Handling of contaminated laundry

1
Handling of contaminated laundry

• Bag and containerize where used (no rinsing or
  sorting)
• Bags labeled and color coded and leak proof
• Protective gloves used when handling laundry

2
Employee Training

• Available hepatitis B vaccine, post exposure
  evaluation, and follow-up to employees who had
  incident
• Training at initial assignment and annually
• OSHA standard
• Explanation of HIV and hepatitis B diseases
• Modes of transmission
• Exposure identification
• Tasks which involve exposure
• Methods used to prevent exposure
• Personal protective equipment use
• Decontamination procedures
• Emergency procedures
• Exposure incident procedures

3
Labels and signs

• BIOHAZARD
• Use of red bags and containers in stead of labels

4
Recordkeeping

• Vaccination and other medical records
• Training records

5
Medical Waste Handling

• State and local laws (44 states require disposal
  and tracking) and RCRA Subtitle J Medical Waste
  Tracking Act Demonstration Program
• Council of State Governors - Model State Plans
  for Medical Waste
• Identify waste
• Packaging and label
• Segregation
• Destruction of waste
• Disposal - most require treatment before disposal
  
• Recordkeeping and tracking
• Training employees
• Incineration, steam autoclave, microwave,
  grinding and chemical treatment
• Transporter and disposal site permitting and
  insurance concerns

6
Infection Control Plan

• Early detection through skin tests
• Training and information
• signs and symptoms
• medical surveillance and therapy
• Site procedures
• Use of controls
• Medical screening and re-test every 6 months ( 3
  months for high risk and 12 months for low risk)
• Management and restriction of infected
  individuals
• Isolation rooms under negative pressure and
  warning signs
• PPE - HEPA respirators

7
Latex Allergies

• Rise in latex glove use as result of OSHA
  Bloodborne pathogen standard and CDC
  recommendations for universal precautions
• Affects about 8 to 10 of health care workers
• Direct skin contact with latex or airborne
  powders from inside
• Severity and hypersensitivity grows with exposure
• Symptoms include contact dermatitis, anaphylactic
  shock, respiratory failure
• Can be confirmed through patch skin testing
• Cornstarch powder can carry latex protein and
  become airborne - air sampling can be done to
  assess exposure
• Control through education, substitution, low
  powder/low allergy gloves, manufacturing rinse
  processes, complete avoidance, and medical
  history and screening
• New non-powdered gloves, low allergen gloves,
  non-latex gloves, establishment of safe zones for
  sensitized

8
Indoor Air Quality/Sick Building Syndrome

• Sensitive elderly population
• Investigation techniques
• Questionnaire
• Air sampling (specific contaminants or indicator
  gasses)
• Ventilation evaluation
• Heat/humidity evaluation
• Sources (chemical, biological, inside, outside,
  chemicals, off-gassing of furnishings)
• Controls (low emission furnishings, HVAC
  maintenance, chemical control, local ventilation
  of sources, moisture control, fresh air volume
  and mixing)
• Standards (chemical levels, CO, ventilation)

9
Life Safety Code

• Topics come from Texas Department of Aging and
  Disability Services (DADS)
• DADS Nursing Facility Requirements for Licensure
  and Medicaid Certification

10
Life Safety Code

• Every facility should have written fire
  procedures
• Staff should be trained on plan
• Staff should practice plan
• Important to know
• PATIENT SAFETY IS YOUR 1 PRIORITY

11
Life Safety Code Response

• Call out code to alert staff
• Activate alarm
• Evacuate all in immediate danger
• Close doors to contain smoke/fire
• Once contained to room of origin, DO NOT
• reopen door or re-enter room
• Close all patient room doors
• MAKE SURE NO RESIDENT IS LEFT BEHIND. . .

12
Life Safety Code Fire Service Access

• Facility must be served by a paid or volunteer
  fire department
• Facility must have an annual inspection by local
  Fire Marshall
• Facility must be served by adequate water supply
• There must be at least one approved readily
  accessible fire hydrant within 300-feet of the
  building.

13
Life safety Code Means of Egress

• Corridors means of egress must be kept clear of
  obstruction
• Was of egress and exit signs must be illuminated
  at all times
• There must be at least ONE working flashlight per
  nurses station
• No latch or lock which requires a key, etc.

14
Life Safety Code Fire Alarms, etc.

• Must be as required by LSC NFPA 72 13
• Wiring must be in compliance with NFPA 70
• Smoke detector sensitivity must be checked
  annually
• Alarm system designed so that when activated the
  following occurs
• Smoke fire doors close smoke dampers close
  alarm indicating location is clearly indicated on
  panel air handlers serving 3 or more rooms, or
  egress, shut down, immediately

15
Life Safety Code - Fire Alarms, etc.

• Alarm bells or horns must be consistent and
  located throughout building
• Flashing alarm lights must be installed to be
  visible in corridors, public areas including
  dining and living room areas
• Master control panel which indicates location of
  alarm/trouble must be visible at main nurse
  station

16
Life Safety Code - Fire Alarms, etc.

• Remote annunciator panels, must be located at
  auxiliary or secondary nurses station on each
  floor
• Manual pull stations at all exits living rooms
  dinning rooms and at or near nurses station
• Kitchen range hood extinguisher must be
  interconnected with alarm system

17
Life Safety Code Portable Fire Extinguishers

• Comply with NFPA 10
• Travel distance no greater than 75-feet
• Minimum Size 2.5 gallon water or 5-pound ABC
• Installed on supplied hangers or cabinets
  approved by TDHS
• Surface wall mounted or recessed in cabinets

18
Life Safety Code Portable Fire Extinguishers

• If gross weight less than 40-pounds top of
  extinguisher must be no higher than 5-feet above
  floor
• If gross weight greater than 40-pounds top of
  extinguisher must be no higher than 3.5-feet
  above floor
• Clearance between bottom of fire extinguisher and
  floor must not be less than 4-inches

19
Life Safety Code Portable Fire Extinguishers

• If provided in hazardous rooms, it must be
  located as close as possible to door opening and
  on the latch (knob) side
• Staff must be appropriately trained on each type
  of extinguisher in your facility

20
Disaster and Emergency Preparedness

• Facility must have detailed and written plans and
  procedures
• Facility must train all employees in emergency
  procedures when they begin to work
• Carry out unannounced drills

21
Emergency Power

• Emergency electrical power system must supply
  power adequate at least for lighting all
  entrances exits equipment to maintain the fire
  detection alarm, and extinguishing systems, and
  life support systems
• Battery systems must be capable of sustaining
  power for 1.5 hours

22
Elevators and Escalators

• Elevators must comply with
• Life Safety Code
• American National Standard Institute for
  Elevators and Escalators (ANSI/ASME A17.1)
• Passenger elevators must be inspected every
  6-months
• Freight elevators inspected every 12-months

23
Safety Operations

• Facility must have written EAP and Response Plan
• Plan must as minimum address 8 Core Functions of
  Emergency Management

24
Safety Operations - 8 Core Functions of
Emergency Management

1. Direction and Control
2. Warnings
3. Communication
4. Sheltering Arrangements
5. Evacuation
6. Transportation
7. Health and Medical needs
8. Resource Management

25
Safety Operations

• Must maintain plan and procedures at Nurses
  Station and with Department Managers within
  facility
• Included must be evacuation routes in event of
  fire explosion other disaster
• Include procedures for transfer of casualties
  clinical records medications and notification
  of appropriate person(s)

26
Safety Operations

• All employees must be familiar with disaster plan
  and trained
• Instructed in location and use of facilitys
  alarm system, fire-fighting equipment, etc.
• Facility must post fire and explosion evacuation
  routes
• Must have a fire safety plan within disaster plan

27
Safety Operations

• Fire safety plan must be rehearsed Quarterly,
  on each shift, with at least one a month
• A comprehensive fire drill report form must be
  completed for each rehearsal

28
Safety Operations

• In smaller, simple, one story buildings where
  exits are obvious, DHS, may not require posting
  of evacuation routes
• Must have an emergency contingency plan to ensure
  residents comfort and safety, including the
  provision of potable water

29
Safety Operations

• Emergency telephone numbers must be clearly
  posted on or near each phone and include numbers
  for
• Local fire department
• Police
• EMS

30
Safety Operations

• MUST report all fires to DHS within 15-days of
  fire
• Must NOTIFY DHS of any disaster or fire resulting
  in serious injury or death, followed by written
  reports
• Fire alarm and sprinkler systems must be tested
  and inspected, QUARTERLY
• The facility can make simple and periodic test of
  its basic alarm system

31
Safety Operations

• Emergency Generators
• Inspected and run under load, weekly for
  30-mintues
• Battery Powered Emergency Lighting Systems
• Functional test every 30-days for 30 min.
• Annual test for 1.5 hrs

32
Safety Operations

• Portable Fire Extinguishers - Kitchens
• Automatic fixed or dry-chemical extinguishers
  mounted in kitchen range
• Inspected every 6-months
• Hoods, exhaust duct, filters must be kept clean
  and free of grease accumulation, etc.

33
Safety Operations

• Portable Fire Extinguishers
• Inspected monthly by employees
• Inspected annually by licensed agent
• Meet NFPA 10 requirements
• Records of annual maintenance kept at facility

34
Safety Operations

• Gas Utility Lines
• Annual tests must be conducted on line from the
  meter and appliances tested, ANNUALLY
• Results must be maintained on file
• UNSATISFACTORY conditions must be reported,
  immediately

35
Safety Operations

• Smoking policies must be adopted and enforced
• NO SMOKING signs must be posted anywhere oxygen
  is used or stored
• No storage of gas-fired equipment is allowed in
  rooms
• No storage of volatile or flammable liquids is
  allowed within building

36
Safety Operations

• Medical equipment, carts, wheelchairs, tables,
  furniture, vending machines, etc., MUST NOT be
  stored in corridors or means of egress
• Smoke/Fire doors, doors to hazardous rooms, etc.,
  must be kept closed

37
Safety Operations

• Electrical extension cords MUST not be used
• All abandoned utilities such as electrical
  wiring ducts and pipes, etc., must be removed
  from facility when no longer in use.