Giselle Rackley Midwifery

December 8, 2020

Guidelines for Universal Precautions & OSHA Standards in Community Midwifery Practice

1. Definition or Key Clinical Information:

1. Universal Precautions- approach to infec on control where all human blood and certain human body fluids are
treated as if known to be infec ous for human immunodeficiency virus (HIV), hepa s B virus (HBV), and other
bloodborne pathogens (BBP).
2. Occupational Exposure- an cipated skin, eye, mucous membrane, or parenteral contact with blood or other
poten ally infec ous materials that may result from the performance of an employee's du es.
3. Blood- human blood, human blood components, and/or products made from human blood.
4. Bloodborne Pathogens- pathogenic microorganisms that are present in human blood and can cause disease in
humans. These pathogens include, but are not limited to, HBV, HCV, and HIV.
5. Contaminated- the presence or the reasonable suspicion of the presence of blood or other poten ally infec ous
materials on an item or surface.
6. Contaminated Laundry- laundry which has been soiled with blood, bodily fluids, or other poten ally infec ous
materials and/or may contain sharps.
7. Decontamination- the use of physical or chemical means to remove, inac vate, or destroy BBP on a surface or item
to the point where they are no longer capable of transmi ng infec ous par cles and the surface or item is
rendered safe for handling, use, or disposal.
8. Exposure Incident- a specific eye, mouth, mucous membrane, non-intact skin, or parenteral contact with blood or
other poten ally infec ous materials that results from the performance of an employee's du es.
9. Handwashing Facilities- a facility that provides an adequate supply of clean water, soap, and single-use towels for
hand sanita on.
10. Sterilize- the use of a physical or chemical procedure to make items or equipment free from bacteria or other living
microorganisms
11. Personal Protective Equipment (PPE)- specialized clothing or equipment worn by an employee for protec on
against a hazard. General work clothes are not intended to func on as protec on against a hazard and are not
considered to be personal protec ve equipment.
2. Guidelines for Clinical Practice
i. Hand Hygiene
1. Indica ons - washing/sani zing hands before and a er: ea ng, client contact, blood draws, invasive
procedures, using toilets/bathrooms, and handling soiled items.
2. Hand sani zer is appropriate for most general contact except prior to or a er invasive procedures.
3. Hands must be washed when there is visible soiling of hands.
4. Nails should be kept short, clean, and without nail polish, decals, or lacquer.
5. Gloves should be worn when caring for clients if there are any open cuts or sores on the staff member’s
hands.

ii. Personal Protective Equipment (PPE)

1. Wear gloves any me the poten al of exposure to bodily fluids is possible or if hands will become soiled.
Dispose of gloves following use and wash hands.
2. Face masks should be worn any me there is a reasonable concern for the spread of respiratory infec ons
(eg. client with a cough, cold, or flu).
3. Protec ve clothing (eg. gowns or aprons) should be considered for use during births or have a change of
clothes available a er any me they become visibly soiled or wet with bodily fluids.
4. Wear protec ve eye wear during the pushing and delivery phase or any other me the possibility of splash
from amnio c or other bodily fluids are high.
5. Wear closed toed, washable shoes any me that sharps may be used.
6. Use barrier devices during resuscita on. Resuscita on devices are single use ONLY.
iii. Sharps Guidelines (Injection Safety)
1. Use safety needles when feasible.
2. Have a sharps container nearby and use it for disposal of sharps immediately a er use.
3. Do not recap used needles. Dispose of them immediately in the sharps container.
4. Use one handed recapping ONLY for UNUSED needles.
5. Perform injec ons a er proper cleaning of the skin and with asep c technique.
6. Train all staff on the protocol for needle s cks; review this protocol annually.
7. Replace sharps container before it reaches the fill line; consult with state regula ons for biohazard/sharps
disposal.

iv. Environmental Cleaning

1. Clean and disinfect any area or item immediately if soiled or visibly dirty.
2. Use appropriate cleaners for surfaces that may have come into contact with clients or with soiled
equipment or linens.
3. Items that come into contact with clients’ skin should be disinfected following use with a household
disinfectant wipe.
4. Disinfect and sterilize reusable items that are used during invasive procedures (eg. metal birth and
suturing instruments) a er each use.
5. Birth tubs must be disinfected in between uses with an EPA-registered disinfectant.
6. Replace linens or exam paper from beds or exam tables between clients.
7. Birth center laundry will be cleaned daily with stain treatment, presoak, and wash.
8. Perform daily disinfec ng of high touch areas/items in clinic spaces (eg. light switches, remote controls,
pens, etc.) at the end of day

v. Considerations for Home-Based Care

1. Perform hand washing or use sani zer upon entering the home and prior to leaving the home.
2. Use indoor-use only closed-toed shoes in client homes. Use slip-free socks if the client requires a shoe-free
home and bring extra to change into when soiled or wet.
3. Use plas c bins or plas cized bags for transpor ng equipment for easy cleaning if soiled or wet.
4. Disinfect all equipment that was used prior to leaving the home.
5. Bring a change of clothing to change into prior to returning home or the clinic.

vi. Guidelines for Use of Water During Labor & Birth

1. Use elbow-length gloves or forearm length surgical gloves when reaching into birth tubs. Wash hands a er
glove disposal.
2. Use a new tub liner and water hose for each water birth.
3. Allow water to run for 3 minutes minimum to remove any sediments or stagnant water prior to connec ng
the hose to fill the birth pool or tub.
4. Drain and refill the pool or tub a er 6 hours from it’s ini al filling if s ll in use.
5. Disinfect the tub a er each use, even if liner is used and intact. Dispose of the used liner.
6. Jacuzzi jets are not recommended in birth tubs, unless they can be removed and sterilized. If the client
wants to use their home bathtub, proper disinfec on by the clients is required or to use a tub liner.
7. Clean and disinfect all reusable items used in the birth pool or tub. Properly dispose of all single use items
a er use in the tub or pool.

vii. Respiratory Hygiene Guidelines

1. Vacuum carpets daily to minimize allergens and infec ous par cles.
2. Maintain a high-quality air filtering system in the clinic. Change filters monthly.
3. Staff members and clients must stay home when sick. Medical release to return to work or care is needed
for a severe illness or highly contagious disease.
 4. Provide client educa on on cough/sneeze e que e. Wash or sani ze hands a er coughing or sneezing.
5. Dispose used ssues in the assigned receptacles. Wash or sani ze hands a er use.

viii. COVID-19 precautions- until state/local ordinances expire

1. Daily temperature checks and hand washing/sani zing for all staff and clients when entering the birth
center is required.
2. Educate clients on symptoms of COVID-19 and when to reschedule in person appointments a er an
appropriate quaran ne period. Virtual visits are an op on during quaran ne periods.
3. Use face masks in all client care situa ons by clients (excluding laboring clients), support personnel, and all
care providers present.
4. Use of a face shield or eye protec on is encouraged in labor and delivery to prevent bodily fluids splashes
to mucosal membranes or eyes.
5. Follow state/local guidelines for the COVID-19 precau ons and protocols.

ix. Handling and Disposal of the Placenta

1. Always wear gloves when handling the placenta.
2. Use a hard plas c, glass, or metal basin to catch the placenta.
3. Package the placenta in a double lined bag or a sealed container. Refrigerate or freeze prior to disposal,
prepara on, or transport.
4. Follow state/local guidelines for the management of biohazardous waste.

3. OSHA Standards
1. Follow all Universal Precau ons when taking care of all clients.
2. If floors become wet or slippery, cleaning and drying should be done as soon as possible.
3. Get assistance when li ing or moving clients (i.e. addi onal staff or li devices) or heavy equipment (i.e. dollies or
wheeled carts).
4. Train all staff on the OSHA standards and protocols; review this training annually.
5. Any OSHA deficits or concerns (i.e. unsafe prac ces, hazardous environmental factors) should be reported to the
head midwife immediately or the same business day.

4.References
1. Arizona Department of Health Services. (2016, Nov). Guidelines for water immersion for labor and birth. Retrieved
from
https://www.azdhs.gov/documents/licensing/special/midwives/training/guidelines-for-water-immersion-water-birt
h.pdf
2. Delaney, S. (2020, Oct 20). Universal precautions in community midwifery practice. [Webinar]. MDWF 2010,
Midwives College of Utah.
3. Midwives' Association of Washington State. (2020, Mar 31). Interim guidelines for community-based midwives
during the COVID-19 pandemic. Retrieved from
https://www.washingtonmidwives.org/uploads/1/1/3/8/113879963/maws_and_wamcrc_interim_guidelines_for_c
ommunity-based_midwives_during_covid-19_pandemic_3.31.2020.pdf
4. United States Department of Labor, Occupational Safety & Health Administration (2012). Standard 1910.1030:
Bloodborne pathogens. https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030
5. King, T. L., Brucker, M. C., Jevitt, C., & Osborne, K. (2019). Appendix 4A Standard Precautions. In Varney's Midwifery
(6th ed., pp. 108-109). Burlington, MA: Jones & Bartlett Learning.