Safety

1
Safety Security

• Big Bend Community Based Care, Inc.
• 2009

2
Welcome Expectations

• This course is designed for the BBCBC system of
  care.
• To move through the course you will need to
  manually click your mouse to advance the slides.
• At the conclusion of the course you will be asked
  to submit an email of completion to the BBCBC
  training department.
• In addition to the PowerPoint presentation
  successful completion of this course requires
  that each participant familiarize themselves with
  the following BBCBC Operating Policies which can
  be accessed on the www.bigbendcbc.org site
• Policy 1400 General Health Safety
• Policy 1404 Building Maintenance
• Policy 1405 Conflict Resolution De-Escalation
  Training
• Policy 1406 Driver Safety
• Policy 1407 Maintenance of a Safe, Hygienic
  Environment
• Policy 1409 Custody Issuance of Keys

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Course Objectives

• Participants will be able to recognize and
  diffuse potentially violent/hostile situations.
• Participants will be able to identify how to
  intervene, seek assistance, make appropriate
  contacts and document situations that affect
  worker safety.
• Participants will develop an understanding of
  universal precautions and infectious diseases and
  learn how to incorporate prevention and
  appropriate responsiveness in the workplace.
• Participants will gain an overview of Office
  Ergonomics and be able to identify causes and
  solutions for Cumulative Trauma Disorders .

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Violence Threats
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Workplace Violence

• Violence can strike from the outside or from
  within.
• The perpetrator can be a stranger or someone
  known to all.
• It can be the result of a robbery, jealous spouse
  or over a disgruntled employee or angry client.
• The policy at BBCBC is one of zero tolerance
  toward violence. Because of this, all acts or
  threats of violence will be taken seriously.

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Workplace Violence (cont.)

• BBCBC defines a threat or act of violence as
  follows
• Including, but not limited to, any act or gesture
  intended to harass or intimidate another person.
• Any act or gesture likely to damage company
  property.
• Any act or gesture likely to leave another person
  injured or fearing injury.
• All employees are responsible for helping to
  maintain a violence free workplace. To that end,
  each employee is asked to report the act or
  threat to his or her immediate supervisor and/or
  a member of the Administrative Management Team.
  An incident/accident report form should be
  utilized for this purpose. Reports may be made
  confidentially or anonymously if the employee
  feels the need.
• Each act or threat of violence will be
  investigated and appropriate action will be
  taken. Any such act or threat by an employee may
  lead to discipline, up to and including
  termination.

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Precautions and Warning Signs

• There are certain precautions that employees of
  both BBCBC and its contract agencies can use to
  help protect themselves from danger.
• There are warning signs and signals that, when
  observed and understood, assist in preventing
  disruptions or physical violence in the
  workplace.

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Stages and Level of Violence

• Stage 2/Level 2 (Escalated potential for
  violence)
• Ignoring or refusing to obey company policies and
  procedures
• Stealing from the agency or co-workers,
  sabotaging equipment, client files or agency
  property
• Making threats verbally, in writing, by E-mail or
  voice mail
• Blaming others for all problems, sees self as
  victimized by management

• Stage 1/Level 1 (Early potential for violence)
• Dehumanizing other people, name calling, racial
  insults or sexual harassment, other verbal abuse
• Challenging authority, insubordination, refuses
  to cooperate with immediate supervisor
• Regularly being argumentative, alienating client
  or co-workers, consistently argues with
  co-workers or management
• Spreads rumors or gossip

• Stage 3/Level 3 (Potential for violence is
  realized)
• Displaying or brandishing a weapon (knife, gun,
  etc.)
• Physical fights, punching, kicking, slapping
• Committing assault, arson, murder, suicide

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De-Escalating Hostile/Violent Situations

• Use effective listening and communication
  techniques such as
• negotiation and mediation
• remain calm and listen attentively
• maintain eye contact
• be courteous and patient
• Keep the situation in your control
• Involve the person in regaining control and
  encouraging self-calming behaviors
• Separate individuals involved in an altercation
• Offer a voluntary escort to guide the person to a
  safe location
• Employ a time out period to allow the person to
  calm down
• Signal a co-worker or supervisor that you need
  help
• Do not make any telephone calls yourself (this
  could be perceived as threatening and escalate
  the situation)
• Keep talking, but follow instructions of the
  person with the weapon
• Don't risk yourself or others
• Never try to grab a weapon
• Watch for a safe chance to escape to a safe area

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Protection in Parking Areas/Outside Buildings

• Park within the designated parking areas,
  especially when working after dark
• Do not leave purses, briefcases, or other
  valuables in sight, as thieves can easily smash a
  window and steal these items in seconds
• Be aware of surroundings at all times when
  leaving the building, especially in late evening,
  attempt to leave with another staff member

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Visitors and ID Badges

• Visitors should check in with the receptionist
  and should be escorted while in the building and
  not allowed to wander freely. This too applies to
  children as well as adults, clients and
  professionals in the service centers as well as
  the BBCBC administrative office.
• Employees should carry their BBCBC picture ID and
  business cards for presentation when requested
  for security reasons.

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13
Additional Materials-Worker Safety

• Visit the Child Welfare Information Gateway
• http//www.childwelfare.gov/systemwide/workforce/o
  rg_culture/worker_safety.cfm

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Domestic Violence

• Although this is a sensitive area, it is
  important for BBCBC and its contract providers to
  know if an employee has reason to fear the
  non-employees significant other, or if there has
  been any previous physical altercations or
  threats. With this knowledge, BBCBC and its
  provider agencies can assist the employee in
  designing a safety plan to reduce the likelihood
  of a problem occurring.

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Medical Issues
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Infectious Diseases

• An infectious disease is a disease caused by
  bacterial, viral, fungal, or protozoan infection.
  Though some infectious diseases are not
  contagious, others may be transmitted from animal
  to person (bird flu and cat scratch disease) or
  from person to person. Examples include viral
  illnesses, HIV/AIDS, meningitis, whooping cough,
  pneumonia, and tuberculosis.

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Local Infectious Diseases

• The most frequent local infections, including the
  common cold, occur in the upper respiratory
  tract. A serious and usually local infection of
  the respiratory tract is tuberculosis, which is a
  problem worldwide.

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Sites for Infectious Diseases

• Other common sites of infection include the
  digestive tract, the lungs, the reproductive and
  urinary tracts, the eyes or ears. Local
  infections can cause serious illnesses if they
  affect vital organs such as the heart, brain or
  liver. They also can spread through the blood
  stream to cause widespread symptoms.

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Infectious Diseases and the Immune System

• The outcome of any infection depends on the
  virulence of infectious agents, the number of
  organisms in the infecting inoculum and the
  response of the immune system. A compromised
  immune system, which can result from diseases
  such as AIDS or treatment of diseases such as
  cancer, may allow organisms that are ordinarily
  harmless to proliferate and cause
  life-threatening illness.

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Transmission of Infectious Diseases

• Transmission of an infectious disease may occur
  through one or more of diverse pathways including
  physical contact with infected individuals.
• These infecting agents may also be transmitted
  through liquids, food, body fluids, contaminated
  objects, airborne inhalation, or through
  vector-borne spread. Vectors may be mechanical or
  biological.

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Mechanical Vectors and Infectious Diseases

• A mechanical vector picks up an infectious agent
  on the outside of its body and transmits it in a
  passive manner. An example of a mechanical vector
  is a housefly, which lands on cow dung,
  contaminating its appendages with bacteria from
  the feces, and then lands on food prior to
  consumption. The pathogen never enters the body
  of the fly.

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Biological Vectors and Infectious Diseases

• In contrast, biological vectors harbor pathogens
  within their bodies and deliver pathogens to new
  hosts in an active manner, usually a bite.
  Biological vectors are often responsible for
  serious blood-borne diseases, such as malaria,
  and viral encephalitis,. Biological vectors are
  usually, though not exclusively, arthropods, such
  as mosquitoes, ticks, fleas and lice.

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Universal Precautions

• Work practice controls are designed to change the
  way in which a task is performed to reduce the
  likelihood of exposure to bloodborne pathogens.
• The most important work practice control is
  implementation of "universal precautions" which
  are a set of precautions recommended by the CDC
  which are designed to prevent transmission of
  human immunodeficiency virus (HIV), hepatitis B
  virus (HBV), and other bloodborne pathogens when
  providing first aid or health care.
• Under universal precautions, blood and certain
  body fluids of all patients are considered
  potentially infectious for HIV, HBV and other
  bloodborne pathogens.
• Body Fluids requiring the use of Universal
  Precautions
• Universal precautions apply to blood, other body
  fluids containing visible blood, vaginal
  secretions and semen. Universal precautions also
  apply to tissues and to the following fluids
  cerebrospinal, synovial, pleural, peritoneal,
  pericardial, and amniotic fluids.
• Universal precautions do not apply to feces,
  nasal secretions, sputum, sweat, tears, urine,
  and vomit unless they contain visible blood.
• Universal precautions do not apply to saliva
  except when visibly contaminated with blood or in
  the dental setting where blood contamination of
  saliva is predictable.
• General infection control practices are used to
  further minimize the already minute risk for
  salivary transmission of HIV. These infection
  control practices include the use of gloves for
  digital examination of mucous membranes and
  endotracheal suctioning, hand washing after
  exposure to saliva, and minimizing the need for
  emergency mouth-to-mouth resuscitation by making
  mouthpieces and other ventilation devices
  available for use in areas where the need for
  resuscitation is predictable.

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Prevention Efforts in BBCBC Offices

• Each one of our service centers have a constant
  flow of traffic by professionals, caretakers and
  children. An exaggerated effort is made to keep
  the lobby area clean as well as door handles,
  phones and conference areas. Special attention is
  paid to toys in the common areas. Cleaning and
  good hygiene can also prevent
• Influenza
• The common cold
• Strep throat
• Intestinal disorders
• Pneumonia

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Preventing Infectious Diseases

• Wash your hands often/use an alcohol-based hand
  sanitizer, especially
• After using the bathroom
• Before preparing food or eating
• After changing diapers
• After blowing your nose and/or using hands when
  sneezing or coughing
• After caring for a sick person
• After playing with or handling your pet

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Pandemic Flu

• BBCBC is dedicated to ensuring that employees
  needs are met should there be threat of such an
  event as a Pandemic Flu. The following is an
  excerpt from the Department of Health regarding
  an outbreak of a Pandemic Flu (such as Bird Flu).
  This checklist will help to gather the
  information and resources you may need in case of
  a flu pandemic.

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Flu Precautions Response

• 1. To plan for a pandemic
• Store a two week supply of water and food. This
  can be useful in other types of emergencies, such
  as power outages and disasters.
• Have any nonprescription drugs and other health
  supplies on hand, including pain relievers,
  stomach remedies, cough and cold medicines,
  fluids with electrolytes, and vitamins.
• Volunteer with local groups to prepare and assist
  with emergency response.
• Get involved in your community as it works to
  prepare for an influenza pandemic.

• 2. To limit the spread of germs and prevent
  infection
• People with respiratory illness should stay home
  from work or school to avoid spreading
  infections, including influenza.
• Avoid close contact with people who are coughing
  or otherwise appear ill.
• Avoid touching your eyes, nose and mouth.
• Wash hands frequently to lessen the spread of
  respiratory illness.
• People experiencing cough, fever and fatigue,
  possibly along with diarrhea and vomiting, should
  contact their physician.
• If you think you have influenza, please call your
  health care provider and discuss whether you need
  to be seen in their office, emergency department
  or stay home.

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Medical Emergencies

• If the injury is minor, provide first aid as
  necessary with a departmental First Aid Kit.
• If the injury or condition is not minor call
  (9-1-1). Give the operator the following
  information
• Location of victim
• Type of injury
• Your name and call back number
• Notify your supervisor of the situation.
• Follow any further instructions the 911
  dispatcher or you supervisor gives you.
• Comfort victim until EMS arrives.

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Office Ergonomics
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Office Ergonomics

• Ergonomics is the science of designing the job
  to fit the worker, not forcing the worker to fit
  the job. Ergonomics covers all aspects of a job,
  from the physical stresses it places on joints,
  muscles, nerves, tendons, bones and the like to
  environmental factors which can affect hearing,
  vision, and general comfort and health.

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Cumulative Trauma Disorders

• To understand CTDs, it is necessary to understand
  how the body works. Body Movements are produced
  by contracting and relaxing muscles. The muscles
  are attached to bones by tendons. Tendons are
  smooth, and in some parts of the body they glide
  back and forth inside tubes called synovial
  sheaths. The sheath produces a lubricant called
  synovial fluid to help the tendons glide easily.
  CTDs result when repeated stress is placed on the
  tendons, muscles, or nerves causing inflammation
  or damage.

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Cumulative Trauma Disorders (cont.)

• The following are some of the most common CTDs
• Tendonitis inflammation of the tendons
• Ttensynoitis inflammation of the synovial
  sheath
• Carpal Tunnel Syndrome results when the median
  nerve is compressed either form the swelling of
  tendons and sheaths or from repeated bending of
  the wrist.
• Some of the conditions that my lead to CTDs are
• Repetition long or concentrated hours of typing
  or using a mouse.
• Posture long hours of sitting in the same
  position while typing, especially if it is in an
  uncomfortable or poorly supported position, or if
  the wrists are bent.
• Lack of Rest - intensive hours at the keyboard
  with few breaks

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Cumulative Trauma Disorders (cont.)

• Symptoms of CTDs
• Tingling or numbness in the hands or fingers
• Pain in fingers, hands, wrists, or even shooting
  up into the arms or forearms
• Loss of strength or coordination in the hands
• Numbness or discomfort in the hands which wakes
  you up at night.
• Carpal Tunnel Syndrome
• Carpal Tunnel Syndrome is a common problem that
  affects the hand and wrist. This condition, or
  syndrome has become the focus of much attention
  in the last few years due to suggestions that it
  may be linked to occupations that require
  repetitive use of the hands such as typing.

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Preventing CTDs to hands and wrists

• One of the keys to preventing CTDs is to keep
  your hands and wrists in a neutral position as
  possible. In other words, you want to avoid
  typing with your wrist bent to either side, or up
  or down. You do not want your wrists to be
  flexed in any direction.
• The neutral position may be obtained by adjusting
  your desk height, chair height, or keyboard
  position. Here are some tips for preventing hand
  and wrist CTDs
• The keyboard should be slightly lower than normal
  desk height. If it not low enough, try raising
  your chair height. Prevent your legs from
  dangling by using a footrest.
• Home row of keys should be at elbow level

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Preventing CTDs to hands and wrists (cont)

• While typing, it is best not to rest your wrists,
  and they should not be bent up, down or to the
  side. This may be easier if they back edge of
  the keyboard is tilted down slightly, away from
  you. The knuckle, wrist, and top of forearm
  should form a straight line. Wrist supports or
  rests give you a place to rest your hands only
  when pausing from typing, not while you are
  typing.
• Do not pound the keys. Use light touch.
• Use two hands to perform double key operations
  like Ctrl-C or Alt-F instead of twisting one hand
  to do it.
• The elbows should form a 90 degree angle while
  hanging at the sides from the shoulders. They
  should remain relaxed in a lowered position while
  typing.
• Take lots of breaks to stretch and relax. Take
  frequent micro-breaks (lasting few seconds or
  so) as well as longer (several minute) breaks
  every hour or so.
• Hold the mouse lightly
• Keep your hands and arms warm.

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Eyestrain

• Eyestrain is another ergonomic problem frequently
  associated with the use of computers and Video
  Display Terminals (VDTs). Keep in mind that the
  solutions presented here are only
  recommendations.
• If following these recommendations seem to make
  matters worse, try something else!
• If you arent experiencing headaches or eyestrain
  while you work on the computer, dont worry
  about making changes obviously your setup works
  for you.

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Symptoms of Eyestrain

• Sore, tired, itchy, dry, or burning eyes.
• Headaches
• Difficulty focusing between the VDT and source
  documents
• Blurred or double vision
• Color fringes/after images
• Increased sensitivity to light

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Causes of Symptoms

• Glare Glare can be caused by sources of light
  such as windows, lamps , or overhead lighting.
• Look at your monitor screen to see if there are
  any blotches of light. While you may not be
  conscious of this irritation, it can cause
  eyestrain over the course of a long day. Glare
  can also be caused by too much contrast between
  the screen background and the displayed text.
• Solution Adjust your monitor so that it is not
  reflecting the light sources. Tilt the monitor
  down so that it doesnt reflect overhead light,
  or move it perpendicular to windows. Close
  shades or blinds if the computer cannot be moved.
  Move lamps so that they are not reflected
  directly in the monitor. Use glare screens.

• Improper Lighting if the light in the work area
  is too bright or too dim, the human eye has to
  work extra hard to compensate for these harsh
  environmental factors. People may not even be
  aware that their eyes are under duress, but over
  time they may develop symptom of eyestrain.
• Solution use indirect, ambient lighting and an
  adjustable light source at the desk, where extra
  illumination is required.

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Causes of Symptoms

• Eyewear Many computer users wear bifocals or
  trifocal lenses fitted for reading print and
  distance viewing. Sometimes these prescriptions
  may not be adequate for computer work.
• Solution If you wear glasses of any sort and
  frequently experience headaches while working at
  a computer, you should probably check with your
  eye doctor to make sure you are wearing the
  correct prescription for such work.

• Viewing angle and distance If your monitor is
  too far away, you may have to strain to read the
  print. Likewise, if it is too close, you may
  also strain your eyes. If the monitor is too
  high, you will have to angle your neck to look up
  at it, which could cause your neck to be sore,
  and may contribute to headaches. Also, when you
  are continually looking up, you may not fully
  close our eyes when you blink, and this can cause
  your eyes to dry out.
• Uninterrupted focus on the screen When people
  concentrate, they blink less often. Sometimes
  they concentrate so hard that they blink only
  once per minute, instead of the normal once every
  five seconds. This, too, will cause the eyes to
  dry out and become irritated.
• Solution Take micro-breaks! Frequently look up
  from your monitor and focus on an object several
  feet away. Make a conscious effort to blink.

• Uninterrupted focus on the screen When people
  concentrate, they blink less often. Sometimes
  they concentrate so hard that they blink only
  once per minute, instead of the normal once every
  five seconds. This, too, will cause the eyes to
  dry out and become irritated.
• Solution Take micro-breaks! Frequently look up
  from your monitor and focus on an object several
  feet away. Make a conscious effort to blink.

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Physical Stressors

• Include repetitive motions such as those caused
  by typing or any continuous motion. This could
  include work that causes vibration or heavy
  lifting, working in an awkward position, or
  holding a telephone to your ear with your
  shoulder. Repetitive motions, vibration,
  excessive force, and awkward positions are
  frequently linked to ergonomic disorders
  however, the majority to Cumulative Trauma
  Disorders (CTDs) or Repetitive Strain
  Injuries (RSIs) are caused by repetitive
  motions that would not result in undue stress or
  harm if only performed once. Carpal tunnel
  syndrome, tendonitis, Tenosynovitis, Dequarvains
  Syndrome, Thoracic Outlet Syndrome, many back
  injuries, and several other conditions may result
  from repetitive motions.

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Environmental Stressors

• Could include such things as indoor air quality
  or excessive noise. Sick building syndrome,
  with its accompanying headaches, congestion,
  fatigue and even rashes, can result from poor air
  quality in a building or office. Excessive noise
  around heavy machinery or equipment can cause
  permanent haring loss. Improper lighting can
  cause eyestrain and headaches, especially in
  conjunction with computer monitors.
• It is important to listen to the signals your
  body gives you. If you suffer pain in the wrists
  or hands after a long day of typing, examine your
  work area and work practices to see if they may
  be causing the problems. Learn to make
  adjustments. Raise or lower chairs to avoid
  typing with your wrists at an odd angle. Adjust
  computer monitors to avoid glare. Take frequent
  breaks from repetitive tasks to give your body a
  rest. Always use proper lifting techniques.
  Sometimes small modifications to work procedures,
  posture habits, and/or work station design can
  make a big difference in the way you feel at the
  end of a day.

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References

• http//en.wikipedia.org/wiki/Infectious_diseases
• http//www.idsociety.org/factsaboutid.html
• http//www.edcp.org/factsheets/prevent.cfm
• http//www.health.state.ri.us/disease/communicable
  /thingstodo.php
• For More Information
• Visit www.pandemicflu.gov
• The Centers for Disease Control and Prevention
  (CDC) hotline, 1-800-CDC-INFO (1-800-232-4636),
  is available in English and Spanish, 24 hours a
  day, 7 days a week. TTY 1-888-232-6348.
  Questions can be e-mailed to cdcinfo_at_cdc.gov.
• Links to state departments of public health can
  be found at http//www.cdc.gov/other.htmstates.

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Training Documentation

• Thank you for completing this online training
  presentation.
• To document your participation please immediately
  send an email listing your name, position,
  agency, email address, and circuit to the BBCBC
  training department at training_at_bigbendcbc.org
• Please let us know any training topics you would
  like to be provided with in a classroom training,
  online presentation or training resource
  materials.
• BBCBC Training Coordinator contact Carol Edwards
  850-694-0728