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Transcript of Chapter 21 safety
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CHAPTER 21
Safety
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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
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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
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“Safe”
Freedom from danger, risk or injury
Central Service Technicians are responsible for working safely after they have been ,made aware of workplace hazards
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Accidents and Injury:
Are not funny
Can happen to anyone
“It will never happen to me.” is a dangerous attitude
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HAZARDS
Common Central Service Workplace
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Soiled Receiving and Decontamination Areas
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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
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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
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CUTTING INSTRUMENTS INCLUDING KNIVES, SCALPELS,
BLADES, NEEDLES AND SCISSORS OF ALL TYPES
Sharps
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Handling Compressed Gas Cylinders
Central Service Technicians must understand and follow basic safety precautions when handling, transporting, and storing compressed gas cylinders
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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
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SAFETY
Ethylene Oxide
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Dangers of EtO
EtO is a Toxic Gas
100% EtO is Flammable
100% EtO is Explosive
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Carcinogenic
Shown to facilitate cancer in laboratory tests
Follow manufacturer’s handling instructions
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Teratogen
A chemical substance that may cause harm to an unborn fetus
Pregnant women should be aware of teratogens
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Common EtO Terminology
…reading the fine print
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Parts Per Million
Parts Per Million (PPM) is the term used to measure the volume of gas in a vapor
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Time Weighted Average
Time Weighted Average (TWA) refers to the exposure level broken down over the entire length of the employee’s shift
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Short Term Exposure Limit
Short Term Exposure Limit (STEL) refers to the concentration limit over a short time
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Permissible Exposure Limit
Permissible Exposure Limit (PEL) is the maximum concentration limit allowed by OSHA over the length of the shift.
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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
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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
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EtO Safety Precautions:
Facilities must comply with federal, state, and local requirements for:
Air QualityWorker SafetyDischargeAir MonitoringRecordkeeping
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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
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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
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THE PROCESS OF CHANGING WORK, OR WORKING
CONDITIONS TO REDUCE EMPLOYEE STRESS.
Ergonomics
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AN INJURY TO, OR DISORDER OF THE MUSCULOSKELETAL SYSTEM WHERE
EXPOSURE TO WORKPLACE RISK FACTORS MAY HAVE CONTRIBUTED TO THE DISORDER’S DEVELOPMENT OR
AGGRAVATED A PRE-EXISTING CONDITION
Work-related Musculoskeletal Disorder
(WMSD)
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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
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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
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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
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Preventing Patient Injuries
Central Service Technicians help keep patients safe from injuries, accidents, and infections
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Preventing Patient InjuryPatient 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
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Preventing Patient InjuryContaminated 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
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Preventing Patient InjuryChemical 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
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Preventing Patient InjurySupply 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
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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
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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
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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
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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
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Central Service Occupational Hazards
Physical
ChemicalBiological
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Fire and Explosions
All healthcare employees must take precautions to minimize the risk of fire and explosions in the healthcare facility
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THE WEIGHT OF COMBUSTIBLE MATERIALS PER SQUARE FOOT OF
AREA IN WHICH THOSE MATERIALS ARE LOCATED
Combustible Loading
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Healthcare Fire Safety Programs Must Include:
Minimization of the Combustible LoadFire Response PlansEarly DetectionRemoval of Persons in DangerContainment of Fire and Combustible
ProductsExtinguishmentEvacuation
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Fire Triangle
Combustible/Flammable Substance
Source of OxygenSource of Ignition
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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
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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
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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.
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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
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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
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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
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Disaster Plans and Preparedness
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…BEING READY FOR THE UNEXPECTED…
Disaster Preparedness...
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Types of Disasters
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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.)
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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.)
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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
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Elements of a Central Service Disaster Plan:
Protocols for inventory replenishment and delivery of emergency supplies
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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:
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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:
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Directions for alternative communications and transportation if existing systems (i.e. telephones, elevators, etc.) cannot be used
Elements of a Central Service Disaster Plan:
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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:
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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:
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The Threat of
Bioterrorism
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Planning for suspected or confined terrorism events must be well-organized and rehearsed
The Threat of
Bioterrorism
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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
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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):
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Endemic Disease
A disease that occurs more or less continuously throughout a community
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Checklist for Disaster Readiness
Page 427 in the text provides a checklist for Disaster Readiness
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In All Activities, Central Service Technicians Must:
Protect the Patient
Protect Fellow Healthcare Workers
Protect Themselves