Environmental Safety in Home Health Care

BY

DR ANJUM HASHMI MBBS,CCS(USA),MPH.

Director Employees' Health, East Najran Hospital, NAJRAN,KSA

Workplace Safety & Risk Management • Home Healthcare workers face a wide

range of hazards on the job, including travel, patient care related injuries, back injuries, latex allergy, violence and stress.

• Transportation to remote patient locations and weather conditions result in additional risks to the home healthcare workers.

Dimensions of Environmental Safety

The Environment of Care• Patient's home environment must be

assessed to determine whether the home medical care provider can safely provide the service needed for the patient.

• Patient's home should be assessed for cleanliness, temperature control, running water, toilet facilities and infestation with insects or rodents.

Hazards for Home Health Care Workers • Physical Hazards – Workplace Injury: Slips, trips,

falls, overexertion, back injury, temperature extremes; unhygienic conditions & transportation-related risks.

• Biological Hazards – Infective diseases, blood borne pathogens, needle stick injuries.

• Chemical Hazards – Hazardous drugs, cleaning and sterilizing agents.

• Psychological Hazards – Occupational stress, workplace violence, guns and other weapons; illegal drugs; verbal abuse and other forms of violence in the home or community.

Physical Hazards

Musculoskeletal Disorders (MSD) • The risk factors includes:• Forceful exertions (activities that require

a person to apply high levels of force, such as during lifting, pushing, or pulling heavy loads)

• Awkward postures when lifting a patient /equipments.

• Repeated activities without adequate recovery time.

Awkward Postures Resulting MSD

• Rooms in patient’s homes are often small or crowded, and workers must often use awkward postures during patient care and transfer tasks.

• Beds are not adjustable, thus preventing the HCW from raising or lowering the patient to the best position for a proper lift.

• Home healthcare workers frequently endure long periods of standing or walking.

Recommendations for Home HCWsto Avoid MSD

• Move along the side of the patient’s bed to stay in safe postures while performing tasks at the bedside. Do not stand in one location while bending, twisting, and reaching to perform tasks.

• When moving the patient, stand as close as possible to the patient without twisting back, keeping knees bent and feet apart.

• To avoid rotating of spine, make sure one foot is in the direction of the move.

• Use ergonomic assistive devices if available.

Ergonomic Assistive DevicesSlide/draw sheet Slide/transfer board

Patient moving slingRolling toilet/shower chairGait/walking belt

Recommendations for Home HCW cont

• Use a friction-reducing device such as a slip sheet whenever possible.

• Use gentle rocking motions to reduce the exertion while moving a patient.

• Pulling a patient up in bed is easier, when the head of the bed is flat or down and

raising the patient’s knees & encouraging the patient to push (if possible) can also be helpful.

Chemical Hazards

Latex• Latex is the milky sap obtained by tapping the

rubber tree. • The raw material is mixed with a preservative,

such as ammonia, then concentrated as a latex concentrate to make products such as disposal gloves, adhesive tape, elastic bandages, rubber aprons, stomach and intestinal tubes.

• This milky fluid contains variable amounts of proteins that can be absorbed through the skin or inhaled and can cause allergic reactions in susceptible workers.

Latex Allergy• The three main types of latex allergy: • Irritant contact dermatitis: It has a gradual onset,

takes days. • Allergic contact dermatitis/Type 4 (Delayed

hypersensitivity): Occurs 6 to 48 hours after contact.

• Immediate hypersensitivity/Type 1 ( IgE mediated reaction): Occurs within minutes and rarely lasts longer than 2 hours. It can have a sudden onset but the sufferer can use latex for years without problems.

Recommendations for HCWs• Prevent unnecessary exposure to latex

products. If gloves use is necessary then: • Use non latex gloves.• Avoid inhaling the cornstarch powder lining

the gloves. Choose powder free gloves. • Wash hands with a mild soap and dry hands

completely after using gloves.• Avoid oil-based creams or lotions when using

latex gloves.

Biological hazards

Unsanitary Conditions• Unsanitary conditions are of special concern as

the spread of infectious disease within the home is well documented in literature, home care can pose a risk of infection to HCWs.

• Cross-contamination (e.g., transfer of pathogens through direct and indirect contact with raw foods, animals, and contaminated inanimate objects) can place HCWs at risk.

• One household area of potential concern in this regard is the bathroom. Gerba, et al

Needlestick Injuries• Needlestick and Sharp

Injuries (NSIs) are accidental skin penetrating wounds caused by sharp instruments in a medical setting.

• A break of skin can be from a needle or other "sharp" such as a scalpel / glass.

Epidemiology of NSIs

• An injury from a contaminated sharp object exposes workers to bloodborne pathogens that can cause serious or fatal infections like:

• Hepatitis B• Hepatitis C• HIV• HCW must ensure that he/she should receive

proper follow-up medical care after NSI.

• Infections are caused by needlestick injuries

Activities Associated with NSIs• Disposing of needles attached to tubing.• Manipulating the needle in the patient.• Recapping and bending needles.• Transferring body fluid between containers

using needles or glass equipment.• Failing to dispose of used needles in sharps

containers.• Rapid work pressures.• Bumping into a needle, sharps, or other HCW.

NSI Prevention Recommendations • Follow standard precautions i.e., use gloves.• Avoid recapping, if needed use

use one hand scoop method.

• Do not bend needles.• Before starting a procedure, plan for the

safe handling and disposal of needles.

NSI Prevention Recommendations • Dispose the used needles and any other

contaminated sharps materials promptly in designated sharps disposal containers.

• Carry standard-labeled, leak-proof, puncture-resistant, sharps containers with you to homes.

• Secure used sharps containers during transport to prevent

spilling of sharps.• Discard when 2/3rd filled.

Care of Needlesticks Injuries • Wash immediately needlesticks injury or

cuts with soap and running water. Do not squeeze and do the antiseptic dressing.

Care of Blood & Body Fluid Splash• Flush splashes to the nose, mouth, or skin

with running water.• Irrigate eyes with clean water, saline and

seek medical treatment immediately. Inform the supervisor & write OVR of the

incident to receive follow-up care.

Psychological Hazards

Workplace Violence • The patient’s home may be in a high-

risk area for violence; there may be drug traffic or high-crime areas nearby.

• A patient’s history of mental illness alcoholism, drug abuse, or violence may also increase the risk.

• More time spent in the patient’s home may result in a higher risk of violence.

Types of Workplace Violence

• Threats: Expressions of intent to cause harm (verbal, body language, written).

• Physical assaults: Attacks including slapping, beating, rape, homicide, and the use of weapons such as firearms, knives.

• Mugging: An aggressive assault, usually by surprise and with intent to rob.

Recommendation for HCWs• Always know where you are going. Have

accurate directions to the house.• Always let administration know where you

are and when to expect you to report back.• Park the car in a well-lighted area.• Keep glass windows of car closed.• Keep your mobile phone in pocket.• Keep healthcare equipment, supplies, and

personal belongings locked & out of sight.

Recommendation for HCWs contd • Before getting out of the car, check the

surrounding location and activities. • During the visit, use basic safety precautions: — Be alert. — Evaluate each situation for possible violence. — Watch for signals of impending violent assault, such as verbally expressed anger and frustration, threatening gestures, signs of drugs or alcohol abuse, or presence of weapons.

Recommendation for HCWs contd • Maintain behavior that helps to diffuse anger: — Present a calm, caring attitude. — Do not match threats. — Do not give orders. — Acknowledge the person’s feelings.• Avoid behaviors that may be interpreted as

aggressive (for example, getting too close, touching unnecessarily, or speaking loudly).

• Write OVR for any type incident of violence.

Waste Management• Infectious Wastes generated in the home

care setting should be handled properly.• Non sharp wastes should be placed into

designated containers e.g., yellow plastic bag followed by hand hygiene.

• Dispose sharps (e.g., needles, lancets) in sharp container to prevent NSI.

• Store waste at designate place at Home Medical care office for disposal with hospital waste.

Surface Decontamination • If a surface in patient home become

contaminated should be cleaned and disinfected with 1:10 dilution Clorox spray (100ml Clorox {bleach} in 900ml water contact time 5min) or disinfect with spray solutions approved by infection control department.

• Then clean with tissue / gauze and dispose it, in yellow biohazard bag.

Blood & Body Fluid Spill• Don appropriate PPE (gloves, mask & gown).• Cover the spill with paper towels or other absorbent

materials.• Carefully pour a freshly prepared 1:10 dilution of

Clorox/bleach around the edges of the spill and into the spill. Allow a 10 minutes contact period.

• Use paper towel to wipe up the spill, working from the edges into the center.

• Clean spill areas with fresh paper towels soaked in Clorox.

• Dispose paper towels into a yellow biohazard bag.

Emergency Preparedness Plan• Home healthcare workers may be

exposed to disasters like floods, earthquakes, sand storms etc.

• HCWs should be trained during their orientation to follow the hospital emergency preparedness plan.

Summary• Measures to manage risk do not

require highly sophisticated resources but do require good planning and adherence to safe practices.

• As the saying goes “An ounce of prevention is worth a pound of cure”.

Reference• Niosh Hazard Review Occupational Hazards In

Home Healthcare, Department Of Health And Human Services, Centers For Disease Control And Prevention, National Institute For Occupational Safety And Health.

THANK YOU