Environmental Safety Hazard Communication, Emergency Preparedness Fire Prevention I. Hazard Communication • More than 30 million workers are potentially exposed to one or more chemical hazards. • There are an estimated 650,000 existing hazardous chemical products, and hundreds of new ones are being produced annually which pose a serious problem for exposed workers. • As an employee, you have both a need and a right to know the identities of the chemicals you are exposed to when working. • You also need to know what protective measures are available to prevent adverse effects from occurring. • By understanding the physical and health hazards you may come in contact with in your workplace, you will be able to take the necessary steps to protect yourself and prevent adverse effects caused by chemicals used in your workplace. Hazardous Materials • Defined as chemicals that can be harmful to individuals exposed to them. Types of Hazardous Material • Toxic or Poisonous: Most chemicals and their fumes are toxic at some level. Ex: chemotherapy drugs • Corrosive: Can dissolve other substances, such as strong acids. Ex: bathroom cleansers. • Explosives: Can explode when exposed to heat or flame. Ex: aerosol cans and oxygen. • Flammables: Can burn easily, rapidly, and give off intense heat. Ex: cleansers and solvents. Basic Safety Rules for Working with Hazardous Material • Chemical manufacturers and importers must convey the hazard information by means of labels on containers and Safety Data Sheets (SDS). • Find out additional information about materials by using SDS. Current SDS information is provided by calling MSDS Online. Contact phone numbers are located in each facility. • Be alert to warning signs regarding the presence of hazardous materials. LHC Group 11/07;1/09; 8/11;1/13; 12/15

Environmental Safety-1

• Read labels carefully. • Do not use unlabeled or outdated materials. • Ask questions about the use of a material if unsure. • Have a spill kit available when administering chemotherapy drugs. • Have an impermeable container for sharps disposal; use it for transport of sharps. • All sharp containers should be emptied when ¾ full. • Wash with soap and water following accidental contact with body fluids or items potentially contaminated by body fluids. • Follow SDS first aid instructions/precautions if exposed to chemical substances. Handling Hazardous Materials • Avoid contact between unprotected skin and clothing with hazardous material. • Use protective equipment (gloves, gown, eyewear) when specified. • To prevent chemical contact with skin, do not wear clothes with holes and tears. • Use pre-packaged spill kits to clean up cyto-toxic spills. • Use latex gloves for administering cyto-toxic agents. • Transfer all materials to new containers and label with contents and date. Storage of Hazardous Materials • Store oxygen cylinders in a stable, protected area. • All oxygen cylinders must be kept in an upright, secure position with used cylinders kept in a different area. • Keep medical gases (oxygen) away from extreme heat. Please Note • Failure to follow policies and procedures regarding safety precautions associated with the identifying, handling, and storing of hazardous materials and wastes, to include medical gases such as oxygen, as well as failure to appropriately instruct the patient/ family and failure to assess the use of hazardous materials may result in serious illnesses, injury, and death. II. Emergency Preparedness Emergency Preparedness Plan • An organizational chart is maintained by the facility. • In case of an emergency, staff will contact their supervisor for instructions. The Administrator will: 1. Ensure emergency preparedness plan is up-to-date. 2. Critique annual emergency training exercise. 3. Ensure agency maintains contact with local parish offices of Emergency Preparedness. 4. Review and update the emergency plan annually, following the annual training exercise as well as after any actual emergency, in conjunction with agency managers. The Safety Officer will: LHC Group 11/07;1/09; 8/11;1/13; 12/15

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1. Ensure staff is trained in their emergency roles. 2. Ensure triage board/list is maintained in the facility. 3. Alert managers and patients as emergencies occur. 4. Ensure patients are notified timely of emergencies The Director of Nursing will: 1. Assign essential personnel to teams that will be directed by the charge nurse. (All essential personnel will be required to report to work in the event of a declared emergency.) 2. Ensure that patient care is delivered in an adequate, safe manner. 3. Assist Social Services/Care Management in the triage of patients if evacuation is necessary. Social Services/Case Management will: 1. Inform patients/caregivers of appropriate safety and emergency preparedness plan. 2. Ensure Patients are evaluated for evacuation needs. Staff will: 1. Report for duty as directed by their immediate director. 2. Deliver patient care as directed by the DON and charge nurse Potential Natural and Man Made Emergencies • Severe Storms: Hurricanes Tornadoes Floods Ice/Snow • Bio-terrorism • Pandemic • Petro/Chemical: Oil Rig Chemical Plant Transportation (water, rail, road) Preparation for Emergencies and Disasters... • The emergency plan will be updated to reflect changes in the organizational chart, risk conditions, patient information, and staff. • All staff will be trained in the provision of the plan. Patients will be Triaged according to the Emergency Management Plan The facility will: • Instruct patients and caregivers on the emergency plan. In-House Emergency Preparedness Drills will test: LHC Group 11/07;1/09; 8/11;1/13; 12/15

Environmental Safety-3

• Procedures used to triage patients needing assistance to evacuate. • Process used to obtain supplies and medications during an emergency. • How prepared the staff is to respond to an emergency situation. When a Declaration of Emergency is declared: • Emergency Plan is implemented per orders of the Administrator, Nursing Director, Alternate Nursing Director, Safety Director, or designee. • Hospital will maintain emergency supplies. • The facility designee will communicate with Senior Management and the Host Hospital (as applicable) at set intervals during the emergency. In the Event of an Evacuation: • Insure that records are kept up-to-date with authorization forms signed so that info can be reported to the Office of Emergency Preparedness in the local parish. • CEO/Administrator/Senior Management will give order to evacuate after speaking with the local Office of Emergency Preparedness. • Contact family, if possible. • Patients will be evacuated by ambulance to alternate sites. III. Fire Prevention Fire Prevention is the Responsibility of All Staff • Be familiar with the fire plan & where fire exits are. • Know location of smoke detectors/fire extinguishers and know how to use the fire extinguishers. • Be cautious in your work habits to prevent fires. • Report any potential fire hazards. • Act immediately if any smoke or fire is noticed. Alarm System & Building Construction • Properly marked evacuation routes and exits. • Fire extinguishers rated for class A, B, C fires (multi-purpose extinguishers). • Diagram of the location of each fire extinguisher and evacuation routed strategically posted in the offices and public areas. • Clear signs on oxygen cutoffs When a Smoke Detector is Activated • The location of the fire needs to be identified, if possible, with all staff alerted to the location of the fire. • Evacuate patients in immediate area • Isolate fire – close all doors and shut off oxygen • Fire extinguishers are to be brought to the site of the fire and an attempt to extinguish the fire should be made. • If the fire is unable to be controlled, all staff will be requested to evacuate the facility. Fire Extinguishers LHC Group 11/07;1/09; 8/11;1/13; 12/15

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The acronym “PASS” simplifies operation of the fire extinguisher: P = PULL the pin held in place by a plastic tamper-tab, which will break as the pin is pilled. A = AIM low; point nozzle at base of the fire from up to 6-8 feet away. S = SQUEEZE the trigger; the extinguisher will only discharge while the trigger is squeezed. S = SWEEP from side to side; delivering the agent back and forth at the base of the fire. Fire Alert Guidelines If you discover a fire, stay calm and the acronym “RACE” will help you do what is needed. R = RESCUE: People in immediate danger of fire/smoke must be removed to safe area. A = ALARM: Activate fire alarm. C = CONFINE: Close all doors and move people to safe area. E = EXTINGUISH: Extinguish fire with fire extinguisher only if you can do it safely. If an alert is given of a fire: • Stop normal work activities. • Listen to determine where the fire is located. • If the fire is in your area, take action as per “RACE”. • Be prepared for evacuation: horizontal first, then vertical evacuation • Use only stairways. DO NOT use elevators • Remove any obstacles that may cause an obstruction of a corridor. • Do not turn off lighting or electrical breakers. • Feel closed doors before opening. If door is too hot to touch, do not open it. • Wait for the ‘ALL CLEAR” to be announced before returning to work area. Guidelines for Supervisors • Complete incident report for all fire alarms. • Conduct annual fire drills in each agency office. • Use drills as a learning tool to evaluate effectiveness of fire safety program. • Mandatory training of all staff annually. • Review and update fire plan annually and as needed. • Keep records of fire prevention activities. Patient Education • Make sure patients are educated on: escape plan, fire hazards related to medical equipment and supplies, hazards of smoking in bed, and oxygen safety.

LHC Group 11/07;1/09; 8/11;1/13; 12/15

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INFECTION CONTROL In the Healthcare Setting INTRODUCTION Whether you have direct contact with your patients and their body fluids and specimens, or simply casual contact with your patients, all healthcare workers need to practice infection control. Infection is developing new offensives due to things like HIV, antibiotic resistant organisms, and drug-resistant forms of tuberculosis. In home healthcare settings, patients may go home with infections that have gone undetected in the hospital. Therefore, infection control practices are important in and out of the home to protect yourself from the spread of infection. This course will explain how infections are spread; the differences between Standard and Transmission-Based Precautions; required immunizations; what to do if you are exposed to infection; and how to avoid the common mistakes made by healthcare workers. HOW DOES INFECTION OCCUR? INFECTIOUS AGENTS= viruses, bacteria, fungi They can be found in blood, body fluids, feces, body surfaces, floors, and on medical equipment. The HANDS are especially susceptible to the spread of infection. A HOST, is a person in a condition that is especially prone to infection. Hosts may be newborn babies; elderly patients; patients with weak immune systems; patients with chronic disease or multiple health problems; and patients with catheters, incisions, breathing tubes, or IV’s. SPREADING INFECTIONS POINTS TO REMEMBER… You DO NOT have to look sick to spread an infection You may be exposed without becoming a host if you are immune to an infection

LHC Group 11/07; 1/09; 3/10; 8/11; 1/13; 12/15

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You can become sick only when a large dose of the infectious agent invades your body and takes over its ability to resist the infection. METHOD OF TRANSMISSION Transmission can occur in a host’s body through inhalation; body openings such as the eyes, nose, and mouth; through broken skin; and by contaminated objects that enter the bloodstream. As a healthcare provider, you can break the cycle of transmission and prevent the infection from spreading if you prevent the infectious agent from initially reaching a host. There are 5 methods of transmission:  Contact  Droplet  Airborne  Vector-borne  Common Vehicle TYPES OF TRANSMISSION Contact Transmission occurs when the infection is transferred physically from one body surface to another. It can also occur indirectly from an object to the host. Droplet Transmission occurs when infectious droplets are present in the air after an infectious person coughs, sneezes, or speaks. The droplets travel a short distance to the host’s eyes, nose, or mouth. Airborne Transmission occurs over further distances. They are in the form of microscopic droplets that remain in the air for long periods of time. Vector-borne Transmission occurs when fleas, flies, rats, and other vermin transmit infectious microscopic organisms. Common Vehicle Transmission occurs when infectious agents are transmitted through food, water, medications, or equipment has been contaminated. Healthcare workers can prevent the transmission of infectious agents by following certain precautions with all patients regardless of their diagnosis. STANDARD PRECAUTIONS These precautions are used by healthcare workers to protect themselves and their patients from becoming infected. Standard Precautions apply to blood, body fluids, excretions and secretions, broken skin, and mucous membranes. They protect you against HIV, Hepatitis B, and Hepatitis C. Requirements:

LHC Group 11/07; 1/09; 3/10; 8/11; 1/13; 12/15

Infection Control-2

• • • • • • • • •

Healthcare workers must wear gloves when handling blood, all body fluids, excretions and secretions, and contaminated objects or surfaces. Healthcare workers must thoroughly wash their hands after any contact with body fluids even if gloves are worn. A mask, goggles, and a gown should be worn if splashes may occur. Healthcare workers should know where respirators, such as ventilators, are at all times. Make certain that reusable equipment is properly disinfected before use on another patient. Healthcare workers should never bend, recap, or break a used needle unless the procedure requires it. All equipment used in patient care should be handled to prevent exposure to other healthcare workers, patients, and visitors. Patient equipment and soiled linens should be kept away from the healthcare worker’s clothing, skin, and mucous membranes, and other clean items. Used sharps should be placed in a Bio-Hazardous or puncture resistant container immediately after use.

NOTE : Eighty percent of exposures are sharps related; therefore you should handle sharps with extra care and use needle safety devices. TRANSMISSION-BASED PRECAUTIONS These precautions must be used along with Standard Precautions when a patient has a certain highly infectious disease. Transmission-Based Precautions are based on how the infection is spread and include:   

Droplet Precautions Airborne Precautions Contact Precautions

DROPLET PRECAUTIONS Droplet Precautions are used with patients who have illnesses that are transmitted when large droplets travel a short distance and land in a person’s eyes, nose, or mouth. This can occur through sneezing, coughing, or suctioning. Mumps, rubella, and some strep infections can be transmitted this way. In such cases healthcare workers must isolate the patient from others by at least three feet or place them with other patients who have the same infection. Healthcare workers must wear a mask when working within three feet of the patient. The patient’s movement should be limited. The patient must wear a mask during transport. AIRBORNE PRECAUTIONS

LHC Group 11/07; 1/09; 3/10; 8/11; 1/13; 12/15

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Airborne Precautions are transmitted by airborne droplets that travel through the air and remain there for long periods of time. They are to be used with patients who have tuberculosis, measles, chickenpox, zoster, and other infections as such. In such cases, the healthcare workers must isolate the patient in a closed room with negative air pressure. The room should be private or shared with patients who have the same infection. The healthcare worker must wear a special respirator while in the same room as the patient. The patient’s movement should be limited. The patient should wear a mask during transport. CONTACT PRECAUTIONS Contact Precautions are used with patients who have infections that are transmitted easily by direct contact with a patient or a contaminated object or surface. They are to be used with patients who have highly infectious drug-resistant organisms like methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE), clostridium difficile (c-diff) and other infections such as zoster, scabies, and impetigo. HIGHLY INFECTIOUS & DRUG-RESISTANT ORGANISMS

 VRE= is a bacteria that lives in the stomach and causes infection when a 

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person becomes ill. They cannot be killed by the antibiotic, Vancomycin. It is not treated easily and is highly contagious. MRSA= is a specific strain of bacteria that is resistant to all penicillin antibiotics and is carried on the skin or in the nose of healthy people. Infection occurs through a break in the skin or an open wound. A common symptom is boils or abscesses on the skin. C-diff=is a species of gram positive bacteria that causes diarrhea and other intestinal disease when competing bacteria are wiped out by antibiotics. C. difficile is the most serious cause of antibiotic-associated diarrhea (AAD) and can lead to pseudomembranous colitis, a severe infection of the colon, often resulting from eradication of the normal gut flora by antibiotics. Zoster= is a painful disease also known as Shingles. It is caused by the same virus as chicken pox. The virus goes through dormant stages and then becomes active again at unknown times. It lives in nerve tissue and causes blisters that usually develop on one side of the body. Impetigo= is a skin infection in the form of blisters and sores that may be clear but eventually become cloudy and burst, causing scabs. They tend to remain on the skin for long periods of time. Ecthyma is a form of impetigo Scabies= is a microscopic mite that buries itself under the skin and lays eggs. It forms a pimple or burrow on the skin. Scabies can be spread from direct skin contact and from undergarments and bed linens. It can be treated with medicated lotions.

LHC Group 11/07; 1/09; 3/10; 8/11; 1/13; 12/15

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In such cases, the healthcare worker must put gloves on before entering the room. Wash their hands with an antimicrobial cleanser before leaving the room. Wash hands with soap and water when caring for a patient with c-diff. Wear a gown when needed during patient care. Always wear a gown when caring for a patient with c-diff. Avoid unprotected contact with objects that the patient used or touched. Dedicate equipment to an individual patient whenever possible. NOTE: LHC Group hospitals recognize that there are multi-drug resistant organisms and other increasingly problematic organisms that may be associated with hospital infections. For that reason, each facility will recognize enhanced contact precautions designated as Maximum Contact Precautions. A gown will always be worn when entering the room of a patient designated as requiring Maximum Contact Precautions. KNOW YOUR INFECTION CONTROL PLAN As a healthcare worker, you need to know your agency’s Infection Control Program and follow it. This program includes the Occupational Safety and Health Administration’s (OSHA) blood borne pathogen standards, tuberculosis control guidelines, and the Center for Disease Control’s (CDC) recommended isolation precautions. PROPER HEALTHCARE PRACTICES Clean bedpans and urinals thoroughly with soap and water. Disinfect wheelchairs, walkers, and canes with a proper disinfectant as needed. Urine collection bags should be properly cleaned according to your agency’s procedures. Weight scales should always be disinfected before each use. Other reusable items such as blood pressure cuffs & stethoscopes should be disinfected with a cleaning solution after patient care. Properly disinfect thermometers after each use. Make sure medical instruments and equipment are re-sterilized after each use. PROTECTIVE PRACTICES ON THE JOB You can decrease the risk of spreading infection with safe work practices. GET IMMUNIZED- The CDC recommends you get immunized against influenza, measles, mumps, rubella, chickenpox, and hepatitis B. Your supervisor should help you determine the immunizations you will need. Immunizations are powerful against the spread of infection. WORK RESTRICTIONS-Remember to follow work restrictions that exclude employees from certain types of work because of medical conditions or health issues. LHC Group 11/07; 1/09; 3/10; 8/11; 1/13; 12/15

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Pregnant employees are not at an increased risk for becoming infected in the work place and are not typically excluded from caring for patients with infections. If you are very sick, use common sense and simply do not go to work. Report any exposure and illnesses to the proper personnel. HANDLING SHARPS-Remember to follow safety measures during procedures that require the use of sharps. Place all used sharps in a Bio-hazard or puncture-resistant container. Note: Never bend, break, or recap used needles. IMPROPER USE OF ANTIBIOTICS-To protect your patients and your job, make sure the proper medical staff always checks culture results of patients and prescribes the least potent antibiotic possible for the patient. ALWAYS WASH YOUR HANDS-Hand washing is the most important measure to take when preventing the spread of infection. If soap and water are not immediately available, use an antimicrobial cleanser or other waterless cleansing agent containing alcohol. Wash your hands before entering a patient’s room and before touching any medical equipment you will be using on the patient. Wash your hands immediately after bathing the patient or after performing any other patient care. Wash your hands after coming in contact with a patient’s blood, body fluids, secretions or excretions such as vomit, feces, wound drainage, saliva, and any contaminated objects or surfaces even if gloves are worn. Wash your hands every time you don gloves, remove gloves and again before leaving the patient’s room. The Association for Professionals in Infection Control and Epidemiology (APIC) has stated that healthcare workers wash their hands only half as frequently as they should. PRACTICE GOOD PERSONAL HYGIENE Try to protect against splatters of blood and body fluids and other potentially infectious substances. DO NOT eat, drink, apply cosmetics such as lip balms, or handle contact lenses where there is a chance you may be exposed to a patient’s blood or body fluids. DO NOT store food or drink near blood, urine, other body fluids, or other potentially infectious substances. Finger nails should be kept clean and short. Use of artificial nails is prohibited. PERSONAL PROTECTIVE EQUIPMENT PPE provides the healthcare worker with a barrier against infectious diseases and substances. PPE can include gloves, gowns, goggles, masks, and respirators. Make sure LHC Group 11/07; 1/09; 3/10; 8/11; 1/13; 12/15

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you know where these devices are at all times during patient care, especially when you anticipate a need for them. REMOVAL OF CONTAMINATED GLOVES- When removing contaminated gloves, avoid touching the outside of the gloves at all times. Always wash your hands immediately after removing them. Properly dispose of the used gloves. WHAT TO DO IF YOU ARE EXPOSED If you come in contact with infectious substances or contaminated objects, don’t panic! Wash the exposed area immediately with plenty of soap and warm water. Flush eyes, nose, and/or mouth with plenty of running water. DO NOT use bleach or abrasives on the skin. They can cause the skin to break, increasing your risk of exposure.  Exposure should be reported to your supervisor immediately! – With certain infections, treatments may work best when begun right away. Your agency should have specific guidelines for receiving medical exams if you are exposed to communicable diseases. SUMMARY        

You can prevent the spread of infection and protect yourself as well as your patients by following a few simple precautions. These precautions are Standard and Transmission Based. Remember to practice proper hand washing technique when needed. Make sure you receive all required immunizations. Remember to report any exposures to potential infections as soon as possible. Pay close attention to and follow any work restrictions. Preventing the spread of infection requires the total commitment of healthcare workers. Prepare yourself and your patients with the proper methods to control infection.

LHC Group 11/07; 1/09; 3/10; 8/11; 1/13; 12/15

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HIPAA COMPLIANCE What is HIPAA? HIPAA is the acronym for Health Insurance Portability and Accountability Act. The AS (Administrative Simplification) provisions of HIPAA directed the federal government to adopt national electronic standards for transfer of certain health care data between health care payers, plans, and providers. As a result, all ‘covered entities’ who conduct business electronically must be HIPAA compliant by October 16, 2002. Do I need to comply with HIPAA regulations?? • The LHC Group is a ‘covered entity’ and therefore MUST comply with HIPAA regulations What must be kept confidential? • PHI: Protected Health Information What is Protected Health Information? • Any information about a patient’s physical or mental health condition that could identify the patient. • Demographics • Any form or medium: Oral, Written, Electronic How is PHI used? • Sharing, application, utilization, examination, or analysis of PHI within the organization What is the Disclosure of PHI? • The release, transfer, access, or divulging of PHI to an outside person or entity Access the Minimum Necessary • What can I access? Only information you “need to know” to do your job. • Does it apply in every situation? PHI applies in situations regarding treatment & patient care. Minimum Necessary • HIPAA requirement: Identify members of the workforce who need access to confidential information Identify what information can be accessed Limit access

LHC Group 11/07; 1/13; 12/15

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How Do I Know… ...When information is considered private? Did you learn is through your job? If yes, then it is considered private. How Do I Handle… …An individual asking for access to their record? • Individuals have a right to access • Route requests to appropriate department or staff …An individual’s request to change their medical record? • Individuals have the right to amend or correct their record Requests will be investigated • Route requests to appropriate department or staff …A family member or close friend asking about a patient? • You may give directory information such as: Name, location, condition in general terms • Other type of clinical or billing information Obtain permission from patient Use judgment if permission cannot be obtained. …Another member of the workforce inquiring into a patient’s condition or treatment? • Determine if it is necessary to their position • Is it related to treatment? “Privacy-Friendly” Practices • Abide by the agency’s Notice of Privacy Practices • Shred or destroy documents with PHI when no longer needed • Fax or copy machines should be located away from unauthorized individuals • Do not talk in public areas about PHI • Keep patient information out of public areas • Secure records in all locations • Use passwords to access PHI electronically • Computer screens use screen savers when user is away • Remember individuals’ right to privacy during treatment What Happens If… …a privacy policy is violated?? • Organization-specific sanctions which include disciplinary action and/or termination • Right to file a complaint • Civil and criminal penalties Health Information Management Professionals • Have a professional concern for protecting patient privacy • Seek advice for compliance issues

LHC Group 11/07; 1/13; 12/15

HIPAA Compliance-2

What the Privacy Rule will mean for Patients • Increased control over the uses and disclosures of their health information • The opportunity for more understanding of how their health information is used and to whom it is disclosed. • Specific rights regarding their health information including the right to: - A paper copy of the agency’s Notice to Privacy Practices - Lodge complaints - Request restrictions on the uses and disclosures of health information - Receive confidential communication - Access to their health information - Amend health care information - Request an accounting of disclosures of health information Non-Solicitation Policy • Only a physician can refer or admit patients to receive services from the facility. If a patient requests to be transferred from their present health care provider to one of this organizations agencies or locations, instruct the patient to discuss this with their physician. • Any act of coercion, bribery, harassment, intimidation or any form of solicitation of patients by employees will result in immediate termination from employment. Take pride and ownership in the fact that your organization is concerned about privacy and recognizes its importance in providing quality healthcare.

LHC Group 11/07; 1/13; 12/15

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