled linens such as clothing, towels, chux pads, bedding, etc (United States Department of Labor, 1910.1030 - Bloodborne pathogens, 2012, p. 12). b. Use a large container that is lined with a plastic trash bag during the birth; keep this easily accessible (United States Department of Labor, 1910.1030 - Bloodborne pathogens, 2012, p. 12). c. Place contaminated laundry that is likely to leak into bags or containers to be transported until washing (United States Department of Labor, 1910.1030 - Bloodborne pathogens, 2012, p. 12). d. The employer is responsible for ensuring that employees who have contact with contaminated laundry are provided with appropriate PPE (United States Department of Labor, 1910.1030 - Bloodborne pathogens, 2012, p. 12). Taylor Rackey MDWF 2010 3.6 Guidelines for Universal Precautions & OSHA Compliance Revised August 10th, 2019
7. Labor in Water and Waterbirth
a. Waterbirth tubs should always be used with a brand-new single use disposable liner; waterbirth tubs should be cleaned with a germicidal soap before and after each use; to maintain standard precautions, shoulder length gloves should be used during waterbirth (Delaney, 2019). 8. Handling and Disposal of the Placenta a. Always wear gloves when handling the placenta; the placenta should be double-bagged, with client identification labels on both bags; if the placenta will be left with the client for disposal, they are responsible for disposing the placenta in accordance with local regulations; if the client intends to encapsulate or ingest the placenta, it should be stored in the refrigerator or freezer as soon as possible after birth, no more than 4 hours postpartum. 9. Specific Infection Prevention and Control Strategies in an OOH Birth Setting a. Planned birth space should be cleaned and disinfected; midwives and students should practice good personal hygiene; midwives, students, client and family/friends should all cover their mouths when coughing or sneezing; always wash hands upon the entry of a home, before and after glove use, before a procedure, when soiled, and as needed; if clothes come in contact with blood or bodily fluids, they should be removed as soon as practice; a change of clothes should always be readily available; contaminated instruments are to be washed and disinfected before being appropriately stored in a container until they are able to be sterilized. 10. Indications for the Use of Clean Technique a. General physical exam, palpation, vaginal exam, blood draw, IV insertion, culture collection, delivery of newborn, handling of newborn prior to bathing, handling linens, consumables, clothing, etc. that are soiled with bodily fluids, clamping of the umbilical cord. 11. Compliance with Work Safety Regulations Established by OSHA a. Report any employee deaths to OSHA within 8 hours (United States Department of Labor. Reporting fatalities, hospitalizations, amputations, and losses of an eye as a result of work- related incidents to OSHA, 2014, p. 1). b. Always report employee in-patient hospitalizations to OSHA within 24 hours (United States Department of Labor. Reporting fatalities, hospitalizations, amputations, and losses of an eye as a result of work-related incidents to OSHA, 2014, p. 1). c. The report of a fatality, inpatient hospitalization, amputation, or loss of an eye must occur using one of the following methods: i. By telephone or in person to the OSHA Area Office that is nearest to the site of the incident; by telephone to the OSHA toll-free central telephone number, 1-800-321- OSHA (1-800-321-6742); by electronic submission using the reporting application located on OSHA's public Web site at www.osha.gov. (United States Department of Labor. Reporting fatalities, hospitalizations, amputations, and losses of an eye as a result of work-related incidents to OSHA, 2014, p. 1) d. Maintain a log of any needlestick accidents or other accidental exposures Taylor Rackey MDWF 2010 3.6 Guidelines for Universal Precautions & OSHA Compliance Revised August 10th, 2019
References:
Birthwise Midwifery School (2018-2019). Midwifery Skills Guide. Bridgton, ME
Delaney, S. (June 18, 2019). Prenatal Care 1: Universal Precautions in Midwifery Care. [Webinar] Midwives College of Utah. Retrieved from https://recordings.rna1.blindsidenetworks.com/midwifery/cda8e89b56539168d4657c82e4005 5075e833347-1560869897740/capture/ King, T., Brucker, M., Kriebs, J., Fahey, J., Gregor, C., & Varney, H. (2015). Varney's Midwifery(5th ed.). Burlington, MA: Jones & Bartlett Learning. United States Department of Labor, Occupational Safety & Health Administration (2012). Bloodborne Pathogens. Retrieved from: https://www.osha.gov/laws- regs/regulations/standardnumber/1910/1910.1030 United States Department of Labor, Occupational Safety & Health Administration (2014). Reporting fatalities, hospitalizations, amputations, and losses of an eye as a result of work-related incidents to OSHA. Retrieved from: https://www.osha.gov/laws- regs/regulations/standardnumber/1904/1904.39
Patient understood the effects of consuming sweets and soda to her blood sugar level. She will avoid soda and limit sweets intake to manage her blood glucose