BASIC HEALTH AND SAFETY TOPICS FOR PHYSICIANS

Tulane University - Office of Environmental Health & Safety (OEHS)

BASIC HEALTH AND SAFETY TOPICS FOR PHYSICIANS

Information for Tulane University physicians who serve as residents,

house officers, or medical staff

May 2007


OBJECTIVES

– Know the purpose of program– Know how to respond if injured on the job – Know how to report an emergency security

situation– Know how to respond if confronted by an

individual with a weapon– Know the types of external and internal

disasters


OBJECTIVES

– Know how to respond to a Bomb Threat– Know the communication methods for emergency

incident notification at Tulane University – Know how to evacuate and respond to a fire– Know locations and types of fire extinguishers and how

to use them– Know identification, handling, and disposal of

hazardous materials– Know how to respond to a hazardous material incident


OBJECTIVES

– Know how to identify and report faulty, damaged, or in need of repair equipment

– Know the types of utility systems and how to report problems

– Know the location of the medical gas shutoff valves and how they can be shutoff in the case of an emergency

– Know radiation safety for patient care


SCOPE

• This module applies to residents, house officers, and medical staff who are employed by the Tulane University Health Sciences Center (TUHSC).

• Please complete the quiz at the end of the training module.

• By successfully completing the quiz, a certificate will be issued and data indicating participation in this program will be electronically sent to OEHS for recordkeeping.


SAFETY

• This program has been developed to describe how Tulane University will provide a physical environment free of recognized hazards and manage staff activities to reduce the risk of injuries.

• The Office of Environmental Health & Safety (OEHS) has been established to implement this program for Tulane University.

• The OEHS is not responsible for the Environment of Care Program at the Tulane University Hospital and Clinic (TUHC) except for Radiation Safety.


POLICIES AND PROCEDURES

• The Tulane University Environmental Health & Safety Policies and Procedures Manual contains the safety policies and procedures for Tulane University. You should also become familiar with the health and safety policies and procedures for the facility at which you practice.

• If you are injured on the job, then complete the following checklist: – Notify your supervisor, Complete a First Report of Injury Form (FROI),

Notify the Worker's Compensation (W/C) Specialist at 988-2869. If necessary, seek medical treatment at nearest hospital or clinic. Provide copy of FROI to healthcare provider. Provide all medical documentation to supervisor and W/C Specialist. Keep copies of documentations.

• For a copy of the FROI Form, go to the following website: http://www2.som.tulane.edu/oehs/safety/18F-oehss04.pdf


SECURITY

• At TUHSC, to report an emergency security situation or if you observe a suspicious individual or circumstance, tell the nearest TUHSC Police Officer or dial 988-5555 or if on campus, dial 55555.

• The following locations are staffed by TUHSC Police staff at all hours: TUHC Emergency Room and the TUHSC Police Dispatchers Station in the Medical School Lobby.

• Know the emergency telephone number for your facility.• To respond in the case of any or all suspected thefts or

non-emergency events, call TUHSC Police at 988-5531, or contact the designated private security service at your healthcare location.


SECURITY

• Always wear your identification badge on the outer clothing except when working in a sterile environment.

• Never unlock or leave security-sensitive areas unlocked.


SECURITY

• If you are confronted by an individual with a weapon, cooperate and follow their specific instructions. Give them what they ask.

• Avoid eye contact and discreetly obtain description of the individual.

• After you are certain that the person has left, call TUHSC Police at 55555.

• If you are at a non-TUHSC facility, contact their security department or dial 911 if appropriate.


Security

• At TUHSC, to report security incidents involving patients, visitors, personnel and property, call TUHSC Police at 988-5555. If you are at a non-TUHSC healthcare facility, contact the designated security department or service.

• Advise your supervisor of the occurrence.• For additional crime prevention and safety tips, go

to the following website: http://www.tuhscpd.tulane.edu


SECURITY

• If you have trouble starting your vehicular at the TUHSC campus, then contact TUHSC Police to attempt a jump start. They can not provide other roadside assistance.

• Upon request at all hours, TUHSC Police will provide foot and/or vehicle personal safety escorts within the TUHSC areas for anyone associated with Tulane University.

• Off campus escorts can not be provided.


EMERGENCY PREPAREDNESS

• Mass Casualty – In the case of an internal or external disaster involving

injuries, an emergency situation will be announced by Administration or Nursing Supervisor.

– An internal disaster can involve a hazardous material incident, fire, explosion, etc. in which rapid emergency response is needed to provide care and treatment for victims.

– An external disaster can involve an explosion, building collapse, severe weather emergency, etc. in which mass casualties are generally transported to a healthcare facility.



• Bomb Threat – If you receive a telephone call indicating a bomb threat,

keep the caller on the phone. Pay attention to the caller, voice, mannerisms, background noises, etc. Have someone immediately call TUHSC Police at 988-5555. If you are at a non-TUHSC healthcare facility, contact the designated security department or service.

– For response, complete the checklist found at the following website: http://www2.som.tulane.edu/oehs/safety/03F-oehss01.pdf



• Severe Weather – Employees will be advised of an emergency

situation via website, email, public address, or supervisors. For official information regarding Tulane University, staff must call the Alertline: 862-8080 or 1-877-862-8080 or http://emergency.tulane.edu.

– Stay in contact with your supervisor directly. Do not call the operators for information.



• In order to continue patient services in the case of a severe weather emergency, physicians will be designated as essential by their departments or managers and may be asked to return to the facility to assist beyond their normal work schedule.

• However, if it is a major hurricane, then staff may be asked to evacuate.



• Total Facility Evacuation– This is the movement of patients and occupants from an

area or the entire hospital and clinic to outside grounds or an adjacent area which is safe.

– Assist with patient care or other duties as requested by the Charge Nurse, Clinic Manager, or Supervisor.

– Patients may be transported to designated facilities.


LIFE SAFETY (FIRE)

• Evacuate an area if a fire is discovered and occupants must be moved.

• For healthcare and ambulatory healthcare facilities, remain on the same floor. Relocate occupants to the next smoke compartment which is a designated safe area of refuge on the floors. For information as to their exact locations, contact your supervisor or the Hospital Safety Officer.

• If there is a fire inside a unit or area, then move all occupants through the designated smoke barrier doors to the next compartment and proceed to administer medical care and life support using available equipment.

• Occupants may move in any direction from one smoke barrier zone to another.


LIFE SAFETY (FIRE)

• If you discover a fire, follow the acronym: E S C A P E – E - Evaluate the situation.– S - Secure the area by removing occupants in the area of the fire. – C - Close the doors to the room where the fire is located. – A - Activate the building fire alarm system. – P - Phone 55555 for TUHSC or the appropriate emergency

number for your healthcare facility. DO NOT CALL 911 unless it is the designated number to be used by your facility for emergencies.

– E - Extinguish the fire as appropriate


LIFE SAFETY (FIRE)

• Remember – it is not required that you extinguish the fire.• To enter the room to extinguish the fire, first feel the

closed door with the back of your hand. If it is warm or hot to the touch, then do not open the door. Assist with evacuation and/or other functions.

• Do not enter the room or any area if it is filled with smoke.• If the door is not warm or hot, then slowly open the door. • Before entering make sure you keep your back to a safe

and unobstructed exit to which the fire will not spread. • Extinguish the fire using an available portable fire

extinguisher.


LIFE SAFETY (FIRE)

• To use a portable fire extinguisher, follow the acronym: P A S S – P - Pull the pin on the handle

– A - Aim the nozzle at the base of the fire

– S - Squeeze the handle

– S - Sweep the fire from side to side.

• Be sure that the fire is confined to a small area.


LIFE SAFETY (FIRE)

• Know the location of the nearest fire extinguisher and on what types of fires it can be used.

• Hallway fire extinguishers inside cabinets are generally dry chemical extinguishers which can be used on all common types of fires (Class ABC).

• Carbon dioxide fire extinguishers (Class BC) can not be used on fires involving combustibles (Class A) but can be used on all other types of common fires.


HAZARDOUS MATERIALS AND WASTE

• For spills at TUHSC excluding TUHC, call OEHS at 988-5486 or go to http://www.som.tulane.edu/oehs/hazspill.htm.

• Hazardous materials include but are not limited to chemical, biological, explosive, flammable, radioactive and toxic materials.

• They may be solid, liquid, or gaseous in nature. • Hazardous materials become hazardous waste

when they are no longer usable or recyclable.



• When handling all hazardous materials or wastes, precautions must be taken to preclude accidental contact with the material/waste to include Personal Protective Equipment (PPE), work practice controls, and engineering controls, i.e. special exhaust ventilation.

• Staff must be familiar with the hazardous materials with which they come in contact.

• For information, refer to the label and to the Material Safety Data Sheets (MSDSs) which are usually located at the Nurse's Station, in departments, or designated areas.

• All hazardous materials and waste containers must be appropriately labeled.

• Hazardous gases i.e. ethylene oxide and nitrous oxide must be properly exhausted from work areas.



• Biohazardous waste, also referred to as Potentially Infectious Biomedical Waste (PIBW) includes diseased human and animal parts, contaminated dressings, pathological specimens and contaminated laboratory waste, hypodermic needles and other sharps, disposable contaminated clothing, contaminated bandages and gloves.

• Chemical waste includes those that may be toxic, corrosive, explosive, ignitable, or reactive and includes some chemotherapeutic agents.

• Physically hazardous waste includes non-infectious sharps and broken glass items.

• Hazardous materials are identified through the following: Chemical Inventory information provided to the purchaser at the time of purchase, Material Safety Data Sheets (MSDS), and labels on containers.



• All contaminated sharps must be properly disposed of by placing them in specifically labeled puncture-resistant, disposable containers with covers. Do not reuse them. Sharps must never be discarded into trash receptacles or linen receptacles.

• Sharp containers when 2/3’s full should be sealed and properly disposed.



• Prior to wearing PPE, first obtain information on the types of items needed, such as gloves, protective clothing, respirator, eye wear, etc.

• These items are available in your department and must be worn, as applicable. Review the Material Safety Data Sheets (MSDS) for information on the types of PPE needed.

• Be sure that the PPE is suitable for the hazardous material and that you know the limitations of the PPE and how to properly wear and use them.



• If you discover a hazardous material or waste incident, proceed as follows: – Alert persons in the immediate area; confine the spill safely to

prevent further contamination, i.e. close doors, pull down sash of hood; evacuate spill area; notify immediate supervisor or Departmental Safety Representative; if personal contact occurs, use an eye wash fountain and/or safety shower for flushing of the eyes and body for at least 15 minutes. Contact OEHS at 988-5486. Document the occurrence.

• If the incident occurs at a non-TUHSC healthcare facility, then immediately contact your supervisor and the department responsible for spill clean up. Do not contact OEHS.



• Become familiar with the physical and health hazards associated with each hazardous material that you use. Refer to the MSDS for this information.



• Under the OSHA Hazard Communication - Right To Know Standard, employees have a right to know about the hazardous materials on the job and how to protect themselves, both under normal operating conditions and in foreseeable emergencies.

• You must know of operations in your work area where hazardous chemicals are present.

• This standard generally deals with labeling of containers, MSDSs, chemical inventories, and training of employees.



• To detect the presence or release of a hazardous chemical in your area, refer to the MSDS for visual appearance or odor information.

• MSDS Contents include the following: Identity, Manufacturer, Characteristics, Physical and Health Hazards, Routes of Entry, Exposure Limits, Control Measures, First Aid, Precautions for Safe Handling and Use.

• Terms/Definitions– Carcinogen - causes cancer in humans– Corrosive - causes irreversible alteration in living tissue– Flammable – can easily fuel a fire – Toxic - capable of causing health effects– Irritant - can have reversible inflammatory effect– Oxidizer - chemical that promotes combustion in other materials– Routes of entry - points in which chemicals can enter the body– Sensitizer - can cause an allergic reaction in some people– TLV - Threshold Limit Value - exposure over 8 hour day– Water Reactive - reacts with water.


EQUIPMENT

• Equipment that is faulty, damaged, or in need of repair must be immediately reported to the charge nurse, clinic coordinator, or supervisor who will then contact the responsible department or contract service.

• If the device presents a safety hazard, then respond immediately by phoning the appropriate service department. Equipment in need of repair must be properly tagged and not used. Devices that are damaged, overheating, noisy, have frayed power cords or damaged plugs, must be reported using the above procedure. This also includes any loose controls, switches, burned out lamps or any suggestion of device malfunction.

• The user should conduct a Performance Check on the equipment upon its return from the service department.


EQUIPMENT

• Electrical extension cords/adapters must not be used in lieu of permanent wiring.

• Electrical extension cords are permitted only for temporary use.

• Should a department express a need for such a cord/adapter, the following alternatives will be proposed: Relocate the equipment, lengthen the power cord, or install an additional outlet.


UTILITY

• This applies to systems, i.e. Fire Alarm System, Elevators/Escalators, Electrical Distribution and Emergency Electrical Power System, Pneumatic Tube System, Plumbing System, Medical Gas System, Vacuum System, and HVAC (Heating, Ventilation, Air Conditioning), Telephones, Public Address System, Information Systems, and electrical equipment that by design, use or location may pose a possible electrical or safety hazard.

• Problems, failures, and user errors with a utility must be reported to the appropriate maintenance or facilities services department.


UTILITY

• Hallway and stairwell lights, exit signs, Operating Rooms, Intensive Care Units, Emergency Room, nurse’s station, patient rooms (at least one duplex receptacle per bed), and designated systems, i.e. fire alarm, telephone, public address, at least one elevator, etc. are supplied with emergency power from the generators.

• Electrical receptacles and light switches with red covers indicate that they are connected to the emergency generators.

• Also, there should be flashlights at the nurse's stations. • In areas with medical gases, shut off valves are located in the hallways

and are labeled. During an emergency, these should be shut off with the approval of nursing in patient care areas.


RADIATION SAFETY FOR PATIENT CARE

• If a radiation therapy procedure involving sealed sources or radiopharmaceuticals is being performed in a patient room, the room door is labeled "Caution, Patient Contains Radioactive Materials."

• Prior to entering a patient room, one must check with the nursing station.

• The patient chart is also labeled "Caution, Radioactive Materials."

• Note the time that can be spent in the immediate proximity (i.e. within two feet) of the patient per day or per shift. This limit applies to medical personnel and visitors so that they do not exceed their Federal and State radiation exposure limit.



• Radiopharmaceutical therapy also results with radioactive contamination from urine, perspiration, and saliva. Items that come into direct contact with the patient, such as gloves and eating utensils, are assumed to be contaminated and must be left inside the room to be surveyed after the patient has been discharged.

• In all cases, radiation exposure can be reduced by minimizing TIME near radiation sources. Exposure can also be reduced by increasing DISTANCE from radiation sources. Standing behind portable lead SHIELDING can also reduce radiation exposure.



• For further information, refer to the Tulane University Radiation Safety Manual or the designated Radiation Safety Manual for your healthcare facility.

• If there are any questions, then contact the Tulane University Radiation Safety Officer, Mr. Charles Reindl, at (504) 988-2867.


OFFICE OF ENVIRONMENTAL HEALTH & SAFETY

WEBSITE

The following OEHS website is a great resource tool for health and safety information:

www.som.tulane.edu/oehs

Tulane UniversityOffice of Environmental Health & Safety (OEHS)

Louis Mayer, RS, CSP, MPH, CFI Manager – Training, Education, and General Safety

(504) [email protected]

If unable to proceed to quiz, type the link below into your browser

https://pandora.tcs.tulane.edu/ehs/enterssn.cfm?testnum=27

Proceed to Quiz

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BASIC HEALTH AND SAFETY TOPICS FOR PHYSICIANS