CHAPTER 21

Safety

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

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

“Safe”

Freedom from danger, risk or injury

Central Service Technicians are responsible for working safely after they have been ,made aware of workplace hazards

Accidents and Injury:

Are not funny

Can happen to anyone

“It will never happen to me.” is a dangerous attitude

HAZARDS

Common Central Service Workplace

Soiled Receiving and Decontamination Areas

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

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

CUTTING INSTRUMENTS INCLUDING KNIVES, SCALPELS,

BLADES, NEEDLES AND SCISSORS OF ALL TYPES

Sharps

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

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

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

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

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

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

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

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

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

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

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

Handling Compressed Gas Cylinders

Central Service Technicians must understand and follow basic safety precautions when handling, transporting, and storing compressed gas cylinders

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

SAFETY

Ethylene Oxide

Dangers of EtO

EtO is a Toxic Gas

100% EtO is Flammable

100% EtO is Explosive

Carcinogenic

Shown to facilitate cancer in laboratory tests

Follow manufacturer’s handling instructions

Teratogen

A chemical substance that may cause harm to an unborn fetus

Pregnant women should be aware of teratogens

Common EtO Terminology

…reading the fine print

Parts Per Million

Parts Per Million (PPM) is the term used to measure the volume of gas in a vapor

Time Weighted Average

Time Weighted Average (TWA) refers to the exposure level broken down over the entire length of the employee’s shift

Short Term Exposure Limit

Short Term Exposure Limit (STEL) refers to the concentration limit over a short time

Permissible Exposure Limit

Permissible Exposure Limit (PEL) is the maximum concentration limit allowed by OSHA over the length of the shift.

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

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

EtO Safety Precautions:

Facilities must comply with federal, state, and local requirements for:

Air QualityWorker SafetyDischargeAir MonitoringRecordkeeping

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

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

THE PROCESS OF CHANGING WORK, OR WORKING

CONDITIONS TO REDUCE EMPLOYEE STRESS.

Ergonomics

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)

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

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

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

Preventing Patient Injuries

Central Service Technicians help keep patients safe from injuries, accidents, and infections

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

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

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

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

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

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

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

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

Central Service Occupational Hazards

Physical

ChemicalBiological

Fire and Explosions

All healthcare employees must take precautions to minimize the risk of fire and explosions in the healthcare facility

THE WEIGHT OF COMBUSTIBLE MATERIALS PER SQUARE FOOT OF

AREA IN WHICH THOSE MATERIALS ARE LOCATED

Combustible Loading

Healthcare Fire Safety Programs Must Include:

Minimization of the Combustible LoadFire Response PlansEarly DetectionRemoval of Persons in DangerContainment of Fire and Combustible

ProductsExtinguishmentEvacuation

Fire Triangle

Combustible/Flammable Substance

Source of OxygenSource of Ignition

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

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

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.

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

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

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

Disaster Plans and Preparedness

…BEING READY FOR THE UNEXPECTED…

Disaster Preparedness...

Types of Disasters

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.)

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.)

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

Elements of a Central Service Disaster Plan:

Protocols for inventory replenishment and delivery of emergency supplies

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:

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:

Directions for alternative communications and transportation if existing systems (i.e. telephones, elevators, etc.) cannot be used

Elements of a Central Service Disaster Plan:

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:

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:

The Threat of

Bioterrorism

Planning for suspected or confined terrorism events must be well-organized and rehearsed

The Threat of

Bioterrorism

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

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):

Endemic Disease

A disease that occurs more or less continuously throughout a community

Checklist for Disaster Readiness

Page 427 in the text provides a checklist for Disaster Readiness

In All Activities, Central Service Technicians Must:

Protect the Patient

Protect Fellow Healthcare Workers

Protect Themselves