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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 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 51 ECLIPSE PHLEBOTOMY NEEDLE 52 RETRACTABLE BUTTERFLY 53 SAFETY LANCETS 54 SAFETY INJECTION DEVICES 55 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 106 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 107 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 108 HIGH-LEVEL DISINFECTANTS • Glutaraldehyde or peroxide-base (OPA) • Transport item to restricted soaking area • Clean before soaking with plastic brush • Wear PPE!!!!!!! • Read MSDS! 109 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 110 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 111 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 112 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) 113 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 114 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!! 115 116 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 117 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 118 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) 119 TB RISK CATEGORIES LOW RISK • < 3 TB patients • Baseline TST • No annual employee TST MODERATE RISK • > 3 TB patients • Baseline TST • Annual employee TST 120 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 !!!!!! 121 INFLUENZA • Provide flu vaccine to staff • Flu declination form • Coughing etiquette policy • Hand washing • Restrict ill HCW from work 122 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 123 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. 124 INFECTION CONTROL • Microorganisms that cause disease are called pathogens. • Bacteria • Fungi • Parasites • Viruses 125 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 126 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 127 PREVENTION • WASH HANDS!!!! • Soap and water if visibly contaminated • OR, an alcohol based hand rub/gel • Before and after EVERY patient encounter 128 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 129 Contact Information Kathy Rooker Columbus Healthcare & Safety Consultants [email protected] 130