Risk Management in Healthcare Facilities PDF

# Risk Management Risk management is a method used to assess the risks of a specific activity and develop programs to reduce that risk. It also involves injury prevention and claims management (the settlement, defense and prevention of lawsuits). Healthcare facilities must effectively manage injury...

# Risk Management Risk management is a method used to assess the risks of a specific activity and develop programs to reduce that risk. It also involves injury prevention and claims management (the settlement, defense and prevention of lawsuits). Healthcare facilities must effectively manage injury prevention for patients and employees as part of a risk management program. Various authorities, including The Joint Commission (TJC), require that healthcare facilities develop and implement procedures to ensure that they meet minimum safety standards, prevent accidents and/or injuries, and ensure accurate reporting and follow up to help prevent similar incidents. After a situation is examined and hazards or unsafe practices have been discovered, risk management personnel ensure that corrective actions are taken to improve systems, behaviors and/or physical conditions to help prevent employee and patient accidents and injuries, as well as the manufacturer’s Instructions for Use (IFU), standards and regulations, and CS technicians support patient safety. ## Common Workplace Safety Hazards All jobs involve some risks. The key to working safely in any work environment is to understand those risks and take appropriate steps to minimize them. CS technicians must understand potential hazards and pay close attention in work areas within and sometimes outside of their department. The belief that "an accident or injury will never happen to me" creates a false sense of security that results in many injuries each year. Following safety protocols and incorporating them into all work practices is necessary for preventing injuries and accidents. ### Central Service Occupational Hazard In CS, there are three different types of occupational hazards: physical, biological and chemical hazards. Some of those occupational hazards can be present in all areas of the department. Other hazards may be confined to a specific work area. * **Physical safety hazards** may be caused by the environment and the tasks performed within that environment. Due to the nature of the tasks performed, there are many potential physical hazards in the CS department. Physical hazards may include: wet floors, cluttered walkways, heavy carts and sharp instruments. Fire is also a physical safety concern. * **Biological safety hazards** (infectious waste and blood borne pathogens) can potentially be found in any area of the department. Obviously, the decontamination area is the main area of concern for biological hazards. * **Chemical safety hazards** may be found throughout the work area. For example, solutions used in the decontamination area, sterilants used in the sterilization area and some patient care products may pose chemical hazards within the department. The following sections examine general safety hazards and then outline specific safety hazards by work area. The risk of injury from all of these hazards can be minimized by following safety protocols. ## General Physical Hazards ### Ergonomic Concerns General physical hazards include those related to ergonomics, slips, falls, electrical, safety and sharps. Ergonomics is the process of changing work or working conditions to reduce physical stress. CS technicians are exposed to many ergonomic stress factors, such as repetitive motion, lifting and pushing. Ergonomic stressors that employees may encounter include: - __Force__ - Heavy lifting or manipulating equipment or instrument sets. - __Repetition__ - Using the same motion, or series of motions, continually or frequently. - __Awkward positions__ - Assuming positions that place stress on the body, such as reaching or twisting while lifting. - __Vibration__ - Rapid oscillation of the body or a body part. - __Contact stress__ Continuous pressure between the body and a sharp edge. Exposure to these stressors can cause numerous problems, including ligament sprains, joint and tendon inflammation, pinched nerves, herniated spinal discs and other injuries. Training can help employees to: - Recognize the signs and symptoms of injuries, so they can respond to them. - Report potential problems. - Recognize jobs/tasks that have ergonomic stressor. Simple changes, such as stretching before work, shifting position, learning and practicing good body mechanics and breaking up repetitive activities can help employees reduce the risks of ergonomic injuries. Proper lifting and pushing movements can also prevent injuries. When loading and unloading carts from dumbwaiters or elevators, or receiving a cart into the department, it is essential to check the weight on the cart before attempting to move it. Ensuring that the wheels are straight, and that they will roll over door spaces or uneven edges is also important, as is unloading some items to lighten the cart if it is too heavy to move easily. ### Slip and Fall Concerns Slips and falls are always a concern in the CS department. Mobile equipment and ever-present wet floors increase fall risks. To reduce these risks, mobile equipment should be parked away from common traffic areas. Areas that often have wet floors, such as in the decontamination area, around the cart wash exits, and washer unload areas, must be kept as dry as possible, and spills should be wiped immediately. Non-slip footwear should be worn and attention should be given to slippery floors. Signage, such as the wet floor alerts people to the potential hazard. ### Electrical Safety Concerns Burns and shocks from electric equipment can result if safe handling precautions are not observed. Carefully check all electrical cords to ensure they are intact, with no breaks in the insulation. Electrical cords on mobile equipment run a greater risk of being kinked or run over by rolling carts which can make the equipment unsafe. All plugs on electrical equipment must be three-pronged and grounded, and all electrical outlets must accommodate these plugs. Inspecting electrical cords for breaks and plugs for bent prongs is a responsibility of CS technicians. Identifying and reporting a potential hazard during cleaning or delivery can prevent injuries to patients and staff. ### Sharps Concerns Cuts and puncture injuries from sharps can happen in any area of the CS department. Sharp instruments can break the skin’s surface and produce puncture wounds, lacerations and abrasions. If the injury occurs in the decontamination area, these injuries can result in exposure to disease. Some general precautions to prevent sharps injuries include: - Handling all sharps with care. - Not grasping several objects at the same time. - Ensuring that sharp ends point away from any part of one's body during transport. - Placing all disposable sharps, such as needles and blades, in the appropriate sharps container ### General Chemical Hazards Although most chemicals used in CS are found in the decontamination area, chemical hazards may be found in other areas of the department, as well. Splashing chemicals is a common cause of eye injuries, so the use of eye protection is required. Eye wash stations are also required in areas where chemical injuries are a concern. ### Hazardous Substance Concerns Each state categorizes certain chemicals and substances as hazardous. Each CS department should have an easily accessible, understandable, and current list of all hazardous substances with which employees could come in contact. Most facilities today have a comprehensive computerized hazardous chemical list. If employees are required to perform known hazardous tasks, it is important that they understand the safety procedures developed for that task. Prior to performing such tasks, employees must be given information about the hazards to which they may be exposed. This information should include identification of specific hazards, use of PPE, recommended safety measures and emergency response procedures. Employers should take measures to minimize hazards to employees. These could include increased area ventilation, respirators, presence of other employees to assist, and the Rehearsal of emergency procedures ## Safety Data Sheets An SDS (formerly called material safety data sheet - MSDS) contains important information about product materials and properties that employees must know to work safely with any given product. SDS are developed and provided by the manufacturer of the product, and they are specific for each product. SDS contain at least the following information: * **Product identification** Product name, manufacturer’s name, address and telephone number, product item number (manufacturer’s identification) and synonym names. * **List of hazardous ingredients.** * **Physical data** - Vapor pressure, evaporation rate, solubility in water, freezing and boiling points, specific gravity, acidity (pH), vapor density, appearance and odor. * **Fire and explosion information** - Flash point, flammable units, extinguishing media, special firefighting procedures; and unusual fire and explosion hazards. * **Reactivity data** - Stability, incompatibility, hazardous decomposition products and conditions contributing to hazardous polymerization. * **Health hazard data** Effects of overexposure. * **Storage recommendations** - Incompatible materials and storage temperatures. * **Emergency and first-aid procedures.** * **Spill or leak procedures**, spill management and waste disposal methods. * **Protection information and control measures.** * **Special precautions.** ## Employee Monitoring To prevent potential health hazards to workers, OSHA has established permissible exposure limits (PELS) for many chemicals used in sterilant and disinfectant formulations. These include ethylene oxide (EtO), hydrogen peroxide (H,O,), ozone (0,) and others. Glutaraldehyde is a chemical commonly used in CS as a high-level disinfectant. The National Institute for Occupational Safety and Health (NIOSH) recommends that exposure to glutaraldehyde be under 0.2 parts per million (ppm) time weighted average over an eight-hour work shift. The American Conference of Governmental Industrial Hygienists (ACGIH) recommends a ceiling value of 0.05ppm, which should not be exceeded at any time. Healthcare facilities are required by OSHA to: - Provide adequate ventilation systems. - Establish safe work operating procedures. - Provide PPE. - Implement other methods to ensure that occupational exposure limits are not exceeded in the workplace. ## Fire and Explosions The presence of large volumes of combustible materials and flammable substances poses unique risks. The large combustible loading created by single-use items and their wrappings in storage and as trash is especially dangerous. When these materials burn, large quantities of highly toxic smoke are produced. Even with hospital compartmentalization features that limit the spread of smoke and fire, a high-risk situation occurs, therefore, healthcare fire safety programs must include: - Minimization of the combustible load. - Fire response plans. - Early detection. - Containment of the fire and combustible products. - Extinguishment. - Evacuation plans ### Fire Response Plan Every healthcare facility requires a comprehensive fire response plan and each staff member in every department must know his/her specific role in these plans. The fire safety emphasis should begin at the time of new employee orientation and should continue with ongoing training. Every healthcare facility is required to have and maintain sprinkler systems, smoke detectors, fire extinguishers and audible alarms to warn and protect staff and patients. ## Workplace Violence According to OSHA, approximately two million people are the victims of workplace violence each year. All employees should pay attention to possible warning signs, and they should: - Immediately report any direct threats of violence or retaliation to management. - Note behavior, statements or attitudes that are unusual, threatening or disconcerting.