Chapter 21 safety


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Chapter 21 safety

  1. 1. CHAPTER 21 Safety
  2. 2. Objectives: As a result of successfully completing this chapter, students will be able to:  Discuss common safety hazards applicable to Central Service functions and work areas, and explain how employee injuries can be prevented  Describe special safety precautions for handling Ethylene Oxide  Review procedures to report employee accidents and injuries
  3. 3. Objectives: (continued)  Explain the importance of ergonomics and health awareness for Central Service Technicians  Discuss procedures to prevent patient accidents and injuries and to report them if they occur  Explain basic procedures which address three occupational hazards: fire, hazardous substances, and bloodborne pathogens  Discuss the basics of internal and external disaster plans for a healthcare facility
  4. 4. “Safe” Freedom from danger, risk or injury Central Service Technicians are responsible for working safely after they have been ,made aware of workplace hazards
  5. 5. Accidents and Injury: Are not funny Can happen to anyone “It will never happen to me.” is a dangerous attitude
  6. 6. HAZARDS Common Central Service Workplace
  7. 7. Soiled Receiving and Decontamination Areas
  8. 8. Biohazard  Prevent Biohazard exposures (Blood Borne Pathogens) and exposures to chemicals, by wearing appropriate Personal Protective Equipment (PPE)  If you are exposed to body fluids or chemicals notify your supervisor immediately
  9. 9. Safety Tips for Working in Soiled Receiving and Decontamination Areas:  Never put your hands into a basin or container holding contaminated objects that you cannot see  Never put your hands into a trash container; instead remove the inner bag and pour its contents onto a surface, or use an instruments to sort through the contents  Pour out any solution that prohibits visual examination of basin or container contents  Place all disposable sharps (needles, blades, etc.) in an appropriate sharps container
  11. 11. Safety Tips for Working in Soiled Receiving and Decontamination Areas:  Use extreme caution when disarming scalpel blades. Never use your hands. Use needle holder or other tool and wear eye protection  When reprocessing reusable sharps, separate them from other instruments and position them in a way that will avoid injury to others  Follow manufacturers’ recommendations for safe use of chemicals  Always wear PPE to protect yourself from chemical exposures
  12. 12. Safety Tips for Working in Soiled Receiving and Decontamination Areas:  Follow manufacturers’ recommendations for safe operation of cleaning and testing equipment  Use caution when walking in areas with wet floors  Utilize mats or nonskid footwear when appropriate  Use care when loading or unloading carts from dumbwaiters and elevators  Sinks and work surfaces should be at appropriate levels to reduce back and arm strain
  13. 13. Safety Tips for Working in Soiled Receiving and Decontamination Areas:  When scrubbing instruments in a sink, always scrub below the surface of the water to prevent aerosols  Use the concentration of detergents and water recommended by the manufacturer  Use thermal insulated gloves when handling washer baskets, sterilizer carts and other hot objects  Move sterilizer carts to low or no traffic areas to reduce the chance passersby will come in contact with the hot cart and be burned
  14. 14. Safety Tips for Working in Preparation and Sterilization Areas:  Inspect all equipment for frayed electrical cords  Use caution when using heat sealers  Use caution when using a cutting edge  When lifting instrument sets, size up the load and lift with the larger muscles in your legs and arms  Hold the item as close to your body as possible
  15. 15. Safety Tips for Working in Preparation and Sterilization Areas:  Follow all procedures for the handling and disposal of biological tests  Continuously check sterilizers for obvious damage to doors  Only authorized service personnel should access control panels and inner parts of sterilization equipment for repairs and adjustments  Only those people who have been trained to operate sterilizer should do so  Unauthorized hospital personnel, visitors, or visitors should not enter an area that contains sterilizers
  16. 16. Safety Tips for Working in Preparation and Sterilization Areas:  Ensure that proper signs are warning labels are posted to warn of hot surfaces and other hazards  Use only secure and sturdy shelving  Use safety ladders and stools to reach high items. Do not climb on shelves
  17. 17. Safety Tips for Working in Supply Receiving, Breakout, and Storage Areas:  Use appropriate containers for waste  Use specialized containers for storage and disposal of hazardous materials  MSDS Sheets should be available for reference  Use caution when removing items from storage units or shelves  Insure there is time and space to safely retrieve items  Use care when using box-cutting tools  Scalpel blades should NEVER be used to open boxes or containers MSDS
  18. 18. Safety Tips for Working in Supply Receiving, Breakout, and Storage Areas:  Handle paper products with care to avoid skin lacerations  Do not handle broken glass  Avoid twisting and jerking movements when moving objects  Inspect work areas for objects left in pathways. Aisles and doorways must be kept clear at all times  When working in small areas be aware of traffic patterns  To avoid injury perform appropriate stretching exercises before lifting, pushing or pulling  When transporting patients, supply carts, or equipment be sure the path in front and on each side of the cart is clear  Ensure clearance on each side of objects you are carrying to avoid injury to arms and hands
  19. 19. Safety Tips for Working in Equipment Distribution and Central Transport Areas:  Inspect floors for uneven surfaces to ensure equipment being rolled is not thrown off balance  Use caution when approaching automatic doors  Use caution when approaching corners or intersections; use safety mirrors when available  Use caution when pushing objects up or down inclines  Do not ride or step on supply carts or other vehicles  Consider the acquisition and use of powered carts for moving heavy or awkward loads
  20. 20. Safety Tips for Working in Equipment Distribution and Central Transport Areas:  Consider the acquisition and use of powered carts for moving heavy or awkward loads  Assembly work should be performed at levels that will least fatigue and strain employees  Floors in work areas where employees must stand should have fatigue mats to relieve leg strain  Appropriate chairs should be used at computer, clerical, and instrument work stations to properly support employees backs  Computer screens should be used to reduce eyestrain
  21. 21. Safety Tips for Working in Clerical and other Work Stations:  Items used frequently to perform routine tasks should be stored within easy reach  Caution should be used when working with filing cabinets. Open upper drawers increase the risk of the cabinet tipping and open lower drawers increase the risk of someone tripping
  22. 22. Handling Compressed Gas Cylinders  Central Service Technicians must understand and follow basic safety precautions when handling, transporting, and storing compressed gas cylinders
  23. 23. Compressed Gas Cylinder Safety Precautions  Do not dispense gas cylinders that are not labeled  Make sure that gas cylinders are secured at all times to prevent tipping  Handle carefully when transporting. Do not roll, drag, or drop.  Use a cover cap during transport  Cylinder regulators are not interchangeable. Be sure to use the correct regulator for the gas you are handling  Inspect all fittings for damage before connecting  Cylinders should be clearly labeled as ; Full, In Use, or Empty  Empty cylinders should not be store with full cylinders  Gas regulator stem valves require a key. That key should be kept with the regulator at all times
  24. 24. SAFETY Ethylene Oxide
  25. 25. Dangers of EtO EtO is a Toxic Gas 100% EtO is Flammable 100% EtO is Explosive
  26. 26. Carcinogenic  Shown to facilitate cancer in laboratory tests  Follow manufacturer’s handling instructions
  27. 27. Teratogen  A chemical substance that may cause harm to an unborn fetus  Pregnant women should be aware of teratogens
  28. 28. Common EtO Terminology …reading the fine print
  29. 29. Parts Per Million Parts Per Million (PPM) is the term used to measure the volume of gas in a vapor
  30. 30. Time Weighted Average Time Weighted Average (TWA) refers to the exposure level broken down over the entire length of the employee’s shift
  31. 31. Short Term Exposure Limit Short Term Exposure Limit (STEL) refers to the concentration limit over a short time
  32. 32. Permissible Exposure Limit Permissible Exposure Limit (PEL) is the maximum concentration limit allowed by OSHA over the length of the shift.
  33. 33. EtO exposure may be possible:  In the front of the sterilizer by the door  In the rear of the sterilizer by the drains  Near emission control devices  In the tank changing area  When cylinders or connections leak
  34. 34. EtO Safety Precautions:  When transferring sterilized items to aeration cabinets, wear gloves made of neoprene or other appropriate protective material  Do not hold sterilized items that have not been aerated close to your body  When transporting a from the sterilizer to the aerator, pull it instead of pushing to avoid inhaling EtO fumes  Avoid working in areas immediately adjacent to the EtO sterilizer during its cycle. When possible, EtO sterilizer should be located in a separate room  Facilities must have a dedicated ventilation system to remove fumes exhausted during the cycle  Audible and visual alarms should be installed to alert workers to the presence of EtO in the work area
  35. 35. EtO Safety Precautions: Facilities must comply with federal, state, and local requirements for: Air Quality Worker Safety Discharge Air Monitoring Recordkeeping
  36. 36. EtO Safety Precautions:  With some sterilizers the door of the sterilizer must be opened 6 inches after the cycle is complete and the load must sit in the chamber for 15 minutes before transfer to the aerator. (Check manufacturer’s instructions for specific guidelines)  Once items have been placed in an aeration cabinet, the cycle should not be interrupted and the door of the aerator should not be opened  No items should be removed from the aerator until the aeration cycle is complete  Do not mix loads in the aerator. Do not add newly sterilized items to an aerator that has other items in it  Report EtO exposures immediately  Observe out of order and electrical lock out signage
  37. 37. Employee Accident and Injury Reports  All employee accidents and injuries must be reported  Page 409 in the text provides an example of an employee injury report
  40. 40. Ergonomic Stressors: Force - Such as heavy lifting or manipulating equipment or tools Repetition – Using the same motion continually or frequently Awkward Positions – Assuming positions that place stress on the body Vibration – Rapid oscillation of the body or a body part Contact Stress – Pressing the body or a body part against a hard or sharp edge
  41. 41. Reducing WMSDs Management and Staff must commit to implementing and following work procedure and equipment changes that reduce the risk of WMSDs All employees must be trained properly An evaluation of the training programs must be assessed
  42. 42. Reducing the Risk of Injury  Central Service employees should also maintain their physical health in a manner consistent with the physical demands of their work
  43. 43. Preventing Patient Injuries  Central Service Technicians help keep patients safe from injuries, accidents, and infections
  44. 44. Preventing Patient Injury Patient Care Equipment  Test and document all patient care equipment according to manufacturer’s guidelines  Ensure that all equipment has been properly decontaminated  Ensure that all equipment is free from visible defects, such as bent parts, frayed electrical cords, etc.  Track and control equipment, document its use  Ensure that regularly scheduled preventive maintenance is performed and documented  Ensure that the facility’s Biomedical Engineering Department is involved in equipment testing as required  Assure that safety guards are placed over items as required  Always cover contaminated equipment being transported to Central Service to prevent cross-contamination
  45. 45. Preventing Patient Injury Contaminated Supplies and Reusable Medical Devices Ensure that all items are thoroughly disassembled, cleaned, inspected, prepared, packaged, and sterilized according to protocol Test processing equipment Ensure that everyone is properly trained on the equipment they use Insure that all instruments are complete and functional before use Monitor all sterilization equipment
  46. 46. Preventing Patient Injury Chemical Residues Ensure that all items sterilized with EtO are thoroughly aerated before dispensing them for patient use Ensure that all items placed in the EtO sterilizer are dry before they are sterilized Thoroughly rinse items soaked in glutaraldehyde or other chemicals
  47. 47. Preventing Patient Injury Supply and Equipment Transport Use caution when approaching doors, hallway intersections, elevators and high traffic areas Do not use a transport vehicle to prop open or push open automatic doors Do not block hallways with carts and equipment Do not block doors with carts and equipment
  48. 48. Reporting Patient Accidents, Injuries, and Incidents ALL accidents, injuries or incidents involving patients must be reported and investigated All healthcare workers should report unsafe practices or hazards that could pose a threat to patients
  49. 49. Sterilization Process Malfunctions:  If a sterilization process malfunctions, all items in any loads that are thought to be unsterile must be recalled  All Central Service Technicians must be aware of their department’s recall policy
  50. 50. Basic Steps in the Load Recall Process: Obtain a list of all supplies known to be in the load Verify the sterilization controls Notify the Central Service Supervisor, Manager, or Director Notify areas (user units) where unsterile items may be located Retrieve as many items as possible Notify Infection Control, the Operating Room, and the administration according to policy
  51. 51. Basic Steps in the Load Recall Process: Notify physicians if unsterile items were used in any procedures they preformed Document all steps taken Notify Risk Management Department Ensure that qualified service personnel inspect the malfunctioning equipment and that a comprehensive report is developed Consult ANSI/AAMI ST79 for specific information regarding testing before the sterilizer is placed back into service
  52. 52. Central Service Occupational Hazards Physical ChemicalBiological
  53. 53. Fire and Explosions  All healthcare employees must take precautions to minimize the risk of fire and explosions in the healthcare facility
  55. 55. Healthcare Fire Safety Programs Must Include: Minimization of the Combustible Load Fire Response Plans Early Detection Removal of Persons in Danger Containment of Fire and Combustible Products Extinguishment Evacuation
  56. 56. Fire Triangle Combustible/Flammable Substance Source of OxygenSource of Ignition
  57. 57. Many Facilities Use the RACE Plan Remove persons in danger Alarm Call 911 or activate alarms Contain the fire. Close doors in the area Extinguish the fire if safe or Evacuate the area
  58. 58. Hazardous Substances  Healthcare facilities must develop a plan to safely handling chemicals and other hazardous substances  Original and secondary containers of chemicals must be clearly labeled
  59. 59. MSDS Sheets  The chemicals used in Central Service are very different from the ones you use at home.  MSDS Sheets help us understand how to use them safely and what to do in an emergency.  Understanding our Chemicals is in your own best interest.
  60. 60. MSDS Sheets Contain Important Information  Product Identification  List of Hazardous Ingredients  Physical Data  Fire and Explosion Information  Reactivity Data  Health Hazard Data  Storage Recommendations  Emergency and First Aid Procedures  Spill or Leak Procedures  Protection Information and Control Measures  Special Precautions
  61. 61. Healthcare Facilities must:  Make MSDS sheets available to employees.  Provide training to employees  Central Service Technicians are responsible to handle hazardous substances according to procedures
  62. 62. Hazardous Substances  Pages 421 and 422 in the text provide lists of common hazardous materials by hospital department and a list of regulated chemicals and their exposure limits
  63. 63. Disaster Plans and Preparedness
  64. 64. …BEING READY FOR THE UNEXPECTED… Disaster Preparedness...
  65. 65. Types of Disasters
  66. 66. Internal Disaster  Any situation with the potential to cause harm to Central Service employees or where the loss of utilities may drastically impact department operations (i.e. fire, the loss of water, etc.)
  67. 67. External Disaster  A situation in which activities external to the facility affects departmental or facility operations (i.e. a natural disaster, a terrorist attack, etc.)
  68. 68. Elements of a Central Service Disaster Plan:  An emergency call list outlining lines of authority and key individuals to be notified in specific types of disasters
  69. 69. Elements of a Central Service Disaster Plan:  Protocols for inventory replenishment and delivery of emergency supplies
  70. 70.  Posted evacuation plans and practices drills to ensure that employees know alternative ways to leave the department if their safety is at risk Elements of a Central Service Disaster Plan:
  71. 71.  A well-known and understood organizational structure that presents lines of authority  Responsibility lists to identify employees responsible for certain tasks during disaster situations Elements of a Central Service Disaster Plan:
  72. 72.  Directions for alternative communications and transportation if existing systems (i.e. telephones, elevators, etc.) cannot be used Elements of a Central Service Disaster Plan:
  73. 73.  Directions for locations for utility and power shut off points  Plans for prioritizing sterile processing and supply distribution based on failing utilities or internal damage Elements of a Central Service Disaster Plan:
  74. 74.  A facility risk assessment that assesses the facility’s current level of preparedness to help guide planning efforts  A description of how the institution's disaster planning and response efforts are integrated with other community response organizations Elements of a Central Service Disaster Plan:
  75. 75. The Threat of Bioterrorism
  76. 76.  Planning for suspected or confined terrorism events must be well-organized and rehearsed The Threat of Bioterrorism
  77. 77. Factors that Should alert Healthcare Providers to the Possibility of a Bioterrorism Attack: A rapidly increasing disease incidence in a normally healthy population An epidemic curve that rises and falls in a short period of time An unusual increase in the number of people with respiratory and gastrointestinal complaints An endemic disease rapidly emerging at an uncharacteristic time or in an unusual pattern
  78. 78. Lower attack rates among people who have been indoors, especially areas with filtered air or closed ventilation systems A cluster of patients arriving from a single locale Large numbers of rapidly fatal cases Any patient presenting a disease that is relatively uncommon and has bioterrorism potential (i.e. tularemia, pulmonary anthrax, etc.) Factors that Should alert Healthcare Providers to the Possibility of a Bioterrorism Attack (cnt’d):
  79. 79. Endemic Disease  A disease that occurs more or less continuously throughout a community
  80. 80. Checklist for Disaster Readiness Page 427 in the text provides a checklist for Disaster Readiness
  81. 81. In All Activities, Central Service Technicians Must:  Protect the Patient  Protect Fellow Healthcare Workers  Protect Themselves