Safety Protocol PDF

# SAFETY PROTOCOL All the safety protocols improving patient safety which would measurably and sustainably reduce the challenges that patient safety is exposed to. These safety protocols are: 1. 5S 2. Radiation Safety 3. Laser safety 4. Fire safety 5. HAZMAT safety 6. Environmental safety 7. Emerge...

# SAFETY PROTOCOL All the safety protocols improving patient safety which would measurably and sustainably reduce the challenges that patient safety is exposed to. These safety protocols are: 1. 5S 2. Radiation Safety 3. Laser safety 4. Fire safety 5. HAZMAT safety 6. Environmental safety 7. Emergency codes 8. Role of nurse in time of disaster ## 5S PROTOCOL/METHOD It's adoption in health care has played a crucial role in structuring and organizing patient area in hospital. This process inherently improves efficiency and reduces wastages, in this manner. - 5S contributing towards improved patient safety. 5S stands for: 1. Sort 2. Set in order 3. Shine 4. Standardize 5. Sustain These all ways make an improved workplace by enabling the elimination of clutter, reorganization of the functional space and enhanced discipline, in its course aiding better patient safety. ### Benefits of 5S 1. As these 5S removed, items that are unnecessary which allows for maximization of efficiency at the workplace. Thus, in turn, increases productivity and limit the amount of time that would be wasted. 2. The 5S method achieves work commitment through its implementation. It encourages participation in the workplace design and maintenance. This involvement helps workers engage and be more responsible for their action, thereby committing to and taking pride in their work. 3. Reduce waste: A report by quality management states that the 5S process implementation yields a reduction in lost and damaged items. This is of course, due to clear organization protocols and accurate labeling in the workplace which allows the workers to stick to designated standard procedures and diminish any odds of damaging a product and identification of equipment that are not in optimal working condition. It also focuses on keeping pathway of the inventory when it comes to consumables and medications. 4. 5S method has led to improvements in other industries and the project distinguishably explores feasibility and standardization, and their impacts on addressing common safety problems for enhanced patient safety. ## RADIATION SAFETY A radiation protection programme is usually managed by a qualified expert, who is often called a Radiation Safety Officers(RSO). 1. Qualified staff (e.g. RSO, health physicist to provide oversight and responsibility for radiation protection policies and procedures. 2. As Low As Reasonably Achievable (ALARA): It is a guiding principle in radiation protection used to eliminate radiation doses that have no direct benefit. 3. A dosimetry program in which personal exposure monitoring is conducted, as required for federal or state regulations, for external dose and as needed for internal dose. 4. Surveys and area monitoring to document radiation levels, contamination with radioactive materials and potential worker exposures. 5. Radiological controls, including entry and exit controls, receiving, inventory control, storage, and disposal. 6. Worker training on radiation protection, including the health effects associated with ionizing radiation dose, and radiation protection procedures and controls to minimize dose and prevent contamination. 7. Emergency procedures: To identify and respond to radiological emergency situations. 8. Record keeping and reporting programmes: To maintain records and provide dosimetry reports and notifications, as required by federal or state regulations. 9. Internal audit procedures: To annually audit all aspects of the radiation protection programme. 10. Time Distance and shielding for radiation protection: Employers should use engineering controls to maintain occupational radiation dose (as doses to the public). 11. Equipment registration ALARA is applied after determining that radiation dose will not exceed applicable regulatory dose limits. To the greatest extent possible, administrative controls should not be used as substitutes for engineering controls. Engineering controls, in some cases, may be incorporated into facility design. ### Shielding - The need for shielding depends on the type and activity of radiation source. - Uses in adjacent areas, including the area above and below the room or facility, should also be considered. - For shielding of rooms containing medical X-ray equipment or rooms with other medical X-ray imaging devices, the National Council on Radiation Protection and Measurements (NCRP) recommends that the shielding design goal be 500 mrad (5mGY) in a year to any person in controlled (restricted) areas. - For uncontrolled (unrestricted areas) NCRP recommends that the shielding design goal be a maximum of 100 mrad (1 mGY) to a person in a year. - Shielding design requires a qualified expert (e.g. health physicist). - Before using any new or remodeled room or facilities or any new or relocated X-ray equipment, a qualified expert should conduct an area survey and evaluate shielding to verify radiation protection behind shielding materials. - Before performing any room modifications or if any changes occur to a facility that may change radiation exposure levels (e.g. new equipment, increased workload, altered use of adjacent spaces), a qualified expert should review the shielding design. - In general, floors walls ceilings and doors should built with materials that provides shielding for desired radiation protection. ### Interlock System Importance/uses include: 1. A radiation safety interlock system is a device that automatically shuts off or reduces the radiation emission rate from radiation producing equipment (gamma or X-ray equipment or accelerator). 2. The purpose of a radiation safety interlock system is to prevent worker exposure and injury from high radiation levels. 3. In most applications, interlock systems to stop X-ray or particle beam production can be activated by the opening of a worker door (access point) in a restricted (controlled area). This system may also include door sensors or motion detector. 4. Standards for protection against radiation (10 CFR part 20) to activities involving 5. Warning systems: Warning systems can integrated into design of radiation producing equipment or devices and can also be used with radioactive materials. - Such warning systems will set off an audible (easy to hear) alarm (e.g. to warn workers that a radiation hazard exists) or a visible (light) warning signal whenever ionizing radiation is being emitted. - Warning systems should be checked regularly for proper function. - As an example, industrial radiography equipment located in a fixed facility or room may include visible warning signals with colored or flashing light or audible alarm with distinct sound, which are located inside and outside the shielded enclosure for conducting industrial radiography. ### Personal Protective Equipment (PPE): - PPE is used to prevent workers from becoming contaminated with radioactive material. It can be used to prevent skin contamination with particulate radiation (alpha and beta particles) and prevent inhalation of radioactive materials, - PPE will not protect workers from direct, external exposure (e.g, standing in X-ray field), unless the PPE contain shielding material. For example, a leaded apron will reduce X-ray doses to covered area. - Consult a qualified expert (e.g. a health physicist) when choosing PPE and developing a PPE policy for a workplace. 7. Alpha radiations have very low penetrating power and will not penetrate the dead outer layer of skin. Thus, shielding is generally not required for alpha particles as external exposure to alpha particles deliver not radiation dose. 8. Beta radiation: High energy beta particles can travel several meters in air and penetrate into the skin. Thus, first select adequate shielding with an appropriate thickness of low atomic number (Z<14) materials (e.g. specialized plastics or aluminum (Plexiglas®) as well as using PPE such as safety goggles to protect worker's eye against beta particles and a lab coat may be used to prevent skin contamination. 9. X-ray and gamma radiations: Examples of commonly used PPE for radiation protection from Xrays and gamma rays include: a. Lead aprons or vests. b. Lead thyroid collar, offers a protection for thyroid gland. c. Lead gloves protect hand of workers from exposure. d. Safety goggles: Protect worker's eye from radiation exposure e. Respirators should only be used by workers qualified to wear them. 10. Radiation measurement and sampling: Ionizing radiation standards often require employers to monitor radiation exposure. 11. Worker training: One of the most important functions of a radiation protection program is training radiation workers on safe work practices. Employers should provide workers with information and training to ensure that those who are potentially exposed to ionizing radiation hazards understand how to safely use all radiation producing equipment or radiation sources in the workplace. ## LASER SAFETY PROTOCOL ### Introduction The use of laser in the medical field is increasing at a tremendous rate. As the laser treatment increases the potential for laser accidents. ### Laser Safety Thus, the joint commission provide some laser safety protocol which include the following: 1. The hospital minimize risks associated with selecting and using hazardous energy sources, includes ionizing radiations and X-ray equipment and non ionizing equipment such as Laser's and MRI's. Laser uses in medicine include: a. Surgery (photo thermal energy) b. Surgery (photoacoustical energy) c. Tatoo removal (Photothermal energy ) d. Hair removal (photothermal energy / laser) e. Photodynamic therapy (photochemical energy)/(laser) ### 2. LASER stands for Light Amplification by Stimulated Emission of Radiation: The three properties of laser that is: a. Monochromatic: Light that is one color or a single wavelength. b. Directional: Travelling in one direction from point of origin. c. Coherent: Orderliness of wave patterns by being in phase in time and space. These laser properties allow laser to focus a lot of energy onto a small area. ### Classification of Laser 1. Class 1 (no hazard) 2. Class 2 (extended viewing) 3. Class 3 (Direct beam hazard) 4. Class 4 (direct/reflected exposure hazard) ### Basic Features of LASER 1. There are three absorbers of light (LASER) in tissues: a. Water b. Hemoglobin c. Melanin 2. Water absorption (i.e. CO2 LASER used for soft tissue; cell expand when heating occurs). 3. Water transmission (i.e. Diode LASER, KTP Green Light LASER). ## Light Beam Related Hazard Hazardous effects related to the unintentional direct contact with the laser beam. It may be: 1. Eye related 2. Interaction hazards (Plume and fire) 3. Skin related ## Eye Related Hazards 1 Injury can result from (laser) exposure to: a. Direct beam b. Mirror reflection (surgical instruments) Diffuse beam (tissue reflection) ### 1. Damage Dependent on a. Intensity: Lens of eye can focus beam onto the retina. b. Wavelength: Absorbed by different parts of the eye. c. Duration: Fraction of second, before you can blink. ### Interaction Hazards Plume Plume smoke from vaporization can: 1. Creates a visibility problem. 2. Cause nausea 3. Cause potential health hazard. Plume: Lasers are used for surgery ablation (removal of tissues) or cauterization to vaporize coagulate and cut tissue. The by-products of these procedures include vapors, smoke and particulate debris, which are particulate deb collectively called plume. ### Interaction Hazards Plume may be: 1. Bacteria A. 2. Viral particulates 3. Gases including, toluene and formaldehyde, 4. carbon ### Controlled Entry 1. Closing doors and covering windows (when required). 2. Posting of the Proper "Laser in Use" signs outside all entries. ### Education All personnel that may be exposed on the laser shall be required to attend regular ''in-services: on operating the laser and laser safety. ### Laser Safety Measures Wide variety of laser system are used in health care facilities today, therefore it is important to keep medical personnel and pati safe from laser radiation. Five fundamental safety precautions are required when working with high power lasers and laser system; given below: 1. Wear laser safety glasses: Staff must worn laser glasses throughout the entire procedure, taking them off during any laser application can lead to harmful effects. Selecting laser glasses is formost and should directly (related) correspond with the laser used for procedure. 2. Utilize proper storage: It is important to properly store laser glasses and equipment. Protective eye wear should be stored in an individual case or protective unit to keep from scratches and contaminants. If laser glasses are damaged can compromise the protection level. 3. Follow standards and Regulations: Health care facilities required to follow their laser safety standards and regulations. Laser safety officer must provide information to staff regarding safety. All personnel that may be exposed to the laser shall be required to attend regular ''in-services'' on operating the laser and laser safety: 4. Work with trained personnel: - An individual working around high-powered lasers is required to have had proper training and education. - Accidents can easily occur in laser procedures resulting in the loss or damage of vision. - Well trained personnel will significantly reduce the risk of accidental laser exposure. - A trained laser operator will know how to align the laser correctly, making sure to position the laser beam above or below the normal eye levels of seated and standing personnel. 5. Use warning signs: Safety and warning signs can help medical staff and patients be aware of caution area in facility. ## FIRE SAFETY PROTOCOLS Hospital fire safety courses are special training programs designed to educate medical personnel on all aspects of hospital fire safety, led by instructors with extensive emergency-response experience. - The best hospital fire safety courses will cover everything from fire prevention to proper hospital fire safety equipment usage. ### Hospital fire safety protocols include: 1. What to do in case of fire at hospital. 2. Patient rescue (including drags. 3. How to use fire extinguisher. 4. Different type of fires and how to control them. 5. Hospital fire protection system and equipment. 6. How to vacuate safely. 7. Pre-fire planning. ### If fire occurs, follow these steps: 1. Activate the fire alarm procedures. 2. Turn off oxygen, light and any electrical equipment in the vicinity of the fire. 3. Remove the patients who are in immediate danger. 4. Notify the hospital "switch board" of the location of fire. 5. Close windows and doors to reduce ventilation. ### Types and Classification of Fire There are five classes of fire that are categorized based on the type of contributing fuel/combustion materials. ### Class A (Solids) - This type of fuel could be paper and cardboard, common in offices or furniture or fixtures and fittings or even in structure of the building. - This is one of the most common type of fire. Combustible material; wood, cloth, paper, rubber and plastics. ### Type of Fire Extinguisher Used Use class A fire type extinguisher is water extinguisher. This is most popular type of extinguisher but it should never be used near electrical equipment as water is good conductor of electricity. ### Class B (Liquid) Many of the fluids, liquids and chemicals used in hospital can be inflammable or explosive. Like cleaning fluids, solvents, fuels, paints and flammable gases. ### Type of Fire Extinguisher Used Powder extinguishers are the best types to attack class B type of fire. ### Class C Fires that involve energized electrical equipment such as power tools, wiring, fuse boxes, appliances, T.Vs., computers and electric motors. ### Type of Fire Extinguisher Used Like (CO2) Carbon dioxide and dry powder in low voltage situation attack on electric fire. ### Class D (Metal) Metals are not often thought of as a combustible material. But some types of metals like sodium, magnesium, potassium are also good conductors, helping in spread of fire. All metals will soften and melt at high temperature which can be big problem. ### Type of Fire Extinguisher Used Small metal fire can be smothered with dry earth or sand. But class D fire can be tackled by using, Dry powder extinguisher. ### Class K (Cooking Fats and Oil) Deep fat frying and spillages of flammable oils near to heat sources in hospital kitchen can result in a class K fire. Never leave food or frying equipment unattended during use. ### Type of Fire Extinguisher Used The wet chemical extinguisher is approved for use on cooking oils and fats. Fire blanket can also be used for small, class F fire. ### Fire Alarms - There are several ways in which fire can be detected. - The traditional and obvious methods of detection is a person seeing the fire and/or smelling smoke, at which point a fire alarm should be activated or a notification issued. According to the National Fire Protection Association in the United, states, suggested requirements for installing and locating manual fire alarm-initiating devices are as follows: 1. Manual pull boxes should be securely mounted on a background of contrasting color. 2. The operable part of the fire alarm box should not be more than 1.07m to 1.22 m above floor level. 3. Manual pull boxes should be located so that they are conspicuous, unobstructed and accessible. ### Smoke and Heat Detector Alarms - A variety of smoke and heat sensors can be installed as part of a fire alarm system to detect fire that begin in low-traffic area away from personnel/staff. - These sensors should ideally trigger an automatic alert system with visible (flashing lights) and audible bells or voice alerts to indicate that a fire was detected. - The sensors should also be able to pinpoint the location at which the fire was detected through a panel that lights up to indicate the area where the fire detection device was triggered. ### Firefighting Equipment/Fire Suppression - Once a fire has been detected a suppression system/equipment to extinguish the fire is required to minimize damage and avoid evacuation. - A variety of firefighting equipment can be installed in different locations in the hospital to combat specific types of fires with special consideration to the patients occupying each area and the medical equipment housed in those areas. - Thus, firefighting equipment also called fire extinguishers. - Fire extinguishers are labeled with standard symbols and letter representing the classes of fires that they are equipped to fight. ### Types of Fire Extinguishers 1. **ABC dry chemical:** These extinguishers, rated for class A, B and C fires containing _monochromium phosphate_. Monochromium phosphate is a finely extinguished agent similar in powder, gas for extinguishers, which have a range of about 15 feet, are easy to use but extremely messy. They are typically found in hallways and occasionally in labs. 2. **Carbon-dioxide (CO2):** These high pressure vessels all filled with liquid CO2. They are to be used only on flammable liquid or electric fires. Because the CO2 is expelled as a gas, the extinguisher has a very limited operational range. The extinguishers, easily identifiable because they do not have a pressure gauge, are found mostly in labs or mechanical rooms. 3. **Halon:** - Halon fire extinguisher are rated for class B and class C fires but are also effective in fighting class A fire. - They use bromochlorodifluoromethane (halon 1211) as their extinguishing agent. - Halon is an extremely clean agent that leaves no residue, making it effective for use around other sensitive equipment. 4. **Dry powder:** These extinguishers are intended for class D (metal fires). The fire is extinguished by isolating and smothering it with either a copper-based or sodium chloride base powder extinguishers are mounted on two wheel carts. 5. **Class K extinguishers:** - The extinguishers are rated to combat class K (grease) fires. - In recent years, many commercial kitchens have been used more efficient cooling appliances and unsaturated cooking oils that operate at much higher temperatures. - Class K extinguisher uses a wet-potassiumacetate-base, low pH agent that has a greater firefighting and cooking effect for this type of hazard. - Most of these extinguishers can safely be used to fight class A, B or C fires as well as class K. These extinguisher can be found in kitchens where deep-fat fryers are in use. ### Method to use Fire Extinguishers Following steps must be followed before attempt to fight a fire: 1. Make sure that everyone else is leaving the area, someone has sounded the alarm and called the fire department. 2. Ensure that you have an unobstructed escape route at your back. 3. Verify that the fire is small, confined, and not spreading. 4. Make sure that what is burning so that appropriate type of extinguisher have to used to fight fire. 5. Make sure about back to clear exit and stand 2 to 3 meters away from fire. 6. Personnel safety is paramount; if the fire is out of control, leave the area immediately. Fire worsens (or health and safety officers) and hospital staff should be trained on how to use fire suppression devices. Regular training sessions should be undertaken as part of the medical facility's scheduled safety and evacuation stimulations. 7. Four steps in using a fire extinguisher are (through simple symbol PASS): ## HAZMAT - (HAZARDOUS MATERIAL) SAFETY It is extremely important to protect the accidental contamination of the staff and individuals in hospital environment and therefore develop safety procedures to handle hazardous materials. ### List of some hazardous materials to be handled with care: Mercury 1. Mercury 2. Alcohol based cleaning and disinfectant solutions. 3. Lubricant sprays 4. Anti-rusting agents 5. Petroleum jelly/grease 6. Adhesives like feviquick/araldite, etc. ### List of items required to handle hazardous material: 1. Mercury spillage kit 2. Latex or rubber gloves 3. Face mask 4. First aid kit ### Types of Spills Hazardous material spills includes: 1. Biological 2. Chemical 3. Radiological materials 4. Mercury spill ### Management of Spills In a hospital hazardous substances such as body fluids, drugs, cleaning fluids and other chemicals and blood can occur at any time due to broken or faulty equipment or human error. Any such spill poses risk to the staff, visitors and patients who are extremely susceptible to infection. ### Biological Spill 1. **Small volume of spill management:** a. Wear work man's gloves and other PPE appropriate to the task. b. When sharps are involved use forceps to pick up sharps, and discard these items in a puncture resistant container. c. Cove the spill with blotting paper/paper towel. d. Wipe the spill with a newspaper moistened with 1% hypochloride solution. Discard the paper as infected waste. Repeat until all visible spoilage is removed. e. Wipe the area with a cloth mop moistened with 1% hypochlorite solution and allow drying naturally. f. All contaminated items used in the clean-up should be placed in biohazardous bag for disposal. 2. **Large volume of spill management:** a. a Confined contaminated area. b. Wear workman's gloves and other PPE appropriate to the task. c. Cover the spill with newspaper or appropriate absorbent material to prevent from spreading. d. Remove and discard the paper as infected waste. e. All contaminated items used in the clean-up should be placed in biohazardous bag or disposal. ### Chemical Spill Management 1.Neutralizing acid spills: Acid spills can be neutralized with sodium bicarbonate, sodium carbonate or calcium carbonate. ### Process/Procedure: a. Contain the liquid first. b. Sprinkle bicarbonate powder over the spill slowly, starting from outside. c. Acid is neutralized if effervescence ceases in the presence of excess bicarbonate. d. Avoid breathing in the fine powder and the gas evolved (CO2). ### Handling of Mercury Spills (Management/Procedure) In the event of any mercury spillage due to breakage of instrument the following measures are to be taken: ### 1. Do's: a. Remove people and pets from the spill area. b. Close all interior door to the spill area. c. Turn off heading and air conditioning systems. ### 2. Don'ts: a. Remove people and pets from the area so they do not touch mercury. Never vacuum, it will release mercury vapors in air. b. Never use broom, it will break up the mercury. c. Never pour mercury down the drain. d. Never walk around in contaminated clothing or shoes. e. Never put mercury-contaminated items in the washing machine. ### Mercury Spill Management: 1. Evacuate area: As far as possible, keep people who are not involved in the clean-up away from spill area to limit exposures and to prevent the spread of contamination. 2. Put on face mask: In order to prevent breathing of mercury vapor, wear a protective face mask as suggested in the component of the spill lit. 3. Remove Jewellery: Remove all jewellery from hands and wrist so that the mercury cannot combine (amalgamate) with the precious metals. 4. Wear gloves: Put on rubber or latex gloves. If there are any broken pieces of glass or sharp objects, pick them up with care. Place all broken objects on a paper towel, fold the paper towel and place in a puncture proof plastic bag or container provided with lid. Secure the plastic bag/container and label it as containing items contaminated with mercury. 5. Use syringe without a needle/eye dropper and sticky tape: A syringe (without needle) shall be used to suck the beads of mercury. ### Collection in Leak Proof Bag or Container: Place all the materials used during the clean up, including gloves, mercury spills, collected from spill area into a leak proof plastic bag or container with lid and seal properly and label as per these guidelines. Such collected waste should be stored in designated area only. ### Cleaning of floor surfaces contaminated with mercury and cleaning of room surfaces: Sprinkle sulphur or zinc powder over the area which will quickly bind any remaining mercury. In case, zinc powder is used, moisten the powder with water after it is sprinkled and use a paper towel to rub it into cracks in the flooring. ### Labelling: All the bags or containers containing items contaminated with mercury should be marked properly and labeled with following details: "HAZARDOUS WASTE". Handle with Care date of Stoarage/Generation, name and address of the hospital along with contact number. ### Management of Radiological Materials/Spills 1. Stop the procedure and cover the spill with radioactive absorbent paper (radiacwash-count off). 2. Isolate the area first so others don't get contaminated. Use red tape or ribbon, if possible. 3. Monitor for skin contamination and clothing contamination. Change gloves often. 4. Survey and clean up the contaminated area. ### Minor Radiation Spill Management: 1. Alert people in immediate area of the spill. Wear protective equipment, including safety goggles, disposable gloves, shoe covers and a long-sleeved lab coat. 2. Place absorbent paper towels over liquid spill. 3. Using proper radiation-safety techniques, clean the contaminated areas, moving from the edges towards the center. 4. Dispose of all contaminated waste in a radioactive-materials-waste container and properly seal and label it. ### Major Radiation Spill Management: 1. Attend to the injured or contaminated persons and remove them from exposure. 2. Alert people in the laboratory. 3. Have potentially contaminated personnel stay in one area until they have been monitored and shown to be free of contamination. 4. Call the radiation safety office. 5. Close doors and prevent entrance into the affected area. ## Material Safety Data Sheet (MSDS) ### Introduction A material safety data sheet is a technical document which provides detailed and comprehensive information on a controlled product related to: 1. Health effect of exposure to the product. 2. Hazard evaluation related to the product's handling, storage or use. 3. Measure to protect workers at risk of exposure. 4. Emergency procedures. Information in the SDS (Safety Data Sheets) should normally be presented using the following heading in the order given below: 1. Identification 2. Hazard (s) identification 3. Composition/information and ingredients 4. First-aid measures 5. Accidental release measures 6. Fire-fighting measures 7. Handling and storage 8. Exposure controls/personal protection 9. Physical and chemical properties 10. Stability and reactivity 11. Toxicological information 12. Disposal consideration 13. Transport information 14. Regulatory and other information. ### Material Safety Data Sheet Content A supplier material safety data sheet must provide at least nine categories or sections of content and and approximately sixty items of information distributed among those categories. An MSDS must be reviewed at least every three years. The categories must have the following similar headings: 1. **Hazardous ingredients:** - The chemical names and concentrations concerning the hazardous ingredients. - CAS number which is useful in locating more information especially if the product is known by numerous names. 2. **Preparation information:** - The name address and telephone number of who prepared the MSDS. - The date of MSDS was prepared. - If more than three years old, it must be updated section. 3. **Product information:** - Identify the product by the name on the supplier label. - Provides the chemical name, family and formula (including molecular weight). - Lists the product identifiers, manufacturer and supplier names, addresses, and emergency telephone numbers. 4. **Physical data:** This section include information including how it looks and how it will behave when it is used, stored, spilled and how it will react with other products indicated through: a. The state it is in, e.g. liquid. b. The odor and appearance of the product. c. The specific gravity, vapor density, evaporation rate, boiling point and the freezing point. d. The vapor pressure, the high the concentration the higher the possible air concentration. e. The odor threshold, which is the lowest airborne concentration of a chemical that can be perceived by smell. f.The pH reflecting the corrosive or irritant nature of the product. 5. **Fire and explosion hazard:** The temperature and conditions that can cause the chemical to catch fire or explode: a. Upper Explosion Limit (UEL) or Upper Flammable Limit (UFL) will indicate the higher concentration of a substance in the air that will produce a fire or explosion when a source of ignition (heat, spark or flame) is present. b.Lower Explosion Limit (LEL) or Lower Flammable Limit (LFL) will indicate the lowest concentration of a substance in the air that will produce a fire or explosion when a source or ignition is present. 6. **Reactivity data:** a. The chemical stability of the product and its reactions to light, heat, moisture, incompatible materials. b. Storage requirements based on the reactivity or instability of the product. c. Incompatible products that must not be mixed or stored near each other. d.The need for disposal before they become extremely reactive. 7. **Toxicology properties:** a. The harmful effects of exposure. b. How the product is likely to enter the body and what effects it has on the organs in the body. c.The short term (acute) and the long term (chronic) health effects from exposure to the product. d. The exposure limits, which indicates the maximum concentration in air of a hazardous substance (gas, vapor, dust, mist, fume) to which nearly all workers (without PPE) can be repeatedly exposed without adverse health effects. 8. **Preventative measures:** a. Instruction for the safe use, handling and storage of the product. b. The personal protective equipment or safety devices required. c. The steps for cleaning up spills. d. Information on the waste disposal requirements. 9. **First aid measures:** a. Specific first aid measures related to acute effects of exposure to the product. b. First aid steps in the correct sequence. c. Information to assist in the planning for emergencies. ### Location of the MSDS 1. Hard copy readily available. 2. Computer terminals. 3. Employees and others must know where the MSDS how to use them. ### MSDS must State 1. That an exemption has been granted. 2. Date it is granted 3. Registry number 4. Product hazards ### Medical Access Doctors and nurses can access withheld information however, this information remains confidential. ### Aim of the Data Sheet - The data sheet is the second element of WHMIS information delivery system and is intended to supplement the alert information provided on labels. - The third element of the system is the education of the employees in hazard information on controlled products, including instruction in the content and significance of information on the MSDS. **Note:** WHMIS Workplace Hazardous Material Information System. ### Responsibilities Related to the MSDS Suppliers 1. Develop or obtain MSDS for each controlled product imported or sold for use in a workplace. 2.Ensure the purchaser of the controlled product has a copy of the current MSDS at the time of prior the purchaser receiving the controlled product. 3.Make available any information that is considered confidential (trade secret) information and therefore exempt from disclosure to any physician or nurse who request that information for the purpose or making a medical diagnosis or providing medical treatment. 4. Ensure the MSDS for the controlled product: a. Disclose information that is current at the time of sale or importation of the product. b.Was prepared (manufactured) and dated not more than 3 years before the date of sale or importation. c. Is available in both official language. ### Employer 1.Ensure that an up-to-date supplier MSDS is obtained from the supplier the first time a controlled product is received in the workplace. 2. Evaluate the data sheet received to determine its date of production. The data sheet must be dated within 3 year of current date. 3. Maintain up-to-date MSDS: a.As soon as practical but no later than 90 days after new hazard information become available to the employer. b. At least every three years. 4.Ensure a copy of all data sheets which are required for the workplace are made readily available at the worksite to: a. Workers who may be exposed to the controlled product. b. The Occupation Health Committee (OHC). ### Worker Following training by the employer: 1. Follow the safe work or preventative measures as instructed by the employer. 2.Knows where the sheets are located and how to find information on safe use and first aid measures. ## ENVIRONMENTAL SAFETY ### Introduction - The environmental concerns affects the hospital internally and externally. - Actually, the hospital requires a safe internal environment. - Maintaining a safe environment reflects a level of competent healthcare that must be fulfilled for patient safety. Many internal factors have a significant impact on hospital environment such as: 1. Waste management 2. Noise and infection control ### External Factors such as sources 1. Water 2. Sewage 3. Disposal ## EMERGENCY CODES Emergency codes are used to identify and notify the most appropriate individuals of an event that requires an immediate response and action. ### Activation of Emergency Code Any emergency code is activated by calling the hospital switchboard. - If you notice an emergency, you can dial emergency number from any internal hospital phone. - State your name, location and emergency you have identified, for example 108 number for ambulance in India. - Dial 108 is Toll-free emergency ambulance number in India. ### Aim of Emergency Codes To provide care and support to: 1. Incident victims while maintaining care and safety of patients. 2. Employee and visitors within a healthcare facility during an emergency event or incident. ### Types of Emergency Codes 1. Code blue: Cardiac arrest. 2. Code red: External disaster 3. Code brown: Internal disaster 4. Code pink: Baby disaster 5. Code grey: Security threats/workplace violence. 6. Code orange: Medical Emergency Team (MET) ### Code Blue 1.If is the most recognized universal emergency code. Code blue means there is a medical emergency occurring within the hospital. The team is comprised of: a. Doctors b. Nurses c. Respiratory therapist d. A pharmacist - Code blue is generally used to indicate a patient requiring resuscitation or in need of immediate medical attention, most often as a result of respiratory arrest or cardiac arrest. When called overhead, the page takes the form of "code blue (floor), (room)" to alert the resuscitation team where to respond. - Every hospital as a part of its disaster plan, sets a policy to determine which units provide personnel for code coverage. ### Code Red It is for an external disaster incident which has taken outside the hospital. - For example, Floods, earthquakes, tsunamis, Train accident, building collapse, etc. - External disaster is declared when the expected patient inflow is more than emergency department bad capacity. - It is only declared by the C.E.O of the hospital or emergency department head. ### Code Brown This code represent an event of internal disaster that may impair the operations of the hospital and disrupt normal patient care activities. For example, Power outage/fire/flood. ### Code Pink It is for baby disaster including child missing from hospital/sent with wrong parent or any other child related disaster. ### Code Grey It is required for security personnel: Applies to any event where hospital security personnel are needed. - This may include, but not limited to: a violent/combative person; a missing person; criminal activity or other situations where enhanced security is required. ### Code Orange - Medical Emergency for example: Chest pain accompanied by sweating, nausea, vomiting, shortness of breath, radiating pain that moves to the arm or neck, dizziness, or feeling that your heart is breathing irregularly or too fast. - Severe bleeding that doesn't stop after 15 minutes of direct pressure. ### Code Benefits to the Public 1. Hospital emergency codes of extremely important to the safety of people inside a hospital. Hospital employees, including doctors undergo extensive training to respond to each of these events, allowing them to save lives. 2 One of the primary benefit of code system is that trained hospital employees know to respond to any given emergency without alarming those being treated and hospital visitors. ## ROLE OF NURSE IN TIMES OF DISASTER ### Introduction war, Disaster nursing started with Florence Nightingale (the founder of nursing science) during the Crimean she used environmental resources to treat victims and was the First healthcare practitioner to activate a triage system by sorting patients depending on their needs. Role of nurse in time