ENGINEERING AND WORK PRACTICE CONTROLS
ELEMENT III
Use of engineering and work practice controls to reduce the opportunity for patient and healthcare worker exposure to potentially infectious material in all healthcare settings
In addition to the precautions described above, other practices and controls can be employed to prevent and control infection. These include:
- Engineering controls
- Work practice controls
- Environmental controls
Types of Practices and Controls
Engineering controls are measures that protect workers by removing hazardous conditions or by placing a barrier between the worker and the hazard. Examples include:
- Sharps disposal containers
- Self-sheathing needles
- Sharps with engineered sharps injury protections
- Needleless systems
According to the Occupational Safety and Health Administration (OSHA, 2012), engineering controls shall be examined and maintained or replaced on a regular schedule to ensure their effectiveness.
ENGINEERING CONTROL DEVICE EXAMPLES

Syringe with retractable needle.

Self-resheathing needle.

Resheathing disposable scalpel.

Phlebotomy needle with hinged shield as an add-on safety feature.
(OSHA, 2020)
Work practice controls reduce the likelihood of exposure to pathogens by changing the way a task is performed, such as:
- Practices for handling and disposing of contaminated sharps
- Handling specimens
- Handling laundry
- Cleaning contaminated surfaces and items
- Performing hand hygiene
(OSHA, 2012)
Environmental controls help prevent the transmission of infection by reducing the concentration of pathogens in the environment. Such measures include but are not limited to:
- Appropriate ventilation
- Environmental cleaning (housekeeping)
- Cleaning and disinfecting strategies (including food service areas)
- Cleaning, disinfection, and sterilization of patient care equipment
- Proper linen and laundry management
- Disposal of regulated medical waste
(CDC, 2019e)
Sharps- and Injection-Related Practices and Controls
Engineering, work practice, and environmental controls have all been developed to prevent and control the spread of infection related to the use of needles and other sharps in the healthcare setting.
SHARPS HANDLING
OSHA requirements for handling sharps state that contaminated sharps are needles, blades (such as scalpels), scissors, and other medical instruments and objects that can puncture the skin. Contaminated sharps must be properly disposed of immediately or as soon as possible in containers that are closable, puncture-resistant, leak-proof on the sides and bottom, and color-coded or labeled with a biohazard symbol.
- Discard needle/syringe units without attempting to recap the needle whenever possible.
- If a needle must be recapped, never use both hands. Use the single-hand “scoop” method by placing the cap on a horizontal surface, gently sliding the needle into the cap with the same hand, tipping the needle up to allow the cap to slide down over the needle, and securing the cap over the needle with the same hand.
- Never break or shear needles.
- To move or pick up needles, use a mechanical device or tool, such as forceps, pliers, or broom and dustpan.
- Use blunt-tip suture needles to decrease risk of percutaneous injury.
- Dispose of needles in labeled sharps containers only. Sharps containers must be accessible and maintained upright.
- When transporting sharps containers, close the containers immediately before removal or replacement to prevent spillage or protrusion of contents during handling or transport.
- Fill a sharps container up to the fill line or two thirds full. Do not overfill the container.
(OSHA, 2012)
SAFE INJECTION PRACTICES
Unsafe injection practices put patients and healthcare providers at risk for infection. Safe injection practices are part of Standard Precautions and are aimed at maintaining a basic level of patient safety and provider protections. A good rule to remember regarding safe injections is “One Needle, One Syringe, One Time.”
Healthcare providers are required to follow CDC-recommended practices for injection and/or IV therapy:
- Draw up medications in a designated clean medication preparation area that is not adjacent to potential sources of contamination, including sinks or other water sources. Clean and disinfect the medication preparation area on a regular basis and any time there is evidence of soiling.
- Perform proper hand hygiene prior to handling medications.
- Access parenteral medications in an aseptic manner, using a new sterile syringe and sterile needle.
- Prepare an injection as close as possible to the time of administration to prevent compromised sterility.
- Disinfect the rubber septum with alcohol and allow to dry.
- Do not leave a needle inserted into a medication vial septum for multiple use.
- Always enter a medication vial with a sterile needle and sterile syringe, even when obtaining additional doses of medication for the same patient, and discard after use.
- Use a syringe and needle only once to administer a medication to a single patient. Do not use the same syringe to give an injection to more than one patient.
- Do not use a syringe for patient after using it to inject medications into an IV tubing port of another patient, even if that tubing port is several feet away from the IV catheter site.
- Vials labeled as single-dose or single-use should be used for only a single patient as part of a single case, procedure, or injection.
- If a single-dose or single-use vial appears to contain multiple doses or more medication than needed for a single patient, do not use for another patient or store for future use for the same patient.
- If a single-dose or single-use vial will be entered more than once for a single patient as part of a single procedure, use a new needle and new syringe each time. Discard the vial at the end of the procedure; do not store for future use.
- Do not combine (pool) leftover contents of single-dose or single-use vials or store single-dose or single-use vials for later use.
- Multi-dose vials should be dedicated to a single patient whenever possible. If used for more than one patient, keep and access in a dedicated clean medication preparation area.
- If a multi-dose vial enters an immediate patient treatment area (operating room, procedure room, anesthesia and procedure carts, and patient rooms or bays) it should be dedicated for single-patient use only.
- Discard medications according to the manufacturer’s expiration date (even if not opened) and whenever sterility is compromised or questionable.
- If a multi-dose vial has been opened or accessed, the vial should be dated and discarded within 28 days unless manufacturer specifies a different length of time or date.
- Single-dose vials that have been opened or accessed should be discarded according to the manufacturer’s time specifications or at the end of the case/procedure for which it is being used. Do not store for future use.
(CDC, 2019f)
Safe injection practices are also described by OSHA. They include:
- Contaminated needles and other contaminated sharps shall not be bent, recapped, or removed except as noted below. Shearing or breaking of contaminated needles is prohibited.
- If an employer can demonstrate that no alternative is feasible or that such an action is required by a specific medical or dental procedure, bending, recapping, or needle removal must be accomplished through the use of a mechanical device or one-handed “scoop” technique (see above).
- Immediately or as soon as possible after use, contaminated reusable sharps shall be placed in appropriate containers until properly reprocessed. Reusable sharps that are contaminated with blood or OPIM shall not be stored or processed in a manner that requires employees to reach by hand into the container.
(OSHA, 2012)