mod 12.pdf

INTRODUCTION It has been said that "safety is no accident," and that statement couldn't be more true, especially for healthcare professionals who are responsible for keeping patients, employees and visitors free from injury. Safety requires ongoing education, safeguards, proper planning and the comb...

INTRODUCTION It has been said that "safety is no accident," and that statement couldn't be more true, especially for healthcare professionals who are responsible for keeping patients, employees and visitors free from injury. Safety requires ongoing education, safeguards, proper planning and the combined implementation of safety systems to reduce risks, prevent injury and save lives. The Central Service (CS) decontamination area is a perfect example of how safety systems and due diligence is essential for ensuring safety. Employees are educated in biohazard safety and must follow specific regulations, such as those established by the Occupational Safety and Health Administration (OSHA), to reduce the risk of injury. This chapter will identify common risks found in the CS work areas and discuss ways to minimize the risk of 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 275 year. Following safety protocols and incorporating them into all work practices is necessary for preventing injuries and accidents. Central Service Occupational Hazards 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, 276 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. 277 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 278 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 0.05 ppm, 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 279storage 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. AREA-SPECIFIC SAFETY CONCERNS There are safety concerns that are common in specific work areas within the CS department. Must personnel notifying about the need for PPE in the decontamination area. Soiled Receiving and Decontamination Areas Safety tips when working in soiled receiving and decontamination areas include: Never reach into a basin or container holding contaminated objects, unless the objects in the basin are clearly visible. Use a sponge forceps to grasp the object or pour out any solution that prohibits visual examination, and then remove objects from basins or containers one at a time. Never use foaming detergents when handling contaminated 280 instruments in the decontamination sink, as the foam can prevent visualization of sharp objects. Never reach into trash containers or sharps containers. Use extreme caution when disarming scalpel blades. Do not attempt to do so without training. Never disarm by hand. Always use a needle holder or tool specifically designed to remove blades. When processing reusable sharps, separate them from other instruments and position them in a manner that protects anyone who may handle them. Follow the manufacturer's recommendations for safe use of chemicals. Always wear recommended PPE to protect all skin surfaces. and mucous membranes from chemical burns. Follow the manufacturer's recommendations for safe operation of cleaning and testing equipment. Use caution when walking, and inspect the floor for slippery surfaces. Utilize mats and non-skid footwear. Sinks and other working surfaces should be at levels to afford easy access, and to reduce back and arm strain. Preparation and Sterilization Areas Safety tips when working in preparation and sterilization areas include: Move sterilizer carts to low/no traffic or other designated areas, so co- workers will be less likely to come in contact with hot carts. Use thermal insulated gloves when handling steam sterilizer carts, washer baskets and other objects subjected to high temperatures. Keep sterilizer doors closed when not loading or unloading the chamber to protect co- workers from coming in contact with the hot inner door. Use caution when using heat sealers. Keep away from heated components. Be sure to follow the manufacturer's instructions. Be cautious when using a cutting edge to prepare paper/plastic packs. Be cautious when testing instruments for sharpness. When lifting instrument sets, use the larger muscles in legs and arms. Hold the item as close to the body as possible without actually touching the body. Follow procedures for using and disposing of biological indicators. Ensure that proper signs and labels are posted to warn of hot surfaces or other hazard. Supply Receiving, Breakout and Storage Areas To ensure a safe and efficient supply receiving area, adequate storage space and traffic access must be available. Supply storage and shelving units must be secure and steady. Shelves should be arranged to facilitate maximum space efficiency and allow employees 281 easy access to supplies. Heavy materials and items used most frequently should be placed on middle shelves to enable them to be easily and safely accessed by employees. Lighter, infrequently- used items should be placed on higher shelves. Employees should use appropriate equipment (e.g., steps, stands and ladders) to safely reach upper shelves. Climbing on shelves is not acceptable. Procedures for the safe operation of dollies, hand trucks or carts to handle bulk materials must be available, and employees must be trained to consistently comply with them. Closed trash containers should be available to properly dispose of unwanted materials. Containers for the appropriate storage of hazardous or flammable materials must be readily available to avoid exposure to hazardous substances. Employees working in this area must also follow proper procedures when disposing of and removing hazardous materials. SDS must be available for reference where these substances are used. DISASTER PREPAREDNESS Disaster preparedness is an important component of the CS safety system. Each facility has developed a comprehensive response plan for internal and external disasters. An internal disaster is any situation with the potential to cause harm or injury to the healthcare facility employees or where the loss of utilities may drastically impact departmental operations. Examples of internal disasters include a hazardous chemical spill or leak, loss of power or failure of a utility, such as water, electricity or steam. An external disaster is a situation in which activities outside the facility impact departmental or facility operations. Examples that may necessitate activation of the external disaster plan include earthquakes, floods, hurricanes or other events that result in large numbers of seriously injured patients being sent to the facility. When an external disaster occurs, theentire facility is placed on alert and personnel from each department are expected to perform tasks, based on the situations present. Disaster Plans Elements of a CS disaster plan typically include: An emergency call list outlining the lines of authority, and the key individuals to be notified in specific types of disasters. Note: These may differ for each type of disaster. Protocols for inventory replenishment and delivery of emergency supplies. Usually, supply distribution department personnel are 282 responsible for the maintenance of supplies and, in times of disaster, will deliver to an area for emergency patient care. Posted evacuation plans and practice drills for employees to ensure that they know alternative ways to leave the department if their safety is at risk. Biological Disasters Many healthcare facilities have added biological incidents to their disaster plans. As with other types of disasters, CS technicians should know their role. Close communication with the Infection Prevention department is critical in this type of disaster. CS departments should utilize appropriate resources, such as the Centers for Disease Control and Prevention (CDC; www.cdc.gov) for up-to- date information regarding emerging biological threats. Other resources, such as the World Health Organization (WHO; www.who.org) can also provide guidance. In all instances, coordination between Infection Prevention and all areas impacted by the disaster is very important. EMPLOYEE ACCIDENTS AND INJURIES Even significant efforts to emphasize safety and accident prevention cannot eliminate all employee accidents, and CS technicians can still be injured on the job. If an injury occurs, it must be documented and reported to the appropriate administrative personnel, in compliance with OSHA regulations for healthcare facilities. PATIENT ACCIDENTS AND INJURIES CS professionals have responsibilities to help prevent patient injuries, accidents and infections. They do so as they perform the important tasks of decontaminating, inspecting, testing, assembling. packaging, sterilizing, aseptic handling of sterile items, and delivering items according to established procedures. When their job is done correctly, risk to the patient is greatly reduced. When a patient incident occurs, it must be promptly investigated and documented. Any practices or physical conditions within the facility that can cause a patient injury must also be investigated and reported. All healthcare workers must report unsafe practices or hazards promptly to minimize accidents and prevent their recurrence. EMPLOYEE INFORMATION AND TRAINING No safety and risk management system can be successful without employee involvement. Each employee must understand their role and responsibilities in maintaining a safe environment. This requires education for all staff at all levels of experience , All new CS employees should attend a health and safety orientation 283 provided by the facility to become familiar with hazards and safety practices throughout the facility. They should also attend a department-specific orientation that focuses on, at least, the following: An overview of the requirements contained in the hazard communication regulations, including employees' rights under the regulations. Notification of employees about any operations in their work area where hazardous substances are present. Location and availability of written hazard communication program information. Physical and health effects of any hazardous substances they may encounter. Methods and observation techniques used to determine the presence or release of hazardous substances in the work area. Strategies to lessen or prevent exposure to these hazardous substances through safe control and work practices, and use of PPE. Steps the department has taken to lessen or prevent exposure to these substances. Instructions on how to read labels and review SDS to obtain appropriate hazard information. Emergency spill procedures. Disaster and fire plans, and the role of the Cs department in their development and implementation. EMPLOYEE PREPAREDNESS An important factor in safety and risk management is employee awareness and preparedness. Every employee should approach each shift and each task with two questions in mind: "What can I do to ensure my safety and the safety of those in the facility?" and "What do I need to 284 know to respond if I am faced with an emergency?" Some strategies to help ensure emergency preparedness include: Be familiar with safety policies. Ask questions if specific information is not understood. Be familiar with the chemicals used. Know how to handle them safely and what to do in the event of an emergency. Know how to work safely around equipment. Understand the hazards and know where emergency shut-off buttons are located. Be familiar with evacuation routes, the location of fire extinguishers and fire alarm boxes. Leave each area safe. Wipe up spills, prevent trip hazards and do not cross contaminate. Maintain a safe environment at all times. Pay attention to detail. Report anything that threatens the safety and well-being of those in the facility. The success of any safety system is dependent upon the individuals who work within that system. Creating and maintaining a culture of safety reduces the risk for everyone. CONCLUSION Central Service technicians play an important role in every healthcare facility's safety program. It is important to know the expectations and be able to perform efficiently and calmly during any type of situation that may arise. For the safety of patients, visitors, other employees and departmental staff, training and safety drills must be taken seriously, as 285 should the adoption of safe work habits that help ensure preparedness for any unplanned emergency. Module 13 PERSONAL AND PROFESSIONAL DEVELPOMENT Index : 1. Introduction 2. Personal development : what is it and why is it important? 3. Professional development : what is it and why in it important? 4. Central Service Career Paths 5. Planning Your Career Goals 6. The Importance Of Resources 7. Professional Development activities 8. Understanding the interview process 9. Personal and professional development timelines 10. Conclusion 286