Dede Carr, BS, LDAKaren Neu, MSN, CNE, CNP

Healthcare Safety & Standard Precautions

Environmental Safety in Health Care

2

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Competency 3

3. Describe the methods healthcare facilities use to achieve physical, chemical, and biological safety.a. Explain physical hazards and list safe practice

guidelines.b. Explain chemical hazards and their labeling

requirements.c. Explain biological hazards & their safety

guidelines

ENVIRONMENTAL SAFETY Environmental safety means identifying and

correcting potential hazards that can result in accidents.

Examples: Faulty wiring, slippery floors, & infectious wastes in open containers.

Healthcare workers must understand & follow workplace safety policies and procedures to reduce hazards, prevent accidents, and know how to handle incidents correctly if they do occur.

OSHA, as you learned in lesson #1 has many regulatory measures that apply to workplace issues.(Juliar, p. 162)

GENERAL SAFETY GUIDELINES

PREVENTION is the best approach to safety. There are many ways healthcare workers can

contribute to the prevention of common accidents and injuries in the healthcare environment.

Personal safety practices are one way Environmental hazards that may pose a risk in

the healthcare environment

ELECTRICAL HAZARDS Electrical equipment needs to be in good

working order and grounded. The third (longer) prong in an electrical plug is the ground. Theoretically the ground prong carries any stray

electrical current back to the ground whereas, the other two prongs carry the power to the piece of electrical equipment.

Improperly grounded & malfunctioning, or faulty electrical equipment (frayed cords) increases the risk of electrical injury & fire. (Potter & Perry, p. 842)

ELECTRICAL HAZARDS It is the healthcare worker’s responsibility to remove faulty

equipment from service & make a report to the appropriate person at the healthcare facility.

Using machines in good repair, wearing shoes with rubber soles, standing on a non-conductive floor, and using non-conductive gloves are all ways to prevent shock.

However, even with such precautions, the rescuer must never touch the victim until the electricity is turned off or the victim has been removed from contact with the electrical current; otherwise the rescuer may also receive electrical injury.

If a client receives an electrical shock in the healthcare setting, immediately determine whether the client has a pulse. If no pulse, initiate cardiopulmonary resuscitation (CPR) & notify emergency personnel. (Ramont & Niedringhaus, pp. 728-729)

RADIATION HAZARDRadiation injury can occur from overexposure to radioactive

materials used in diagnostic and therapeutic procedures (x-ray or radiation therapy).

Excessive radiation exposure can put the employee at risk for developing tissue damage, contracting cancer, or becoming sterile (unable to bear children), or may lead to infants being born with birth defects.

Exposure to radiation can be minimized by a) limiting the time near the source, b) providing as much distance from the source, c) using shielding devices, such as lead aprons when near the source.

Employees at risk for radiation exposure must wear safety monitoring film badges that record the amount of exposure. Safety guidelines have been developed that determine the maximum level of

radiation exposure allowed per employee. (Juliar, p. 171; Ramont & Niedringhaus, p. 130)

RADIATION HAZARDS There are also strict guidelines for proper

disposal of radiological wastes. Radioactive waste must be placed in a special

container labeled a “radioactive.” It should never be placed in the trash, incinerated, or placed in a bag with other waste products or put down a drain.

Only a licensed removal facility can remove these waste from the healthcare facility.

(Juliar, p. 171)

EXCESSIVE NOISE Excessive noise is a health hazard that can cause hearing loss,

depending on the overall level of noise, the frequency range of the noise, the duration of the exposure and individual susceptibility. Sound levels above120 decibels (units of loudness) are painful and may

cause hearing damage even if a person is exposed only a short period. Exposure to 85 to 95 decibels for several hours a day can lead to progressive or permanent hearing loss.

Tolerance of noise is largely individual. When ill or injured, people are frequently sensitive to noises that normally would not disturb them.

Loud voices, the clatter of dishes, and even a nearby TV can disturb clients, some of whom may react angrily.

Physiological effects of noise include: increased heart and respiratory rates, increased muscular activity, nausea, and hearing loss, if the noise is sufficiently loud. (Berman et al., p. 728)

FIRE HAZARD In healthcare agencies, fire is particularly

hazardous when people are incapacitated and unable to leave the building without assistance.

Healthcare workers must be aware of the fire safety regulations and fire prevention practices of the agency in which they work.

Healthcare workers should know the location of exits, fire alarms, and extinguishers.

(Ramont & Niedringhaus, pp. 126-127)

FIRE HAZARDS A fire needs three components in order to start:

fuel (trash, linen, chemicals), oxygen/air, & heat (sparks, flames, matches).

Most frequent causes of fires: Improper use of smoking materials Defects in a heating system Improper trash disposal Misuse of electrical equipment Spontaneous combustion  

FIRE HAZARDWhen a fire occurs, the healthcare worker follows four

sequential priorities. Use the acronym RACE to help remember the procedure.

R = Rescue or Remove clients immediately in danger.A = Activate the Alarm Pull the alarm or call to

report.C = Confine or Contain the fire by closing all doors,

making sure the medical gas valves are turned off and that circuit breaker panels are turned off.

E = Extinguish the fire or E = Evacuate.

EXTINGUISHING A FIRE Extinguishing the fire requires

knowledge of three categories of fire, classified according to the type of material burning.

Class A: paper, wood, upholstery, rags, ordinary rubbish

Class B: Flammable liquids & gases (gasoline, grease, oils, paint thinner)

Class C: Electrical

EXTINGUISHING A FIREThe right type of extinguishermust be used to fight the fire.1. Air-pressurized water – used

on Class A fire only.2. Carbon dioxide – used on

Class B & C fires only.3. Dry chemical – used on Class

B & C fires only. Each extinguisher has picture

symbols showing the type of fire for which it is to be used.

(Ramont & Niedringhaus, p. 127)

EXTINGUISHING A FIRE

PASSWhen using an extinguisher, remember PASS.

P = Pull pinA = AimS = SqueezeS = Sweep

(Juliar, p. 167)

EXTINGUISHING A FIREPASS

When using an extinguisher, remember PASS.P = Pull pinA = AimS = SqueezeS = Sweep

(www.emory.edu, n.d.)

Using a Fire Extinguisher

Pass Pull the pin Aim Squeeze Sweep

EXTINGUISH OR EVACUATE? Watch this 4:45 minutes YouTube video to

learn when to use a fire extinguisher and when to evaluate.Extinguish or Evacuate

See the Word Document entitled, “Fire Safety” located under “Content” tab Lesson #4.

FIRE HAZARDS The most common cause of death related to a

fire is smoke inhalation. Remain low to the floor, cover your mouth and

nose with a moist cloth, and avoid inhaling too much smoke.

Remember that most residents/clients can notnot get as low to the ground as we can. Give them a moist cloth to cover their mouth and nose as well. (Juliar, p. 169)

FIRE SAFETYPrevention is the Key to Fire Safety  Inspect electrical cords for exposed wires Do not use space heaters Do not allow residents to smoke in their rooms Keep the client’s room free of clutter Do not overload electrical outlets

PREVENTION OF ELECTRICAL HAZARDS Be thoroughly familiar with any equipment before

attempting to use independently for the first time. Know & follow all safety precautions.

Review & follow the manufacturer’s operating instructions. Healthcare workers should not take short cuts or experiment with unfamiliar equipment.

If any damage to the equipment is noted, do not attempt to use it, but report it to the proper person for repair.

Never use electrical cords that are not completely intact, plugs that have been altered (third prong removed), and do not use excessive force to insert a plug into the outlet.

(Juliar, p. 170)

PREVENTION OF ELECTRICAL HAZARDS Never handle any electrical equipment around water

because electrocution can occur (water conducts electrical currents).

Holding electrical equipment with wet hands, standing in water, or removing equipment that has accidently dropped in water can be life threatening. Always dry hands, clean up spilled water, and remove the power source.

If someone is shocked (electrically), do not touch the person or pull the plug from the outlet, because this places you at risk. Instead, turn off the main source of power immediately and be prepared to administer emergency care and call for help. (Juliar, p. 170)

OXYGEN PRECAUTIONSSpecial precautions when oxygen is used are: Sparks may come from some electrical appliances, equipment, or toys.

Before using any of these, always check with the supervisor. Examples include hair dryers, heating pads, space heaters, fans, radios, electric shavers, & hand-held computer games.

Never use flammable liquids, such as alcohol, oils, adhesive tape remover, nail polish, or nail polish remover.

An oxygen tank should be secured to prevent if from falling over. Do not place it in the sunlight or near heat.

Use cotton blankets, gowns, & clothing. Wools and synthetics are more apt to create static electricity.

Smoking is not allowed when oxygen is in use & smoking materials should be removed from the room.

No lit matches or open flames should be permitted in the area.(Juliar, 172)

CHEMICAL HAZARDS Healthcare settings have hundreds of chemicals, such as

cleaning solutions, anesthesia, and chemotherapeutic drugs.

Chemicals can cause harm & injury if swallowed, inhaled, or absorbed through the skin or mucous membranes. Some chemicals create fire hazards.

Take good care when working with these agents. OSHA requires all health care facilities to have an

exposure control plan. In addition, The Globally Harmonized System of

Classification and Labeling of Chemicals (GHS) must be available to all employees.

GUIDELINES IN HANDLING CHEMICALS If a container is not properly labeled or if it can’t be read clearly, do not use

it. Recheck labels at least three times. Read the label carefully when you first

locate it, and then reread it after removing the solution, and again before returning it to the proper location.

Never mix any two chemicals together without first verifying compatibility. Avoid contact with the eyes & skin & do not inhale. Take precautions not to slash or spill solutions. Wear personal protective equipment (PPE) as indicated. Make sure chemicals are used only for their intended purpose. Store chemicals as labeled. Do not pour toxic (poisonous), flammable, foul-smelling, or irritating

chemicals down the drain. Place in specified container per policy. If you spill any solutions, clean up immediately according to established

procedures and dispose of debris properly. (Juliar, p. 171)

WHAT IS GHS? The GHS is an acronym for The Globally Harmonized

System of Classification and Labeling of Chemicals.

The GHS is a system for standardizing and harmonizing the classification and labeling of chemicals.

It is a logical and comprehensive approach to:

• Defining health, physical and environmental hazards of chemicals;

• Creating classification processes that use available data on chemicals for comparison with the defined hazard criteria; and

• Communicating hazard information, as well as protective measures, on labels and Safety Data Sheets (SDS).

WHAT IS THE GHS?G GloballyH Harmonized S System of Classification and Labeling of Chemicals  A common and coherent approach to defining and classifying

hazards, and communicating information on labels and safety data sheets.

Target audiences include workers, consumers, transport workers, and emergency responders.

Provides the underlying infrastructure for establishment of national, comprehensive chemical safety programs.

WHY IS THE GHS NEEDED To have a common worldwide approach to classifying

chemical hazards and communicating hazard information

Harmonized definitions of hazards Specific criteria for labels Harmonized format for safety data sheets

With world-wide use of chemicals a common approach was needed to avoid sector-specific regulations Transportation Production Workplace, Consumer products

WHY IS THE GHS NEEDED? (CONT) Example, a product may be considered flammable or toxic in

one country, but not in the country to which it is being shipped

No country has the ability to identify and specifically regulate every hazardous chemical

In the area of trade, the need to comply with multiple regulations regarding hazard classification and labeling is costly and time-consuming

PURPOSE OF GHSThe GHS is intended to replace multiple systems of labeling and classification with a single unified approach.This is done by:

Creating classification processes that use available data on chemicals for comparison with world wide accepted defined hazard criteria

More effectively and consistently communicating hazard information and protective measures on labels and Safety Data Sheets (SDS).

THE SCOPE OF GHS Covers all hazardous chemical substances, dilute solutions,

and mixtures

Covers all pharmaceuticals, food additives, cosmetics and pesticide residues in food: Will not be covered at the point of intentional intake (use) But will be covered where workers may be exposed and In transport 

IMPLEMENTATION OF GHSDifferent federal agencies are tasked with implementing GHS:

Workplace - OSHA

Transport of Dangerous Goods – DOT

Pesticides – EPA

Consumer Products – CPSC

SAFETY DATA SHEETS (SDS)

What are safety data sheets (SDS)? There is a SDS for each chemical & the SDS contains the

precautions to take when handling the chemical, safety instructions for use, requirements for clean-up, and first aid measures to take if exposure occurs.

Each person is responsible for knowing the chemical used and any potential risks to themselves and their clients. One should read the label of the chemical before using or review the SDS. Know where the SDS is located & how to access them.

Containers must be labeled with the chemical name & function. Labels must also tell any danger or hazard that may exist with that chemical or ingredients, the name, address, & phone number of the manufacturer.

(Ramont & Niedringhaus, p. 131)

SAFETY DATA SHEETS (SDS)

Safety Data Sheets (SDSs) Prepared by the chemical manufacturer or supplier,

SDSs provide detailed safety and health information not found on container labels.

With this information, supervisors/employees can determine necessary controls such as ventilation, work conditions, and procedures for using chemicals safely; as-well-as protective equipment needed to prevent worker contact with hazardous chemicals.

SDSs can also be used to compare products available for a particular job to determine which product is the safest to use.

SAFETY DATA SHEETSHealthcare workers have a right to learn about chemicals they will

work with & how to protect themselves before working with them.

** Review “Employee Right-to-Know” Law Healthcare workers should know: The requirements of the standard The location of the hazard communication program and SDSs How to read chemical container labels and SDSs The identity and location of work process involving chemicals The physical and health hazards, including the symptoms of overexposure

to the chemical How to safely use the chemical & appropriate protective equipment How to detect the presence or release of the chemical What to do in an emergency, such as an injury or an accidental chemical

spill. (Ramont & Niedringhaus, p. 131)

REQUIRED INFORMATION ON SDSA SDS can be in any format, but it

must contain some specific information:

The name of the chemical Name, address & phone number

for hazard & emergency information

Chemical & common names of hazardous ingredients

Physical & chemical characteristics, such as the color and form (solid, liquid, etc.)

Physical hazards that the chemical can pose under working conditions (flammability, explosiveness, reactions to other chemicals)

How the chemical can enter your body

How much of a chemical you can be exposed to safely (exposure limits)

How the chemical can harm you

How to tell if you have been overexposed (dizziness, skin irritation, shortness of breath)

How to protect yourself from being exposed, such as personal protective clothing & equipment

Chemical handling & safe use Emergency and first aid

procedures.

CHEMICAL LABELSChemical labels are coded according to the

National Fire Protection Association

(www.safetysign.us, n.d.)

CHEMICAL LABEL SAMPLE

(www.mountnittany.org, n.d.)

CHEMICAL LABEL SAMPLEHere is a sample based on the NFPA’s coding.

(www.safetysign.us, n.d.)

BIOLOGICAL HAZARDS & SAFETY GUIDELINES

Healthcare environments contain many potential hazards. It is essential to follow safety practices that consider the well-being of others.

Do not open more than one file cabinet drawer at a time to prevent tipping.

Do not place food in a refrigerator that contains lab specimens & medications. (Juliar, p. 163)

BIOLOGICAL HAZARDS & SAFETY GUIDELINES

Do not wear uniforms in non-work places. Keep floors clear by immediately picking up dropped

objects. Use OSHA standards when cleaning up glass, spilled specimens, and liquids.

Broken glass is best picked up with a brush or broom and dustpan & placed in a puncture-resistant wrap or container prior to placing in a plastic bag. This will prevent cuts for whoever handles the bag.

When spills involve bodily secretions or blood, follow the Standard Precautions by wearing gloves and disposing of waste in special bags designated for biohazardous waste. (Juliar, p. 163)

INFECTIOUS WASTES Infectious waste is any item or product that has the potential

to transmit disease. Infectious waste must be handled using standard and transmission-based precautions, placed in containers or bags labeled as to type of waste (i.e., linen, sharps, trash), decontaminated onsite, or removed by licensed removal facility for decontamination.

It is the healthcare worker’s responsibility to follow the facility’s policies and procedures in proper handling, containment, clean-up of spills, and disposal of infectious waste.

Any direct contact with waste that puts the worker at risk for infections should be reported per facility policy.

(Juliar, p. 171)

REPORT FOR SAFETY Properly reporting unsafe conditions & accidents provides a

means of making corrections and preventing future problems. Report any unsafe conditions immediately, such as burned out

exit sign lights, equipment or flooring in need of repair. And side rails or call lights that don’t work.

Report any accidents or injuries immediately and complete an incident report. An incident report is a written document completed when an unexpected situation occurs that can cause harm to a patient, employee, or any other person.

An incident report contains only factual information, and most facilities have policies that specify not to include the report in the patient’s medical chart or to refer to it in the documentation. (Juliar, p. 165)

REFERENCES Berman, A., Snyder, S.J., Kozier, B., & Erb, G. (2008).Asepsis. In A. Berman, S.J. Snyder, B.

Kozier, & G. Erb (Eds.). Kozier & Erb’s Fundamentals of nursing: Concepts, process, and practice (8th ed.) (pp. 668-709). Upper Saddle River, NJ: Prentice Hall

Centers for Disease Control & Prevention. (2007). Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings. [Power Point] Retrieved from http://www.cdc.gov/

Juliar, K. (2003). Minnesota health care core curriculum, 2e. Clifton Park, NY: Delmar Publishing, Thompson Custom Publishing

Kockrow, E.O.(2006). Medical/Surgical asepsis and infection control. In B.L. Christensen & E. O. Kockrow (Eds.). Foundations and adult health nursing (5th ed.) (pp. 270-314). St. Louis, MO: Elsevier, Mosby

Occupational Safety & Health Administration. (2011, January). OSHA Fact Sheet: Bloodborne Pathogens Standard. Retrieved from www.osha.gov

Potter, P.A. & Perry, A.G. (2009). Infection prevention and control. In P.A. Potter & A.G. Perry (Eds.). Fundamentals of nursing (7th ed.) (pp. 641-685). St. Louis, MO: Elsevier, Mosby

Ramon, P.R. & Niedringhaus, D. M. (2008). Infection control and asepsis. Fundamental nursing care (2nd ed.) (pp. 149-176). Upper Saddle River, NJ: Person Prentice Hall