Transcript new Safety Officers should perform an office inspection for risk

CHILDREN’S PRACTICING PHYSICIANS
AN OVERVIEW OF OSHA COMPLIANCE IN
PHYSICIAN PRACTICES
MARCH 19, 2015
PRESENTED BY KATHY ROOKER- CHSC
1
STEP ONE TO OSHA COMPLIANCE
 Purchase a manual from a REPUTIBLE
source!
 Know what regulations apply to your specific
specialty
 Assign a Safety Officer- A MUST DO!
 All new Safety Officers should perform an
office inspection for risk, chemicals,
violence, and overall compliance
2
OSHA GENERAL DUTY CLAUSE
Imposes a duty on the employer to:
• Section 5 (a) (1): “Each employer shall furnish
to each of his employees a place of
employment which is free from recognized
hazards that are causing or likely to cause
death or serious physical harm.”
• You can have a violation of the OSH Act’s
general duty clause, OSHA can prove that the
employer…………….
3
OSHA GENERAL DUTY CLAUSE
 Had prior knowledge that a dangerous
condition existed
 Employer did not remove the hazard from the
workplace
 The hazardous condition was causing or
likely to cause death or serious injury
 The employer ignored employee concerns
and/or complaints
 Failed to eliminate condition by
implementing alternative methods
4
EMPLOYER RESPONSIBILITIES
• Provide a workplace free from hazards
• Follow all OSHA
regulations/recommendations
• Display the OSHA 3165 poster
• Notify OSHA of any deaths or
hospitalizations
• Maintain all paperwork and logs as
required by OSHA
5
INVESTIGATING/REPORTING
ACCIDENTS/INCIDENTS
 Investigate with the intent of determining the
facts that led to the accident
 Do not assign blame at this point
 Safety Officer should evaluate the cause and
determine how/why it happened
 How can another incident be prevented?
 Identify underlying causes and potential
hazards
6
RECORDING ACCIDENTS/INJURIES FOR OSHA
• For most businesses, federal OSHA requires the
recording and posting of accidents/injuries resulting
in loss of work days, work restrictions, and
treatment beyond first aid. (OSHA logs 300, 300A,
and 301) except for small businesses with no more
than 10 employees and certain business types. In the
healthcare field, exempt businesses are physician and
dental practices, osteopathy practices, and misc. and
health and allied services.
(Source: HCPro OSHA Manual for Medical Facilities)
7
WHAT DO I DO IF I AM NOT EXEMPT?
• Employers not exempt from OSHA’s recordkeeping
requirements must prepare and maintain records
of work-related injuries and illnesses.
• Review Title 29 of the Code of Federal Regulations
(CFR) Part 1904 –
“Recording and Reporting Occupational Injuries and
Illnesses” to see exactly what cases to record.
8
OSHA RECORDKEEPING STANDARD 29 CFR 1904
(Text extract from the OSHA 3169 publication)
Revised in 2004
IT’S IMPROVED AND IT’S EASIER
Employers have a system for tracking workplace injuries and
illnesses. OSHA’s recordkeeping log is easier to understand
and to use. Written in plain language using a question and
answer format, the revised recordkeeping rule answers
questions about recording occupational injuries and illnesses
and explains how to classify particular cases.
9
RECORDKEEPING FORMS
OSHA 300 FORM:
• Log of Work-Related Illnesses/Injuries
• Used to classify Injuries/Illnesses
• Document extent/severity of each case
• What happened and how did it happen
• Track days away from work, restricted or
transferred
10
RECORDKEEPING FORMS
OSHA FORM 300A:
• Work-Related Illnesses and Injuries summarized from
Form 300
• Separate form makes it easier to calculate incidence
rates
• Shows totals for the year in each category. The
employer is required to post this form every year in a
conspicuous location so that the employees are aware
of the illnesses/injuries that have occurred in the
facility in the past year. ( Unless Exempt)
• Post this form February 1 through April 30
11
RECORDKEEPING FORMS
OSHA Form 301:
• Injury and Illness Incident Report
• Includes more details about how the
incident/injury occurred
• Date employee was hired
• Time employee began work
• Time of event
• Was employee treated in the ER or hospitalized?
12
WHAT PROMPTS AN OSHA INSPECTION
• Usually complaint driven
• Serious signed employee complaints
• Referrals from other government entities, such
as CLIA Inspectors, alleging serious hazards
• Follow up inspections
13
WHAT AN INSPECTOR MAY ASK
EMPLOYEES
OSHA inspectors will determine if
employees:
Are familiar with the facility’s safety policies and procedures
Have complied with these policies and procedures
Can verbalize actions to take in the event of an emergency
Are aware of the hazards of the products with which he/she
works
14
WHAT AN INSPECTOR IS ENTITLED TO
REVIEW
 Bloodborne Pathogens Exposure Control Plan
 Hazard Communication Policy/SDS
 Posters and Logs (#3165 and Sharps Injury Logs)
 Hepatitis B Vaccination Records
 OSHA Annual Training Records
 General Industry Standard Records
(Fire Extinguisher Inspections, Evacuation Plan)
15
WILLFUL VIOLATION
• Up to $70,000 for each willful or repeated violation
• Most serious
• Intentional disregard to OSHA regulations
• Indifference to employee safety
• Minimum of $5,000 fine
16
REPEATED VIOLATIONS
• A previously cited violation has not been
rectified (three years)
• $70,000 fine
• AND…….$7,000 per day until corrected
17
OTHER THAN SERIOUS VIOLATION
• Can cause accident or illness
• No danger of death or serious physical harm
• Lack of signage
• Fines up to $7,000
18
SERIOUS VIOLATION
• Death or serious injury could occur
• Knew or should have known hazard existed
• Example-no eyewash where certain hazardous
chemicals are used
• Fines up to $7,000
19
OSHA POLICIES
 Evacuation procedures
 Emergency preparedness
 Severe weather
 Safety sharps
 Systems failure
 Workplace violence
 Bloodborne pathogens
 Restricted access areas
 Hand washing
 Hepatitis B vaccinations
20
OSHA POLICIES
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
BBP post exposure testing/ follow-up
Decontamination
Hazard Communication
Hand Washing
Biohazard Waste
Annual Training/ New Employee Training
Facility Review
TB Risk Assessment
Respiratory Protection
Influenza
21
FIRE: A.R.A.C.E
• Announce “Code Red”
• Rescue those in immediate danger
• Alarm: Activate the fire alarm or call 911, give exact
location of fire, your name and type of fire
• Contain the fire by closing all doors and windows
• Extinguish or Evacuate
22
USING A FIRE EXTINGUISHER
• Pull pin
• Aim nozzle at base of fire
• Squeeze handle
• Sweep stream over base of fire
23
FIRE DRILLS
• “Recommended” to conduct a fire drill at
least once a year (TWICE IF YOU DID NOT
HAVE EVERYONE PARTICIPATE IN THE
FIRST DRILL)
• Must have a written evaluation of the drill
and a sign-in sheet of the participants
24
EVACUATION DIAGRAM
•Required if 10 or more employees
•Draw a floor plan
•Show escape routes to exits, fire
extinguishers, fire alarms
•OSHA does not stipulate where to
post
25
ELECTRICAL SAFETY
• Check electrical cords for defects
• Label all defective equipment so it won’t be
used until it is serviced
• Equipment needs 3-pronged ground cords
• Position equipment so cords do not present
a tripping hazard
• DO NOT use extension cords as permanent
wiring
26
OSHA’s JURISDICTION OVER
WORKPLACE VIOLENCE
• OSHA has issued workplace violence guidelines
for the healthcare industry.
• Employers who fail to prevent violence in the
workplace, may be cited under OSHA’s General
Duty Claus.
27
WORKPLACE VIOLENCE
• Contact with the public
• Providing a service
• Working with unstable persons
• Working alone or in small numbers
• Working early morning or late evening
hours
• Working in high crime areas
• Guarding expensive goods, such as
pharmaceuticals
28
WORKPLACE VIOLENCE
• Provide safety education
• Role play
• Assess workplace to identify
potential security hazards
• Prohibit weapons in the facility
• Provide panic buttons
29
FIRST AID KIT
• OSHA requires a separate, readily available first aid kit for
employee injuries
• Store in a convenient place
• Required Equipment:
• Absorbent compress-32 sq.inch (no side smaller than 4”)
• Adhesive bandages-1x3”(16)
• Adhesive tape-5 yards
• Antiseptic, 0.5 gms. (.14 oz) 10 applications
• Burn treatment, 0.5 gms. (.14 oz) 6 applications
• Medical exam gloves (4)
• Sterile Pad- 3x3” (4)
• Triangular Bandage- 40x40x56” (1)
• Directions for requesting emergency assistance
30
BASIC FIRST AID FOR COMMON
EMERGENCIES
 Bleeding
 Broken Bones
 Eye Injuries
 Electrical Shock
 Choking- (Heimlich Maneuver- DC’d)
(Abdominal Thrust)
 Heart Attack- CPR recommendations
31
THE STANDARD………………
Intent:
Eliminate/minimize occupational exposure to
Hepatitis, HIV, and other bloodborne
pathogens by adopting universal precautions
for blood and other potentially Infectious
materials
32
WHAT ARE BLOODBORNE
PATHOGENS?
• Bloodborne Pathogens are infectious
microorganisms in human blood that can cause
disease in humans. These pathogens include, but
are not limited to hepatitis B (HBV), hepatitis C
(HCV) and human immunodeficiency virus (HIV).
Needlesticks and other sharps-related injuries
may expose workers to bloodborne pathogens.
33
HEPATITIS B
• Hep B infection is a major infectious bloodborne
occupational hazard to healthcare workers. Death may result
from acute and chronic hepatitis. Infected healthcare
workers can spread the infection to family members, or,
rarely to their patients. Hep B vaccination, engineering and
work practice controls, and proper PPE can prevent almost
all occupational HBV infections.
• HBV attacks and replicates in liver cells. Infection with HBV
can produce two outcomes in a susceptible person. Selflimited hepatitis B and chronic HBV infection.
34
HEPATITIS B VACCINE
• OSHA follows the most current US Public
Health Guidelines for pre-exposure and
post-exposure antibody testing
• The USPHS does NOT recommend that
titers be drawn beyond the 1-2 month
period after the 3rd vaccine (or 6th if
repeating series)
35
HEPATITIS C
• Hep C is the most common cause of occupationally acquired
illness. Hep C can cause acute or chronic liver disease. It
accounts for 70% of chronic hepatitis and 30%of end-stage
liver disease in the US. The incubation period of acute HCV
infection is 7-8 weeks with 25% of patients developing
symptoms including jaundice. Less than 15% of infected
patients spontaneously clear HCV after 6months of infection.
The risk of Hep C infection after an exposure to HCV
seropositive blood is variable. The average estimate is 3%. Of
these, 50% become carriers and may progress to serious
chronic liver diseases such as cirrhosis or carcinoma.
36
HUMAN IMMUNODEFICIENCY VIRUS
• HIV is a virus that causes AIDS.
• Acquired Immunodeficiency Syndrome
• Immune system is depleted of cells by the HIV
virus
• Conversions from exposures < than 1%
• Symptoms:
– Fever
– Diarrhea
– Pharyngitis
– Headaches
– Joint/muscle pain
– Tiredness
– Weight loss
– Nausea
– Swollen lymph nodes
37
OVERVIEW OF BLOODBORNE PATHOGENS
STANDARD COMPONENTS
• Determine which
employees fall under
standard of exposure
control
• Vaccinate employee
• Implement methods
to protect staff
against HepB
• Evaluate
circumstances of any
exposure incident
• Train employees on
hazards
• Keep vaccination
records for 30 years
38
UNIVERSAL PRECAUTIONS
The official definition from the OSHA
Bloodborne Pathogens Standard,
29 CFR 1910.1030(b) is:
“according to the concept of universal
precautions, all human blood and certain
body fluids are treated as if known to be
infectious for HIV, HBV, and other
bloodborne pathogens.”
39
IMPLEMENTING UNIVERSAL
PRECAUTIONS
• Do not bend, break, remove, or recap
needles after use.
• Engage “Safety” on sharps immediately
after use.
• Decontaminate surfaces when exposed
to blood or body fluids.
40
4 WAYS EMPLOYEES ARE INFECTED
•Needle Sticks
•Cut/Scrape on Non-Intact Skin
•Splash/Spray to a Mucous
Membrane
•Sharps injury from scalpels, slides,
or capillary tubes.
41
BIOHAZARD WASTE AND
SHARPS CONTAINER
• Labeled
• Leak proof
• Located close by
• Can’t casually knock over
• Can mount sharps containers at 52-56
inches from floor
42
POTENTIALLY INFECTIOUS
MATERIALS
•Unfixed tissues/organs
•Certain body fluids
•Semen/vaginal secretions
•Blood and OPIM’s
•Contaminated body fluids
•Unknown body fluids
43
EXPOSURE CONTROL PLAN
•Exposure determination list
•Engineering and work practice
controls
•Labels and signs
•Personal protective gear
•Hepatitis B vaccine/post exposure
•Recordkeeping
•Employee training
44
WORK PRACTICE CONTROLS
•Change the way you do specific
procedures
•No two handed re-capping of
needles
•Be careful handling contaminated
sharps
•May require PPE!
45
HAND WASHING
•According to WHO, there are 4
“ moments” for hand washing:
Before Patient Contact
Before Aseptic Task
After Body Fluid Exposure Risk
After Patient Contact
46
HAND WASHING
• First line of infection prevention
• Compliance rates are down to between
30-40 percent !!
Hand washing is like a “do it yourself”
vaccine
Involves 5 simple steps to reduce the
spread of diarrheal and respiratory illnesses
47
HAND WASHING
•
WET
LATHER
SCRUB- 20 SECONDS
RINSE
DRY
48
HAND WASHING
•THE CDC SAYS:
“ CLEAN HANDS SAVES LIVES “
49
NEEDLESTICK SAFETY & PREVENTION ACT
• BBP amended January 18, 2001
• Effective July, 18, 2001
• Evaluate and implement sharps with
built-in safety features
• Report all sharps injuries
50
VACUTAINER TUBE HOLDERS
OSHA Administrator John Henshaw stated that “removing
contaminated needles and reusing blood tube holders can
cause multiple hazards.”
Henshaw also said “single use blood tube holders, when
used with engineering and work practice controls,
simply provide the best level of protection against needle
stick injuries. That is why the standard prohibits removing
and re-using blood tube holders.”
10/16/2003
OSHA TRADE RELEASE
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ECLIPSE PHLEBOTOMY NEEDLE
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RETRACTABLE BUTTERFLY
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SAFETY LANCETS
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SAFETY INJECTION DEVICES
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SAFETY SCALPELS
56
ANNUAL EVALUATION
• OSHA requires that you annually evaluate
sharps that are used in your office.
• Request samples for your venders
• Document the evaluation and switch
devices if the staff finds an alternative
that provides better protection.
57
SHARPS INJURY LOG
Must Contain:
• Type and brand of device
• Area where incident occurred
• How incident occurred
• Was a safety device used
• Could anything have prevented
accident
58
POST EXPOSURE FOLLOW-UP FLOW
• Report incident to employer
• Test source patient
• Send employee to HCP for
testing/evaluation
• Employee is informed of test results
• Whether HBV was received
• KEEP CONFIDENTIAL!!!!
• HCP-provides counseling
• Provides PPE if appropriate
• Evaluates illnesses
59
AFTER EXPOSURE
• Do not donate blood
• Inform sex partners of potential exposure
to infection
• Avoid pregnancy
• Clean and disinfect surfaces on which
your blood or body fluids have spilled
• Do not share razors, toothbrushes, etc.
60
FOLLOW UP BLOOD WORK
• Obtain consent from “source”
• Draw a STAT HIV, and HBsAg, HBsAb,
HepC Ab on the patient
• Perform baseline testing on the employee
• Run the same tests on employee, no need to
run a STAT HIV
61
FOLLOW UP BLOOD WORK
• If the source is NOT infected with a bloodborne
pathogen, no further testing is required on the
employee
• If the source is unknown, won’t consent to allow
the blood work to be run, or if the source is
infected with a bloodborne pathogen, perform
this blood work for follow up testing :
HCV- Anti-HCV and ALT testing in 4-6 months
HIV- HIV antibody testing in 6wks, 3 months, and 6 months
post exposure.
ALWAYS CHECK WITH THE CDC FOR POST EXPOSURE UPDATES!
62
INJECTION SAFETY
• CDC, State, and Local Health
Departments identified improper use of
syringes, needles, and medication vials
• Compromised patient safety during
routine healthcare procedures
• Infection outbreaks in medical, dental,
clinics, and surgery centers
63
INJECTION SAFETY
Healthcare providers should NEVER:
• Administer medications from the same
syringe to more than one patient, even if
changing needle
• Enter a vial with a syringe or needle that has
been used for a patient if the same
medication vial might be used for another
patient
• Single use vials should never be used for
more than one patient
• Bags of IV solution should NOT be used for
multiple patients
64
OSHA RECORDKEEPING
• Exposures…………….30 Years +
• HBV vaccines ………..30 Years +
• Employee training…….3 Years +
• MSDS NOTEBOOK-6/1/2045 !!!!!
65
BIOHAZARD WASTE
Definition
Item containing enough blood
or OPIM to drip if squeezed or
flake off if the substance is dry.
66
HAZARD COMMUNICATION STANDARD
• Haz Com Standard in effect since 1988
• The “Right to Know” Standard
• Requires SDS for all hazardous chemicals
• Is the substance dangerous or marked
hazardous?
• Is the staff exposed to this substance?
• SDS REQUIRED ON ALL HAZARDOUS
DRUGS AS DEFINED BY OSHA
• List can be found on OSHA website
67
AMENDED HAZARD COMMUNICATION
STANDARD
“Exposure to hazardous chemicals is one of the most
serious dangers facing American workers today,” stated
Secretary of Labor Thomas Perez.
Revising OSHA’s Hazard Communication Standard will
improve the quality, consistency, and clarity of hazard
information that workers receive, making it safer for
workers to do their jobs and easier for employers to stay
competitive in the global marketplace. (Hilda Solis)
Update 5/12)
(Source-Medical Environment
68
AMENDED HAZARD COMMUNICATION
STANDARD
• This change (first since 1994) will align our
current system with the Globally Harmonized
System (GHS) of Classification and Labeling of
Chemicals. OSHA feels this will reduce confusion
about the hazards of chemicals in the workplace.
• The GHS will classify chemicals according to
their health and physical hazards and establish
labels and SDS for all chemicals used worldwide.
69
GLOBALLY HARMONIZED SYSTEM
• Basic requirements of HazCom are still
in place, but the staff has the right to
“understand” the hazardous chemicals
in the workplace.
• Dangers of all hazardous chemicals
will be easier to comprehend with
newly formatted SDS and pictograms.
• EPA, OSHA, and DOT are all affected
70
KEY CHANGES TO HAZ COM 2012
• Hazard Classifications- specific criteria
for classification of health and physical
hazards, as well as classification of
mixtures.
• Labels-must now include a harmonized
signal word, pictogram, hazard
statement for each hazard class, and a
precautionary statement.
• SDS- will now have a specified 16section format
71
THE NEW SDS
• New look
• New format
• Uniform way of communicating
information about hazardous chemicals
• SDS and chemical label will contain the
same information
• Use of Pictograms
• Chemicals classified based on health
and physical hazards
72
TRAINING SPECIFICS
• Employers are required to train workers by
December 1, 2013.
• Training will need to address the hazard
elements on the label , along with identifying
the nine pictograms recognized by the GHS
and familiarization with the new SDS format.
• Full implementation of the revised HazCom
2012 standard is scheduled for June 1, 2015.
73
CHEMICAL CLASSIFICATION
• Based on health and physical hazards
• Language used to classify and describe
chemicals will be the same among
different manufacturers
• Confusion over type of hazard of the
chemical will be eliminated
• Message will be the same in the entire
world on every chemical
74
CHEMICALS USED IN MEDICAL FACILITIES
Classified As:
• Corrosive
• Toxic
• Strong Sensitizer
• Ignitable- includes both flammables and
combustibles
75
NEW SDS 16 SECTION FORMAT
IN THIS ORDER:
• Product and Company Identification
• Hazards Identification
• Composition/Information on Ingredients
• First Aid Measures
• Firefighting Measures
• Accidental Release Measures
• Handling and Storage
• Exposure Control/Personal Protection
76
NEW SDS 16 SECTION FORMAT
IN THIS ORDER:
• Physical and Chemical Properties
• Stability and Reactivity
• Toxicological Information
• Ecological Information
• Disposal Considerations
• Transport Information
• Regulatory Information
• Other Information
77
GHS LABEL ELEMENTS
• Symbols: GHS hazard pictograms
• Signal Words: “Danger” or “Warning”
• Hazard Statements: phrases assigned to a
hazard class and category that describe the
nature of the hazard. An appropriate
statement for each GHS hazard should be
included on the label for products possessing
more than one hazard.
78
GHS LABEL ELEMENTS
• Precautionary Statements: measures to
minimize or prevent adverse effects.
There are four types of statements
covering prevention , response in cases
of accidental spillage or exposure,
storage, and disposal. The precautionary
statements have been linked to each GHS
hazard statement.
79
GHS LABEL ELEMENTS
• Product Identifier: ( ingredient
disclosure)
• Name used for hazardous product on a
label or in the SDS. The GHS label for a
substance should include the chemical
identity of the substance. For mixtures,
the label should include the chemical
identities of all ingredients that
contribute to acute toxicity.
• Supplier Identification: name, address
and telephone should be on the label
80
GHS HAZARD PICTOGRAMS
• Convey health, physical and
environmental information, assigned to a
GHS hazard class and category.
• Pictograms include the harmonized
hazard symbols plus other graphic
elements, such as borders and
background patterns.
• Harmful chemicals are marked with an
exclamation mark. Pictograms will have a
black symbol on a white background with
a red diamond frame.
81
HEALTH HAZARD
• Carcinogen
• Mutagenicity
• Reproductive Toxicity
• Respiratory Sensitizer
• Target Organ Toxicity
• Aspiration Toxicity
82
FLAME
•
•
•
•
•
•
Flammables
Pyrophorics
Self-Heating
Emits Flammable Gas
Self-Reactives
Organic Peroxides
83
EXCLAMATION MARK
•
•
•
•
•
•
Irritant (skin and eye)
Skin Sensitizer
Acute Toxicity
Narcotic Effects
Respiratory Tract Irritant
Hazardous to Ozone Layer (NonMandatory)
84
GAS CYLINDER
• GAS UNDER PRESSURE
85
CORROSION
Eye Damage Corrosive to
Metals
86
EXPLODING BOMB
• Explosives
• Self-Reactives
• Organic Peroxides
87
FLAME OVER CIRCLE
• Oxidizers
88
SKULL
89
HAZARD STATEMENTS
• Describe the nature of the hazard(s) of a chemical,
including the degree of hazard
• Example “ Causes damage to the kidneys through
prolonged or repeated exposure when absorbed
through the skin”
• All applicable hazard statements MUST appear on the
label
• Statements are specific to the hazard classification
categories
90
MSDS NOTEBOOK
YOU MUST KEEP YOU
CURRENT MSDS
NOTEBOOK AND SHEETS
FOR 30 YEARS FROM
6/1/2015
91
HAZARD STATEMENTS
Single harmonized hazard
statement for level of hazard
within each hazard class
Example: Flammable liquids
Category
vapor
Category
vapor
Category
Category
1: Extremely flammable liquid and
2: Highly flammable liquid and
3: Flammable liquid and vapor
4: Combustible liquid
92
PRECAUTIONARY STATEMENTS
• OSHA Pictograms do NOT replace the diamond
shaped labels that the DOT requires for the
transport of chemicals, chemical drums,
chemical totes, tanks or other containers.
• These labels go on the external part of the
shipped container and must meet DOT
requirements
93
ROUTES OF EXPOSURE
• Inhalation
• Ingestion
• Skin Contact
• Eye Contact
• Injection
94
SDS-Safety Data Sheet
• Keep a Master List
• Copies in area where hazardous chemical is
used
• Examine labels on all chemicals, liquid or
aerosol drugs, disinfectants, and x-ray
developers (older models)
• Look for safety hazard warnings (fires or
explosions)
95
SAFETY DATA SHEETS
• Any substance with hazard warning label
• Drugs and pharmaceuticals except tablets,
pills and capsules (solid, final form)
• Package insert and PDR cannot substitute for
SDS
96
SDS INDICATES…..
• Symptoms of overexposure
• Primary route of entry
• PPE/ventilation needed
• Emergency first aid procedures
97
SUBSTANCES NOT REQUIRING SDS
• Any product that does NOT bear a hazard
warning
• A product that does not contain a hazard
warning, but is available commercially to
the general public and is used exactly as
instructed on the label (e.g., some
cleansers)
98
LABELS AND SIGNS
• Biohazard labels on:
• Refrigerator door
• Sharps containers, waste containers
• Door to lab
• Transport or storage containers
• Restrict access to:
• Instrument cleaning areas
• Biohazardous waste storage areas
99
PERSONAL PROTECTIVE
CLOTHING & EQUIPMENT
• Provided at no charge
• Must protect against contamination
• Wear PPE when you anticipate there may
be a splash or spray to a mucous
membrane.
• Wear PPE when handling hazardous
chemicals
• Educate personnel on using PPE and how
to properly put on and take off the attire.
100
LATEX ALLERGY
• CDC reports about 15% of HCWs have latex
allergies
• OSHA does not ban the use of latex in medical
facilities
• Skin contact and inhalation
• Symptoms vary from skin irritation to severe
respiratory problems to anaphylaxis
• An alternative to latex is required to be available
101
LATEX: OSHA SAYS…
• Use non-latex gloves for housekeeping
• Use latex gloves only when necessary to
protect from infectious agents – then, use low
protein and non-powdered gloves
• Have Epinephrine available for an allergic
reaction
102
MEDICATION SECURITY AND DISPOSAL
• Not specifically required by OSHA
• Some prescription drugs are hazardous
substances
• Store with controlled access
• Keep RX pads in a secure place
• Keep a dispensing record
• Remove expired drugs from stock
• Document how expired drugs are disposed of
(i.e. biohazard bag) OR• Follow State Pharmacy Board regulations
103
MERCURY SPILL CLEAN UP
• Never vacuum!
• Remove people from room
• Ventilate room
• Roll onto paper or use eye dropper
• Place in screw cap jar for recycling
104
LABEL TRANSFERRED
HAZARDOUS CHEMICALS
• When transferring a chemical from a primary
container to a secondary container:
• Label the secondary bottle with contents
identically as the primary bottle
• 70% isopropyl alcohol
• Glutaraldehyde
• OPA
105
HOUSEKEEPING
• Housekeeping Schedule kept in Exposure
Control Plan (OSHA manual)
• Decontaminate work surfaces
• 1:10 bleach (at least 3 min “kill” time)
• EPA-registered tuberculocide
• Follow label directions
• Know disinfectant efficacy against Hep B,
TB, and HIV
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HOUSEKEEPING
 Use an EPA-registered disinfectant that is at least
tuberculocidal
 HBV can survive in dried blood at room
temperature on environmental surfaces for at
least one week
 HCV can survive on environmental surfaces for 1648 hours
 Clean up gross contamination first with soap and
water solution to ensure the disinfectant is
completely effective
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DECONTAMINATION METHODS
• Semi-Critical
• Instruments that contact mucous membranes
and CANNOT be autoclaved (endoscopes,
laryngoscopes, sigmoidoscopes)
• Sterilize in high level disinfectant Instruments
which contact mucous membranes or non-intact
skin (metal vaginal specs, anal, nasal, ear
specs)
• Sterilize in autoclave, or use high level
disinfectant
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HIGH-LEVEL DISINFECTANTS
• Glutaraldehyde or peroxide-base (OPA)
• Transport item to restricted soaking area
• Clean before soaking with plastic brush
• Wear PPE!!!!!!!
• Read MSDS!
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DECONTAMINATING VAGINAL SPECULA
• Contain and transport
• soak prior to washing
• tightly covered with a lid
• Clean
• clean specula to remove debris
• scrub with detergent solution using soft-bristled
brush
• enzymatic cleaner
• Disinfect or Sterilize
• vaginal specula considered “semi-critical” category
of items that require special handling prior to
sterilization
• autoclaving is the preferred choice
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STERILIZATION
 Completely eliminates or destroys all microbial
life including highly resistant bacterial spores
 An instrument that enters the patient’s vascular
system or other normally sterile areas of the
body is considered a “critical” device and MUST
BE sterilized
 Steam autoclaving uses distilled water that
reaches 250 degrees F to 275 degrees F
 20 min. unwrapped/30 min. small pkgs.
 Instruments that touch but do not penetrate body
surfaces, sterilize when possible, or use high
level disinfection if they cannot withstand
repeated exposure to heat
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STERILIZATION
• After pre-cleaning, package items in plastic or
paper peel down pouches
• Use a drying cycle prior to handling for storage
• Use unwrapped instruments immediately
• Store in a clean, dry, dust free area
• Pouched pks will remain sterile indefinitely; if
the package is heat sealed and there is no
moisture present
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ENSURING STERILIZATION
• Chemical integrators
• Each load to ensure the sterilization
cycle has occurred
• Biological indicators
• AT LEAST ONCE A WEEK or every 5th
load to indicate microorganism (spore)
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INSTRUMENT PRE-CLEANING
• Organic debris such as pus, mucous,
saliva, feces and blood may dry on the
instrument and prevent it from being
fully decontaminated
• Bacteria and viruses (HIV) can survive
in device lubricants and organic matter
• Enzymatic solutions are preferred
• Use a soft brush to remove any visible
organic debris
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EYEWASH STATION
• Every medical facility needs an eyewash to flush
the eyes of those who have been splashed or
sprayed with infectious materials or hazardous
chemicals
• Controlled flow of tepid water to both eyes
for 15 minutes
• Both eyelids must be held open with hands while
the eyes are in the stream of water
• NO SQUEEZE BOTTLES!!
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EYEWASH SPECS
• 10 seconds or 100 feet
• Easy access
• Same level
• Perform weekly eye wash station checks
• Run water through for 3 to 4 minutes
• Clean eyepieces weekly with alcohol wipes
• LOG
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PROTECT STAFF FROM CONTRACTING
TB AT WORK
• Perform annual TB risk assessment for your
facility
• How are TB patients identified and managed in
your facility?
• Provide a baseline 2-step TST to all staff that
have patient contact
• Refer employees with +TST for a chest
x-ray
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2-Step PPD Skin Test
• Provide baseline 2-step to all new
employees
• Boosted reaction vs. reaction due to new
infection
• Positive 1st test; infected
• Negative 1st test and positive 2nd –
boosted reaction (LTBI)
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TB RISK CATEGORIES
LOW RISK
• < 3 TB patients
• Baseline TST
• No annual
employee TST
MODERATE RISK
• > 3 TB patients
• Baseline TST
• Annual employee
TST
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RESPIRATORY INFECTION CONTROL
GUIDELINES: FLU AND TB
• Require coughing patients to practice
respiratory hygiene (mask)
• Refer any suspected TB patient out of
the
practice
• Hang CDC notice for patients to cover
their cough
• Protect workers !!!!!!
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INFLUENZA
• Provide flu vaccine to staff
• Flu declination form
• Coughing etiquette policy
• Hand washing
• Restrict ill HCW from work
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COUGH ETIQUETTE PROGRAM
• Hang poster
• Provide tissues, masks, and alcohol
hand sanitizers to coughing, sneezing
patients
• Encourage coughing patients to sit at
least 3 feet away from others or place
them in an exam room
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INFECTION CONTROL
Infection:
A disease caused by microorganisms
that release toxins or invade body
tissues. The body finds a way fight the
invasion. These are the symptoms of
fever, chills, malaise, or muscle and
joint pains.
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INFECTION CONTROL
• Microorganisms that cause disease are
called pathogens.
• Bacteria
• Fungi
• Parasites
• Viruses
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INFECTION CONTROL
• Transmission:
To spread an infection, the microorganism
must find a way to exit the infected person.
Common ways infections are;
coughing or sneezing
stool or urine
seeping skin sores
draining of blood or other fluids
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GLOVES
• Non sterile gloves should be worn in a situation
when your hands may come in contact with the
patients:
1.
2.
3.
4.
eyes, nose, or mouth
blood or body fluids
non-intact skin
Rash or seeping skin disorder
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PREVENTION
• WASH HANDS!!!!
• Soap and water if visibly contaminated
• OR, an alcohol based hand rub/gel
• Before and after EVERY patient
encounter
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RESOURCES
• HCPro OSHA Program Manual for Medical
Facilities
• Medical Environment Updates• OSHA training handbook for healthcare
facilities by Sarah Alholm, MAS
• CDC.GOV
• OSHA.GOV
• Wikipedia.org
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Contact Information
Kathy Rooker
Columbus Healthcare
& Safety Consultants
[email protected]
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