What are Work Practice Controls & How Do I Create Them?

Work practice controls are profession-specific, written procedures that outline how audiology-related services will be executed in a manner consistent with minimizing the potential spread of disease or cross-contamination.  The Occupational Safety and Health Administration (OSHA) requires facilities providing patient care services to have and maintain a written infection control plan; one of the six required sections specifically calls for the inclusion of clinic-specific work practice controls. Since every clinic will differ in terms of breadth of service provided, the number of work practice control to be included in a written plan will depend on the number of services provided by a specific clinic.

To get started, make a comprehensive list of all the services your specific clinic provides. For example, if your clinic dispenses hearing instruments, what other related services are routinely offered? The list you create will be specific to your own clinic and may include the following:

1. Hearing instrument cleaning
2. Hearing instrument verification via real ear
3. Electroacoustic measurements
4. Hearing aid listening checks
5. Creating earmold impressions
6. Drop-off hearing instrument service
7. Earmold or hearing instrument modifications

This process is then repeated for other general services your specific clinic provides. If your clinic is involved in cerumen management, identify all the techniques used for this procedure (i.e. mechanical removal, suction, irrigation, etc) along with any associated risks that must be addressed from an infection control standpoint (e.g. how to handle a nick of the ear canal where bleeding ensues, how to dispose of disposable contaminated with cerumen or blodd).  If your clinic performs vestibular assessments, create a specific list addressing those procedures. Continue repeating this process until a comprehensive list of services is established.  The comprehensive list you end up with will dictate the number of written work practice controls your infection plan requires.

Using hearing instrument listening checks as an example of how to create a work practice control, keep the following in mind.  The work practice control is not designed to outline exactly what a clinician must to do perform a hearing instrument listening check; rather, the purpose is to outline the necessary infection control precautions that must be followed when performing a hearing instrument listening check for the purposes of minimizing the spread of disease.  This requires consciously incorporating universal precautions to the written procedure.  For example, since hearing instrument surfaces are contaminated with a variety of microbial growth, it is important to avoid handling hearing instruments with bare hands until they have been cleaned and then disinfected or some appropriate barrier (gloves) are incorporated in handling procedures.  It is important to ensure that the listening bell and ear tips of the listening stethoscope are cleaned and disinfected as well. The following is an example of a hearing instrument listening check that meets current OSHA standards:

1. Accept hearing instrument from patient using paper towel, avoiding direct contact with bare hands
2. Clean the hearing instrument with the paper towel
3. Disinfect hearing instrument surface with a fresh disinfectant towelette.
4. Attach hearing instrument to listening bell and perform listening check
5. After listening check is performed, use a fresh disinfectant towelette to clean bell and both ear tips
6. Disinfect the bell and ear tips with an unused portion of the same disinfectant towelette
7. Return listening stethoscope to appropriate location for later use

NOTE: the above is just one example of an acceptable work practice control; since executing an audiology procedure may be associated with a range of acceptable variations consistent with infection control standards (i.e. gloves, etc), work practice controls for the same clinical procedure may differ from one clinic to the next. For a complete resource on this topic, readers are referred to Infection Control in the Audiology Clinic available from Oaktree Products.