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Other Hazards

Other Hazards



This topic is part of a document published by the U.S. National Institute for Occupational Safety and Health (NIOSH), which is in the public domain and may be freely copied or reprinted.[1]

Other safety and health hazards to home healthcare workers include infectious diseases; animals; temperature extremes; poor hygiene in the patient’s home; lack of running water, heat, or electricity; fall hazards; severe weather; chemical spills or acts of terrorism; and transportation hazards from daily automobile use.


What can I do to prevent and control the occurrence of or exposure to these hazards?

Infectious Diseases

Home healthcare workers may be exposed to infectious diseases during home visits and may even be a source of infection to the patient if the worker has an infectious disease or uses dirty equipment. Although the bloodborne pathogens standard (as discussed in Chapter 4) includes protection from blood and other potentially infectious materials, an additional infection-control-and-prevention program needs to be in place to protect home healthcare workers and their patients.

Recommendations for employers
  • Implement an infection-control-and-prevention program[2]:
    • Appoint an infection-control nurse or manager to oversee the program
    • Provide infection-control training for healthcare staff upon hire and annually thereafter.
    • Include training on standard precautions (formerly known as universal precautions), an infection control principle that treats all blood and other potentially infectious materials as infectious.
    • Provide information about hand hygiene and cough etiquette.
    • Give training and means for healthcare staff to disinfect or sterilize their medical equipment.
  • Provide all necessary personal protective equipment (for example, gloves, eye protection, masks, and respiratory protection).
  • If a patient has a known case of a disease that can be spread through the air (such as TB), implement appropriate infection-control and respiratory-protection plans for the patient and worker including the following[3][4]:
    • Train the worker on ways to increase ventilation in the immediate area (for example, open windows in the patient’s room).
    • Inform staff about the use of proper respiratory protection (following the OSHA 29 CFR[5]* 1910.134 Respiratory Protection Standard).
  • In the event of a pandemic, such as pan-flu, reinforce your infection-control plan and enact a pandemic influenza plan. See www.flu.gov for a Home Healthcare Services Pandemic Influenza Planning Checklist.
  • Consult the Centers for Disease Control and Prevention (CDC), OSHA, and the state and local health departments to prepare the pandemic influenza plan.
Recommendations for workers
  • Follow your employer’s infection-control plan.
  • Use appropriate personal protective equipment, including medical exam gloves and respiratory protection, when necessary.
  • Train patients, family members and home visitors on proper cough etiquette, hand hygiene, and social distancing.


In focus groups, several workers were concerned about being bitten or otherwise injured by unrestrained animals.[6][7] reported a home healthcare worker found a snake wrapped around an I.V. pole.

Recommendation for employers
  • Make restraint of animals a condition of giving home healthcare.
Recommendations for workers
  • Wait outside until the pet is restrained.
  • If you see fleas or other pests, discuss appropriate control measures with the patient and contact your supervisor.
  • If the patient isn’t receptive to pest control measures, ask your employer to contact social services to help the patient and make it possible to work there.

Home temperature

  • The home healthcare worker may discover temperature extremes in the homes.
Recommendation for employers
  • Train employees about acceptable temperature ranges and what they should do if the home they visit is extremely cold or warm.
Recommendations for workers
  • If you’re concerned about the home being too cold and you cannot change the thermostat, ask your employer to contact social service agencies to help the patient. Local resources may be available to help pay heating bills.
  • If a home is uncomfortably warm, open the windows, use fans, and if necessary, apply cool compresses. Drink plenty of water. If you believe the patient is at risk from the heat, ask your employer to contact social service agencies to help the patient.


Hygiene may be a concern of home healthcare workers. Unsanitary homes may harbor pests including rodents, lice, scabies, or termites.

Recommendation for employers
Train employees about proper home hygiene and what they should do if the home they visit is unsanitary.

Recommendations for workers

  • If a home is unsanitary, consider using clean pads with plastic on one side to set down under equipment and supplies.[7]
  • Take in only the necessary equipment and supplies so potential pests infest fewer things.
  • Avoid setting things such as purses and bags on a carpeted floor.
  • Use non-latex disposable gloves and hand sanitizer.

Lack of Water

Home healthcare workers may encounter a home with no running water or water that is of poor quality. Homes may use bottled water for drinking and have access to cisterns for flushing and bathing.

Recommendation for employers
  • Train employees about potable and nonpotable water and how to ask the patient about available drinking water in their home.
Recommendations for workers
  • If conditions present a health hazard, ask your employer to contact social service agencies to help the patient.
  • Consider bringing several gallons of water if it is needed for patient care.
  • Use hand sanitizer and do not use the toilet in a patient’s home with minimal water.[7]


Home healthcare workers do not have control over the walkways and may encounter icy pavement, wet floors, or wet carpeting. Loose area rugs and other floor coverings can also be hazardous for workers and for patients. The rate of lost-work days from injuries caused by floors, walkways, or ground surfaces for home healthcare workers in 2007 was 39.9, per 10,000 workers[8].

Recommendation for employers
  • Train workers about fall protection and steps they can take to identify and reduce fall hazards for both themselves and the patient.
Recommendations for workers
  • Wear sturdy, flat shoes with good slip protection.
  • Walk slowly on icy or wet surfaces.
  • Examine the patient’s walking path to the bathrooms, eating areas, and sitting areas:
    • Remove or securely tape down rugs using double-sided tape if the patient gives you permission to do so.
    • Secure cords and any other loose materials in the walking path that could cause the patient or you to slip, trip, or stumble.[9]
  • Use handrails.
  • Turn on outside lights before returning to your car in the dark.
  • Clean up spills as soon as they happen.

Severe Weather

Home healthcare workers may be exposed to severe weather including tornados, hurricanes, earthquakes, blizzards, or ice storms.

Recommendations for employers
  • Create a severe weather program and train employees.
Employee training should include what to do while driving or while in a patient’s home during each type of severe weather event.

Recommendations for workers
The Federal Emergency Management Agency (FEMA) recommends the following protective measures for various types of severe weather:

  • Seek shelter immediately if the area you are in is under a tornado warning.
  • Go to a designated shelter area such as a safe room, basement, storm cellar, or the lowest building level.
  • If there is no basement, go to the center of an interior room on the lowest level (closet, interior hallway) away from corners, windows, doors, and outside walls.
  • Put as many walls as possible between you and the outside.
  • Get under a sturdy table and use your arms to protect your head and neck.
  • Do not open windows.
  • If you are in a mobile home, leave. Mobile homes, even if tied down, offer little protection from tornados.
  • If you are in a vehicle, get out immediately and go to the lowest floor of a sturdy, nearby building or a storm shelter.
  • Follow local evacuation orders.
  • If you are in a mobile home, leave. Mobile homes, even if tied down, offer little protection from hurricane winds.

  • Be aware that some earthquakes are actually foreshocks and a larger earthquake might later occur.
  • If you are indoors:
    • Drop to the ground.
    • Take cover by getting under a sturdy table or other piece of furniture.
    • Hold on until the shaking stops.
    • Cover your face and head with your arms and crouch in an inside corner of the building if you are not near a table or desk.
    • Stay away from glass, windows, outside doors and walls, and anything that could fall, such as lighting fixtures or furniture.
  • If you are outdoors:
    • Stay there.
    • Move away from buildings, streetlights, and utility wires.
  • If you are in a moving vehicle:
    • Stop as quickly as safety permits and stay in the vehicle. Avoid stopping near or under buildings, trees, overpasses, and utility wires.
    • Proceed cautiously once the earthquake has stopped. Avoid roads, bridges, or ramps that might have been damaged or destroyed by the earthquake.

Blizzard or Ice Storm
  • Drive only if absolutely necessary. If you must drive, do the following:
    • Travel during daylight hours, don’t travel alone, and keep others informed of your schedule.
    • Stay on main roads; avoid backroad shortcuts.
    • Use snow tires or chains when appropriate.
  • If a blizzard or ice storm traps you in the car, do the following:
    • Turn on hazard lights and hang a distress flag from the radio antenna or window.
    • Remain in your vehicle where rescuers are most likely to find you.
    • Do not set out on foot unless you can see a building close by where you know you can take shelter.

Chemical Spills and Acts of Terrorism

Home healthcare workers may find themselves in a neighborhood that has been affected by a chemical spill or an act of terrorism. The following protective measures are recommended by FEMA in the event of a chemical or hazardous material emergency, or acts of terrorism:

Recommendations for employers
  • Create a program for response to community emergencies and train employees.
Recommendations for workers
  • If you are asked to evacuate an area, do so immediately.
  • Stay tuned to a radio or television for information on evacuation routes, temporary shelters, and procedures.
  • Follow the routes recommended by the authorities—shortcuts may not be safe. Leave at once.
  • If you are told to seek shelter and you are in a vehicle, stop and seek shelter in a building.
  • If you must remain in your car, keep car windows and vents closed, and shut off the air conditioner or heater.
  • If you are requested to remain indoors, do the following:
  • Close and lock all exterior doors and windows.
  • Close vents, fireplace dampers, and as many interior doors as possible.
  • Turn off air conditioners and ventilation systems.
  • Stay in a room that is above ground and has the fewest openings to the outside.
  • Seal gaps under doorways and windows with wet towels or plastic sheeting and duct tape.

Automobile Travel

Driving from home to home exposes home healthcare workers to the risk of vehicular injury or death. The 2007 incidence rate for lost workdays from injuries caused by transportation incidents was more than 10 times higher for home healthcare workers than for hospital workers and more than 3 times higher than that of general industry workers at 17.8, 1.5, and 5.6 per 10,000 workers, respectively[10].

Recommendations for employers
  • Enforce mandatory seatbelt use.
  • Ensure that workers who drive for the job have valid driving licenses.
  • Include fatigue management in safety programs.
  • Ensure necessary worker training for driving specialized vehicles.
  • Avoid requiring workers to drive irregular hours or significantly extended hours.
  • Ensure that employer-owned vehicles are serviced on a regular basis.
  • Consider providing vehicles that offer the highest occupant protection in the event of a crash.
  • Provide maps or global positioning systems (GPS) to employees.
Recommendations for workers
  • Use seatbelts.
  • Don’t use cell phones while driving.\
  • Avoid other distracting activities, such as eating, drinking, or adjusting non-critical vehicle controls, like the radio, while driving.
  • Use detailed maps or a GPS.
  • Have the car checked and serviced regularly.
  • Keep the gas tank at least a quarter full.
  • Carry an emergency car kit containing a flashlight, extra batteries, and flares.


  • CDC. Avian influenza (bird flu) [www.cdc.gov/ flu/avian/].
  • DHHS. Employer preparedness checklists for pandemic and avian flu [www.flu.gov].
  • DHS. Disaster planning guide for home health care providers [www.dhs.gov/xprepresp/programs/gc_1221055966370.shtm].
  • FEMA. [www.fema.gov/hazards/types.shtm].
  • NHTSA. National Highway Traffic Safety Administration home page [www.nhtsa.dot.gov/].
  • NIOSH. Motor vehicle safety [www.cdc.gov/ niosh/topics/motorvehicle/].
  • OSHA. Guidance for protecting employees against avian flu [www.osha.gov/dsg/ guidance/avian-flu.html].
  • University of Illinois—outreach, community, and home care workers health and safety: Great Lakes Center for Occupational and Environmental Safety and Health, Chicago, Illinois [www.uic.edu/sph/glakes/ce/health&safety/index.htm].
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NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.


  1. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health et al. Occupational Hazards in Home Healthcare . 2010;.
  2. . Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. By Siegel JD, Rhinehart E, Jackson M, Chiarello L, the Healthcare Infection Control Practices Advisory Committee. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention CDC. 2007;.
  3. Wurtz R, Lee C, Lama J, Kuharik J et al. A new class of close contacts: home health care workers and occupational exposure to tuberculosis Home Health Care Manage Prac. 1996;volume 8(2):2 23–31.
  4. . Guidelines for preventing the transmission of Mycobacterium tuberculosis in health care settings. MMWR 54(RR–17) CDC (Centers for Disease Control and Prevention). 2005;.
  5. . Code of Federal Regulations. Washington, DC: U.S. Government Printing Office, Office of the Federal Register CFR.;.
  6. . The Answer Group. NIOSH: home healthcare workers. Written summary and videotapes of focus group meetings of home healthcare workers (June 13 and July 7, 1999) and Chicago, Illinois (June 28, 1999). Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. NIOSH. 1999;.
  7. Brillhart B, Kruse B, Heard L et al. Safety concerns for rehabilitation nurses in home care. Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses. 2004;volume 29(6):227-9.
  8. . Table R–7 Incidence rates for nonfatal occupational injuries and illnesses involving days away from work per 10,000 workers by industry and selected sources of injury or illness, 2007. Washington, DC: U. S. Department of Labor, Bureau of Labor Statistics BLS. 2008;.
  9. Parsons KS, Galinsky TL, Waters T et al. Suggestions for preventing musculoskeletal disorders in home healthcare workers. Part 1: lift and transfer assistance for partially weight-bearing home care patients. Home healthcare nurse. 2006;volume 24(3):158-64; quiz 165-6.
  10. . Table R–8 Incidence rates for nonfatal occupational injuries and illnesses involving days away from work per 10,000 full time workers by industry and selected events or exposures leading to injury or illness, 2007. Washington, DC: U. S. Department of Labor, Bureau of Labor Statistics BLS . 2008;.
Topic 2430 Version 1.0


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