EMPLOYEE SAF FETY TRAINING presen nted by DUHS Occupational & Environmental Safety Offfice (OESO) • • • • • •
Division ns Environmental P Programs Radiation Safety y Biological g Safety y Ergonomics Fire Safety Occupational Hy ygiene and Safety
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Safety Management
Security
Hazardous Materials
6 FUNCTIONS OF THE ENVIRONM MENT OF CARE ((EOC)) Utility Systems
Life Safety
Medical Equipment
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Bl db Bloodborne e Pathogens P th HTLV VI V-I Syphilis Malaria
Leptospirosis
Hepa atitis B Hepatitis C HIV
Marburg Fever T Trypanosomiasis i i
Lassa Fever Other Hepatitis Leprosy Borreliosis
Ebola Feve er
Colorado Tick Fever www.safety.duke.edu
Ri k off IInfec Risk f ction ti from f a Needle estick
Hepatitiss B
1/3
Hepatitis C
1 / 200
HIV
1 / 300 www.safety.duke.edu
Hepatitis B Infection “Hepatitis B virus (HBV V) infection is the major infectious occupational hazzard to healthcare workers” Federal Register 54:230 042-23139, May 30, 1989
1-2%
98%
Chronic hepatitis
Recovery
Cirrhosis Liver Cancer www.safety.duke.edu
Occupationally-acquire ed Hepatitis Infections D k U Duke University i it H Ho ospital it l Employees E l 16
Vaccine Trials Dialysis Unit
14 12
#
10
Hospital-wide Hepatitis B V Vaccine i Program P
Hep B Infections Hep C Infections
8 6 4 2
Universal Precautions
OSHA BBP
Hepatitis C postexposure testing Safety Device Emphasis
0 '76 '78 '80 '82 '84 '86 '88 '90 '92 '94 '9 96 '98 '00 '02 '04 '06 '08 '10
The hepatitis B vaccine has virtually eliminate ed hepatitis B occupational infections at Duke Hospital. Since post-exposure testing for hepatitis C antibody was initiated in 1996, 3 occupational infections with hepatitis C have been identified, highlighting the need to use precautions against blood exposure, including g the use of the new safer sharps devices.
Universal (Stand dard) Precautions
ALL blood and body fluids f are considered potentiallyy infectiouss and must be handled with basic (stand dard) precautions
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Safety Devices Found Throughout DUH HS Blood Bl d ttransfer f device d i for syringe blood draws
Shielded phllebotomy p eboto y needle eed e
Push-button, safety catheter IV stylet
Shielded safety “butterfly” needle Mylar-coated capillary tube
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Use Prec cautions Use EXTR REME precautions with ith need dles l and d sharps h
Wear gloves W l anytime i contactt with ih blood is anticipated www.safety.duke.edu
Faces can be protected with ith th the mask k / shield hi ld combination, goggles, or a full f ll ffaceshield hi ld
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Biohazard Labels Label all equipment used for storage or transport of blood or bod dy fluids with a biohazard symbol y (red ( sticker in photo on right) www.safety.duke.edu
Ussed d needles dl should h ld b be placed l d dirrectly into sharps containers WITHOUT recapping pp g or breaking g ne eedles
Sharps •pipettes •glassware •sharps www.safety.duke.edu
Blood or Body y Fluid Spills - Wear gloves glo es - Absorb fluids with disposable towels - Clean area with soap/water - Decontaminate with appropriate disinfectant (ex (ex., diluted bleach,“tuberculocidal” disinfectant) - Place all disposable material into an appropriate bag for disposal
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“Bulk” Bulk blood and body fluids – blood bags – suction liners – >20 mls fluid
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Laboratory Infe ectious Waste •
Au utoclave in OR RANGE bags for dissposal or send in biohazard box (in red bag)
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Needlestick? Cut? C Splash to Face? ?……. Duke Hospital p or Medical Center Employees: Employee Exposure Hotline: 115 Off-site Employees: 684-8115 www.safety.duke.edu
Standard Worrk Practices
NO eating or drinking in patient care areas www.safety.duke.edu
Tubercu ulosis How can I catch TB at work? ? • By breathing in aerosols of TB bacteria • Patients who are coughing/sneezing or undergoing cough cough-induci inducing procedures (bronchoscopy)) www.safety.duke.edu
What Cau uses TB? • Mycobacterium tuberrculosis • Causes TB • Occupational Risk
• Mycobacteria M b t i other th th h TB (MOTT) han • Causes disease in immunocompromised, ex., MAI in i AID DS patients ti t • NOT an Occupationall Risk www.safety.duke.edu
TB can exist as two conditions: Latent TB: Infection with TB T bacteria,, BUT NO symptoms
Active TB ( infectio ous ): Infection with TB T bacteria AND HAS symptomss www.safety.duke.edu
Signs and Sympto oms of Active TB Anorrexia i Fatigue Weigh ht Loss Fev ver Night Sweats S Cou ugh h Hemo optysis CXR Changes
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How do we protect ourselves at DUHS? • Rapid Identification an nd Isolation • Designated Patient Iso olation Room (door sign shown in next slide) • Employee Respiratoryy Protection • Routine PPD Skin Tes sts and Follow-Up www.safety.duke.edu
AIRBORNE ISOLATION •Visitors must report to nurs sing station before entering room. Los visitantes deben n reportarse ante la estación de enfermería
antes de
entrar.
•Wash hands before enterin ng and after leaving room. Lávese las manos an ntes de entrar y después de salir del cuarto.
•Must wear N-95 Respiratorr (must be fit tested to wear) or PAPR to enter patient’s patient s room room. Se requiere mascarillla tipo N-95 (necesita medírsela para el correcto) o protección respirato oria del PAPR para entrar.
tamaño
•Please enter through anteroom. Keep room entrance door closed at all times. Entre por la antesala a, por favor. Mantenga cerrada la puerta de cuarto en todo momento.
•Dietary Dietary may not enter. No puede entrar el pe ersonel que sirve comidas.
•Follow Standard Precaution ns. Tome Precauciones Normales. N
Questions? Call Infecttion Control at 684-5457 ¿Preguntas? Llame al Centro de Control C de Infecciones al 684-5457
entrada al
N95 Resp pirators for TB Fit testting required
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Not fitted with an n N95 respirator? PAPRs: Powered Air Purifying Respirators p No fit fit-testing, testing, but training on proper use is needed
SafetyTech FlexAir PAPRs
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How Do I Kno ow If I’ve Been I f cted? Infec d? PPD Skin Testing:
• When hired • Periodically for “high risk” groups • After exposures to TB, TB and no precautions were used www.safety.duke.edu
Ionizing Radiation R -Occurs in nature -Also p produced and used frequ quentlyy in a medical center setting -Great benefits for disease dia agnosis and t t treatment, t but b t some risks i k asso ociated i t d with ith too much exposure: • birth defects • cancer It is possible to work SAFELY with ionizing radiation.
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Protectiive Factors Distance
Time •spend the minimum amount of time in close proximity i it tto th the radioactive source (materials patient) as (materials, possible
•maintain the maximum practical distance from f the radioactive source
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Personal Protective Equipment (PPE)
Shoe covers
Lead apron Gloves
Lab coat
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Radiatio on Signs •special precautions in effect •check before entering room •do not remove or disrupt anything in the room (coverings, etc.) •Ex: radionuclide patients may have radioactive body fluids www.safety.duke.edu
Radioactiive Waste •do do NOT dispose of radioactive waste in regular trash •sensors exist around Duke and at dumps to detect radiation
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Dosimetrry Badges •radiation radiation badges are issued by the Radiation Safety Division •monitors your amount of radiation exposure p •do NOT wear someone else’s else s badge
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Radiation Exposure and Pregnancy •exposure exposure to the fetus must be e minimized •contact EOHW for a confidential Declaration of Pregnancy •your exposure to t hazardous h d materials, including radiation, will be assessed
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Wear appropriate eye prrotection if in a room where h a llaserr is i iin use
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Chemicals are e Everywhere!
Clinics
Offices/classrooms Environmental Ser ices Services www.safety.duke.edu
Laboratories
Maintenance
In order to work safety with chemicals, chemicals which are found in most every work environment here, Duke follows regulations g p provided by y OSHA. www.safety.duke.edu
OSHA Hazard Communication Stan ndard
Your “Righ ht to Know”
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Labe els • Include identity of Chemical as it Appears pp on MSDS • Include appropriate Hazard Warnings g – Physical Hazards – Health Hazards – Specific Target Organ Effects www.safety.duke.edu
Material Safety Da ata Sheets (MSDS)
The Key to Hazard Communication Can be found on OESO website and on DUHS Intranet www.safety.duke.edu
Chemicall Hazards Physical Hazards s Health Hazards • • • • • •
Flammable C Compressed G Gas Reactive Cryogen Oxidizer Corrosive
• Poison – Carcinogens – Toxic Agents – Reproductive R d ti A Agents t
• Irritants
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Routes of Chemic cal Entry into the Bo ody Inhalation h l i
Ingestion Injection
Absorption
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H lth Eff Health Effects t ACUTE • Effects show up right away (example: eye irritation) • Result of short t term, high hi h llevell exposures
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Health Effects CHRONIC • Usually take a long p time to develop • Result of repeated exposures www.safety.duke.edu
C Ch Chemical i l Disposal Di l • Wa aste Disposal p – info in MS SDS • Ch hemical spills spills, leaks or rele eases – call Spill Response Team
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Container Management M P li Pol licy l
Purpose: To P T prevent containers i with ih contents inconsistent with the conta ainer's label from reaching the patient; and d inappropriate reuse of containers th hat previously contained product used in the process of patient care.
• Verify contents of the container (product name, strength, expiration date (as applicable e)) • Verify container integrity (unbroken sea al) • Read supplemental label information • Sequester compromised containers (i.e, seal is broken label is defaced) broken, • Following disposal/re-use protocol
Equipment Management M • Equipmentt Inspection • Done by Clinical Engineering • Inspection stickers on equipment with due date of o next inspection • Remove any a equipment that appears broken/uninspected • Utility
Syste ems
• Emergenncy power is supplied by backup generatorss via red outlets • Plug esse ential equipment into these www.safety.duke.edu outlets
Ergono g omics: the science of ma atching the job and th product the d t to t the th user.
Before
After www.safety.duke.edu
Benefits of E Ergonomics • Increase worker comfort • Increase productivity and job satisfaction • Prevent development of musculoskeletal disorders (MSD) www.safety.duke.edu
Musculoskeletal Disorders D (MSDs) • • • •
Happen over time Take a long time to he eal Can be quite painful Can result in difficulty y performing daily activ vities • Reduce educe ou our e effectiven ec eness ess a and d efficiency www.safety.duke.edu
Signs g and Symp y p ptoms of MSDs • Pain or inflammation at a the end of the day • Numbness N mbness or tingling in the fingers fingers, leg or foot • Pain that wakes you up u in the middle of the night • Loss of function • Swelling
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Ergonomic c Stressors Repetitive Motion
A Awkward P Postures www.safety.duke.edu
Ergonomic g Stressors Vibration
Excessive Force www.safety.duke.edu
Ergonomic g Stressors
Cold
Contact Stress
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• • • • • • • •
Physical Conditio ons and Personal Activities that can n Contribute to an MS SD Smoking Obesity Sedentary Lifestyles Hobbies and Home Activitties Part time Jobs Part-time Age Hormonal Disorders or Ch hanges Medical Conditions
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Reducing Your Risk for an MSD • Change your work procedures or environment • Use more comfortable equipment/modify equipment • Increase your o ra awareness areness off MSDs, MSDs signs and symptoms work area • Identify risk factors in your w • Take frequent “micro-breakks” to stretch or rest
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What should you do if you have an MS SD? • Seek medical treatment at th he first sign of an MSD • If it is work-related, complete e an Accident/Injury Report p and contact Employe p yee Health • Otherwise, contact your primary care physician
Duke Ergonomics Program 668-ERGO
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Fire/Life Safety y
If a fire broke out in your area, would you know what to do? Do you know your evacuation procedures? What can you do to prevent a fire f in your workplace? www.safety.duke.edu
The Requirements for f a Fire are: 1 Oxygen – 1. which is why you shut windows in the case of a fire or why you can smother th a fi fire on a stove with a lid
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Fire Require es: 2 A Fuel Source – 2. such as empty boxes, which also pose tripping hazards during evacuation... ti and never store flammables within 18” of the ceiling! www.safety.duke.edu
Fire Req quires: 3. An Ignition Source – which can come from a spark from a frayed electrical cord, cooking, an overheated coffee pot or cigarettes
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Fire Requ quires: 4. A chemical reaction – Remove any one of these requirements and the fire will be extinguished
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Be Prepared ! Know your Evacuation Routes – know at least two ways out which do not involve elevator use
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Be Prepared ! Practice Fire Drills – planning and practicing drills can save lives
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Be Prepared ! Know the location of the fire equipment - know where your fire extinguishers and pull alarm stations are
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Be Prepared ! Know your Interim Life Safety Measures – exits and equipment location may change while an area is under construction, so Interim Life Safety Measures will ill b be iimplemented l t d www.safety.duke.edu
Be Prepared p ! Know your fire alarm: •CODE RED •Duke Hospital uses a 4-digit code system •This code alerts staff where the fire is • Know the fire code for your work area; can be found in your site sitespecific fire plan www.safety.duke.edu
Be Prepared ! Know your - designated meeting place if evacuation is required
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In the event of a fire e: Follow the RACE procedure
R – Remove R all persons
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A – Activate the alarm, call 911
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C – Close all doors and windows
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E– Extinguish th fire the fi
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Use a fire extinguiisher when: •the fire is contained an nd not spreading •the extinguisher is read dily available •you know how to use itt properly •personal safety is not ccompromised •there is a clear path forr escape www.safety.duke.edu
Use the acronym PASS to t remember how to use a fire exting guisher
P= Pull the Pin
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A= Aim at the base of the fire
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S= Squeeze th handle the h dl
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S= Sweep p from side to side
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Report all fire-related incidents, regardless g of size or severity, s y, to: - Duke Police Report fire safety hazardss to OESO Fire Safety (684-56 609) Remember P ll the Pin, Pull Pin Call it In - 911 9 www.safety.duke.edu
Hospital Incident Command d System (HICS) – Duke’s emergen ncy plan
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Incident Com mmander (IC) •provides id overallll direction for all hospital operations during a disaster •supported t d by b ffour section chiefs •becomes the point person for the response effort www.safety.duke.edu
Logisti g ics • supplies the necessary resources (equipment, ( supplies, medicine) • maintains the hospital’s physical p y environment (utilities) • logistics staff wear yellow vests during HICS activation ti ti www.safety.duke.edu
Plann ning • gathers information to develop a strategic g plan to manage the long-term operations of the hospital and d th the recovery process • organizes staffing and bed availability il bilit • planning staff wear blue vests t during d i HICS activation www.safety.duke.edu
Operat p tions • provides medical treatment for existing patients as well as medical treatment for those patients admitted as a result of the emergency • operations staff wear red vests during HICS activation
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Fina ance
• handles cost analysis
• lends financial support pp by y providing the accounting functions necessary during an emergency response
• finance fi staff t ff wear green vests during HICS activation www.safety.duke.edu
Emergen ncy Codes Emergency Management Pla an Code Triage - Activation - Standby Code Triage Standby Hazardous Materials Code Orange Medical Emergency Code Blue Fire Alarm Code Red Missing Infant/Child Code Pink Security Alert Code Gray Utility/Communication S t System Failure F il C d Bl Code Black k ED Critical Saturation Code Purple Severe Weather Na ational Weather Service Announcements www.safety.duke.edu
Departmenta al Sub-Plans After activation of a code, A d departmental sub-plans are im mplemented. S p Sub-plans include: •p phone trees for contacting staff •ccommunication pathways n necessary during a disaster •d duties of departmental staff
Become familiar with your sub b-plan
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Example - Code e Pink - Missing Infantt/Child Sequence of events: - Call 911 to notify of mis ssing infant/child - include child child’s s na ame, description, where last seen - Initiate search of y your area a - Monitor exits
“Code Pink – Infant (or Child), C M/F, Age, Location”
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Example - Code e Pink - Missing Infantt/Child Staff response: - Be alert for suspicious behavior, children matching the description - Call 911 immedia ately if something noticed - Do not p put yourself y at risk r by y confronting g a potential p abductor - Follow area-specific procedures
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General Em mergency Proced dures • Aid in the continuation of care • Keep emergency response areaas clear of non-essential personnel • Wear your ID badge
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Drills
In order for this system to work approp priately and efficiently, we must continue to develop the departmental sub-plans and practice the implementation of these sub-plans thrrough drills. Duke’s ability to efficiently respond to a disaster requirres a unified response from all the staff, utilizing the HICS structure. www.safety.duke.edu
Occupational & Environmental S f ty Office Safety Offi www.safetty.duke.edu Duke Universityy Medical Center Environmentall Safety S f Building Researrch Drive Durham,, NC 27710 684--2794
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