PINEHURST SURGICAL CLINIC, P'A' OSHA Training September 2004

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PINEHURST SURGICAL CLINIC, P.A.OSHA Training
September 2004
Revised by Pete McLendon
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OSHA

• The Occupational Safety and Health Act of 1970,
  the law that created OSHA, spells out certain
  duties for all employers and employees.
• Basically, employers are responsible to provide a
  safe work environment and employees are
  responsible to ensure their own safety.

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Safety and Health Hazards

• Imminent Dangers-are hazards that can reasonably
  be expected to cause death or serious physical
  harm immediately.
• Serious Hazards-can cause an accident or health
  hazard exposure resulting in death or serious
  physical harm.
• Other-than-serious hazards-lack the potential for
  causing serious physical harm, but could have a
  direct impact on employee safety and health.

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Electrical Safety

• Hazards of Electricity
• Shock
• Burns
• Arc-Blast
• Explosions
• Fires

• Causes of Electrical Accidents
• Unsafe equipment and/or installation
• Unsafe workplaces caused by environmental factors
• Unsafe work practices

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Preventing Electrical Accidents
Insulation Frayed cord

• Insulation
• no frayed cords
• Electrical protective equipment
• fuses, circuit breakers, cover plates
• Guarding
• access by authorized personnel only

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Preventing Electrical Accidents

• By not following outlined recommendations, the
  potential effects can lead to electrical shock,
  burns and electrocution from contact with live
  parts.
• Do not bring items from home to work because of
  the risk of having an unpolarized two plug
  connection that can become ungrounded.

Standard 29 CFR 1910.304 (f)(4)
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Evacuation Protocols

• Fire
• Tornado
• Earth Quake
• Hurricane
• Act of God

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Fire Safety

• Remain calm, turn off equipment, close
  doors/windows, and evacuate quickly following the
  procedures outlined in our Fire Escape Plan.
• The most important step in the fire escape
  procedure is to verify that everyone is out of
  the building. This should be confirmed before
  attempting to extinguish the fire. Be sure to
  report to your assembly area for accountability.
• Learn the location of the fire extinguishers in
  your area.
• Fire Drills are held 4 times per year.

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WEATHER WHAT IS A WATCH?

• A WATCH means conditions are right for a tornado
  and/or hurricane to develop. Plan your action.

• If a WATCH is issued
• Keep the radio or TV tuned to weather casts.
• Be alert for changes in the weather.
• Be prepared to move to a safe shelter.

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WEATHER WHAT IS A WARNING?

• A WARNING means a tornado and/or hurricane has
  been sighted. Seek shelter.

• If a WARNING is issued
• Seek shelter
• Seek the interior rooms on lower floors
• Stay away from windows, exterior walls, and large
  open rooms.

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Things to Remember in a Weather Emergency

• Move to the center of the building or your
  departments designated area if there are violent
  weather conditions.
• Keep away from file cabinets and other objects
  which may fall.
• Do not use matches or lighters in the event there
  is a loss of power. Have emergency flash lights
  available.

• Avoid elevators!
• Remain calm. Reassure others nearby.
• Help patients.
• Watch out for falling plaster, bricks, light
  fixtures and other objects.
• Stay in the building unless you are in immediate
  danger.

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WHAT IS A CODE 4?

• Any life threatening condition (e.g. heart
  attack, stroke, hemorrhage)
• The following procedures are to be followed in
  the event of a Code 4
• 1. Patient goes into Code 4 condition.
• 2. Nurse or person on the scene notifies nearest
  secretary of Code 4 incident and location. Nurse
  then returns to the patient and attempts
  resuscitation.

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WHAT IS A CODE 4?

• 3. Secretary immediately implements the following
  proceduresa. Dial 604 on the phone (paging
  system) and announces     CODE 4, DEPARTMENT
  NAME ____________b. Calls Rescue Squad - 911c.
  Informs business office receptionist in their
  department of Code 4 and location.d. Calls the
  switchboard, Ext. 200 for names of doctors in
  that morning and/or afternoon.e. Stays at the
  desk and acts as central information point.

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WHAT IS A CODE 4 ?

• 4 . Business office receptionist, after
  notification by secretary immediately goes to
  main hallway in front of department and directs
  incoming personnel and doctors to location of
  Code 4 incident.
• 5. One nurse or lab technician from each
  department is to come to Code 4 scene. These
  personnel are designated and if not present would
  be replaced by other nurses and/or lab personnel
  in department.
• 6. Code 4 physicians are designated as any
  physician in the clinic at time of Code 4. There
  should be at least 2 physicians available for
  each half-day session. Also, any physician in
  department where Code 4 occurs, if in, is to be
  present. They will be notified by personnel in
  department.

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WHAT IS A CODE 4?

• 7. Identical crash carts are located in each
  department for a Code 4 situation.
• If your crash cart does not have a
  defibrillator, designate a department which does
  and have them transport their defibrillator to
  your department in the event of a Code 4
  situation.
• The following departments have defibrillatorsGen
  eral Surgery/Cardiac-Thoracic, Orthopaedic, Head
  and Neck.

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WHAT IS A CODE 4?

• 8. If a Code 4 situation occurs in an area
  without a crash cart
• On the second floor, Head and Neck should bring
  their crash cart in response to the Code.
• In Medical Records or the Lab,  General
  Surgery/Cardiac-Thoracic should bring their crash
  cart in response to the Code.

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WHAT IS A CODE 4?

• 9. Business office receptionist, after directing
  Code 4 respondents to Code 4 scene are to locate
  and direct incoming ambulance/rescue to Code 4
  scene.
• 10. Personnel in other departments, upon hearing
  Code 4 announcement are to immediately notify
  designated Code 4 personnel and physicians in the
  clinic that day of occurring Code 4 and location.
  
• 11. The Code 4 response team should designate a
  Team Leader (the most qualified person at the
  scene) and a Recorder (a person who records all
  events on paper).
• 12. After Code 4 incident is resolved, those
  designated personnel involved will fill out the
  appropriate forms and forward to the Human
  Resources Department.

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WHAT IS A CODE 4?

• Code 4 Designated Response Teams
• These teams consist of employees from each
  department and are responsible for responding to
  a Code 4 emergency situation. The primary
  employee should always respond first. If the
  primary employee is not available, the back-up
  employee should respond. If neither are
  available, the next most qualified employee in
  the department should respond.NOTE This list is
  subject to change at any time. You will be
  informed from time to time of any changes.

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Hazard Communication Standard The Right to Know

• The Right to Know Law requires that employees be
  protected from occupational exposure to hazardous
  chemicals
• The Hazard Communication Standard involves
  anyone who comes into contact with hazardous
  chemicals
• The standard covers MSDS, Labels/Labeling,
  Written HAZCOM Policy, and Employee Information
  and Training

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MSDS

• Manufacturers prepare a Material Safety Data
  Sheet (MSDS) for each hazardous product they
  make.
• The PSC Purchasing Department is responsible to
  obtain a copy of the MSDS for each product we
  buy.
• All MSDS information is kept online in our MSDS
  database. This database will also contain a
  Summary Hazardous Chemical Substance List.
• As new products/chemicals are ordered, the
  departments must review the MSDS, be familiar
  with the risks associated with the chemicals, use
  the appropriate PPE (Personal Protective
  Equipment) and be prepared to handle emergency
  actions in the event of a chemical spill.

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Spill Clean-Up

• Each Department has a BIOHAZARD AND CHEMICAL
  SPILL KIT.
• Kit Contents
• DISPOSABLE SURGICAL GOWN DISPOSABLE SHOE
• LATEX GLOVES COVERS
• EYE PROTECTION PAPER TOWELS
• CAT LITTER/ABSORBENT MATERIAL SHOVEL
• WHITE PLASTIC BAG ANTISEPTIC HAND
• RED BIOHAZARD BAG TOILETTE
• ALWAYS refer to the MSDS for specific clean-up
  procedures for that chemical agent.

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Infectious Waste Disposal

• ALL REGULATED infectious waste must be placed in
  a RED BIOHAZARD bag/container. These should be
  located in each exam room or procedure room.
• Contaminated needles and other sharps must be
  placed in appropriately labeled, red leak proof
  containers immediately after use.
• Once these containers are ¾ full, they are to be
  taken to the lab department. These containers are
  then placed in a larger box for disposal and
  secured in the designated pick up area outside of
  the central lab facility. A contracted company
  will pick these items up for disposal.
• These same procedures should be utilized at our
  satellite facilities as well.

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Infectious Waste Disposal
ALL NON-REGULATED WASTE can be placed in a
regular waste bag or other white bags that may be
marked with the biohazard symbol which indicates
medical waste. These items will go to the
landfill for disposal.
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Bloodborne PathogensModes of Transmission

• Sexual Contact
• Mucous membrane exposure
• Transfusion with infected blood
• Infected mother to her infant during pregnancy or
  at the time of birth (HIV)
• Contaminated instruments (HBV/HCV).

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Personal Protective Equipment

• PSC provides all PPE for employees. This
  includes gloves, mask, eye/face protection,
  gowns, aprons, lab coats, surgical caps and
  hoods, shoe covers and boots.

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HIV - Symptoms

• FATIGUE
• FEVER
• SKIN LESIONS
• WEIGHT LOSS
• SWOLLEN LYMPH GLANDS (NECK, UNDERARM, GROIN)

• NIGHT SWEATS
• MOUTH SORES
• DECREASED APPETITE
• DIARRHEA
• NEUROLOGICAL IMPAIRMENTS

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Hepatitis B Facts for Healthcare Workers

• Hepatitis B infection is the major infectious
  occupational hazard to healthcare workers.
• Hepatitis B is a viral infection causing
  inflammation of the liver. Similar symptoms can
  be caused by a number of other viruses,
  medications, and chemicals. Hepatitis B can be
  found in virtually all body fluids and secretions
• Annually, it is estimated that 300,000 cases of
  HBV infections without pre-or post-exposure
  occur, 10,000 hospitalizations, and 250 deaths.
• prophylaxis, 6-30 of non-immune healthcare
  workers who sustain an exposure from an
  infectious source develop hepatitis B infection.

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Hepatitis B - Symptoms

• ANOREXIA
• MALAISE
• NAUSEA
• VOMITING
• ABDOMINAL DISCOMFORT
• JAUNDICE

• RASH
• MILD FEVER
• CIRRHOSIS
• LIVER CANCER

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Hepatitis B Vaccination
The hepatitis B vaccine is made available to all
employees who have occupational exposure. This
vaccination is available at no cost to the
employee. Each employee will receive training
and if necessary initial vaccination within 10
working days of hire or job change.
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Hepatitis B

• The vaccine is not available for employees who
• Have been previously vaccinated.
• Have known immunity according to antibody testing
• Hypersensitivity to yeast, receiving
  hemodialysis, immunosuppressed
• Each employee must receive a physicians approval
  to begin immunization.
• Pregnant or lactating women (need written consent
  from physician)
• No other prescreening is required.

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Hepatitis C

• Hepatitis C was formerly known as Non A- non B
  hepatitis and was traditionally
  transfusion-associated. But it now affects
  healthcare workers and drug needle users. It is
  also a virus that causes inflammation of the
  liver. Hepatitis C is transmitted in the same
  manner as Hepatitis B. It also manifests similar
  symptoms as HBV.

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Tuberculosis

• Tuberculosis, TB, is a disease caused by bacteria
  called Mycobacterium tuberculosis. The bacteria
  can attack any part of your body, but usually
  attack the lungs.
• TB is spread through the air from one person to
  another. The bacteria are put into the air when
  a person with TB sneezes or throat coughs.
  People near by may breathe in these bacteria and
  become infected.
• The clinic performs TB testing prior to
  employment and annually thereafter for all
  employees.

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TB Symptoms

• A bad cough that lasts longer than two weeks
• Pain in chest
• Coughing up blood or sputum
• Weakness or fatigue
• Weight Loss
• No appetite
• Chills, Fever, Night Sweats

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Exposure Incident

• An exposure incident occurs when a patients
  body fluids may have gained entry into an
  employee. Should this occur, the employee must
  quickly follow these procedures
• Wash the exposed area with soap and running water
  and stimulate blood flow.
• Notify your Supervisor immediately
• Complete the Employee Exposure to Potentially
  Infectious Human Blood and Body Fluid Form. This
  form will lead you through all protocol steps and
  is available on the Intranet.

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ERGONOMICS
A MULTI-DISCIPLINARY ACTIVITY DEALING WITH THE
INTERACTIONS BETWEEN PEOPLE AND THEIR TOTAL
WORKING ENVIRONMENT PLUS SUCH TRADITIONAL AND
ENVIRONMENTAL ASPECTS AS ATMOSPHERE, HEAT, LIGHT
AND SUN, AS WELL AS TOOLS AND EQUIPMENT OF THE
WORKPLACE.
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GOALS OF ERGONOMICS

• AMPLIFY HUMAN CAPABILITIES
• UTILIZE HUMAN ABILITIES
• FACILITATE HUMAN EFFICIENCY
• AVOID OVERLOADING OR UNDERLOADING
• MAKE THE WORKPLACE USER FRIENDLY

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Musculoskeletal Disorders (MSDs) Signs and
Symptoms

• Signs are documented, objective physical findings
  that an employee may be developing an MSD.
  Examples of signs include
• decreased range of motion
• deformity
• decreased grip strength
• loss of function

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MSD Signs and Symptoms

• Examples of symptoms include
• numbness
• burning
• pain
• tingling
• cramping
• stiffness

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Workplace Organization

• Make sure that you organize your work area
• Have sufficient desk area which allows you to
  position your keyboard, mouse, display, document
  holder and other items (such as a telephone) in
  the way that works best for you.
• Organize your desk to reflect the way you use
  work materials and equipment. Place the things
  that you use most regularly, such as a mouse or
  telephone, within the easiest reach.
• Vary your tasks and take periodic breaks. This
  helps to reduce the possibility of discomfort or
  fatigue.

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Back Injury Prevention
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Our Knack for Bad Backs

• It is estimated that 8 out of 10 Americans will
  have a back problem at some time in their lives.
• Back pain is one of the most common health
  problems affecting working people in the U.S.
• It affects people of all ages and in all
  occupations-those whose jobs require heavy
  physical labor and those whose jobs keep them
  seated for most of the day.

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Back Injury Prevention

• Causes of Back Strain
• The way you perform your tasks, and the way you
  treat your back and yourself.
• It is when a person is tired and careless that
  strains can occur.
• Remember to slow down and ask for assistance if
  you need to lift things that are too heavy for
  you too handle.
• Anytime you intend to take on a job that you are
  not accustomed to, or begin a new job requiring
  more use of your back, you must train yourself to
  meet the new exertion.

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Back Injury Prevention

• Are you at risk?
• You are most at risk for back pain if
• Your job requires frequent bending and lifting
• You must twist your body when lifting and
  carrying an object
• You must lift and carry in a hurry
• You are overweight
• You do not exercise regularly or do not engage in
  recreational activities
• You smoke

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How to Work Properly and Avoid Strain

• Moving Patients
• To move a patient lying on an exam table to a
  wheelchair, put the wheelchair close to the table
  and lock the wheels.
• If the patient is not strong enough to sit up,
  place one of your arms behind the patients legs
  and place your other arm under the patients
  back.
• Move the patients legs over the edge of the
  table while pivoting his or her body so the
  patient ends up sitting on the edge of the table.
• Keep your feet shoulder-width apart, your knees
  bent and your back in a natural straight position
  as you help the patient sit upright on the table.

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How to Work Properly and Avoid Strain

• Moving Patients
• Standing up
• If the patient needs assistance getting out of a
  chair, face the patient, spread your feet
  shoulder-width apart, and bend your knees.
• Position the persons feet firmly on the floor
  and slightly apart.
• The persons hands should be on the bed or
  armchair or on your shoulders.
• Place your arms around the persons back and
  clasp your hands together or use a transfer belt
  which fits around the persons waist and provides
  a secure handhold.
• Hold the person close to you, lean back, and
  shift your weight as you lift the person to an
  upright position.

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How to Work Properly and Avoid Strain

• Moving Patients
• Sitting Down
• Pivot toward the chair, bend your knees, and
  lower the person into the chair. The person
  should have both hands on the arms of the chair
  before you lower him/her down.
• Caring
• Caregivers who assist seated or reclining persons
  for long periods of time should stand with their
  knees bent and their back in a natural straight
  position. Dont bend at your waist.

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What to do In Case of Injury

• If your back catches or has a sudden, painful
  muscle spasm at work, you can
• Relieve the pain by assuming a squatting
  position.
• Sitting on a chair or bench and leaning forward
  for a short time can also be beneficial.
• Lying down and supporting your legs on a chair or
  bench for a time can also help. Be sure to relax
  and do this for 20-30 minutes.
• Ice packs help reduce the initial pain and
  swelling.
• Most back pain disappears in a few days.

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Quiz

• True or False
• A tornado watch means that a tornado has been
  spotted.
• You are not allowed to bring in electrical items
  from home since they may cause electrical
  problems due to improper grounding.
• The most important step in the fire escape
  procedure is to make sure that everyone is out of
  the building.
• Back pain only affects people that do heavy
  physical labor.
• Multiple Choice
• Some hazards of electricity include (Choose All
  that Apply)
• Shock
• Choking
• Burns
• Arc Blast
• Our chemical spill kits include (Choose All that
  Apply)
• Paper Towels
• Shoe Covers
• Cell Phone
• Latex Gloves
• A Code 4 should be called for (Choose All that
  Apply)
• Heart Attack