CH 11 - Environmental Safety

Class C

*Electrical fires: electrical equipment, fuse boxes, wiring, and appliances.* Use Class C, BC, or ABC extinguisher. Same as Class B because carbon dioxide is used, which is nonconducting and provides a smothering action. *Cautions* Do not use water or Class A extinguisher on this type of fire unless the electricity has been disconnected. Electrical fires are particularly hazardous because the possibility of electrocution is present.

Incident report

A written document completed when any unexpected situation occurs that can cause harm to a patient, an employee, or any other person. It only contains factual information, and most facilities have policies that specify not to include the report in the patient's chart or to refer to it in the documentation.

Fires can result from

Damaged equipment, overloaded circuits, defects in heating systems, spontaneous combustion, improper trash disposal, and smoking.

Triage system

Guidelines to determine which patients to send where and what treatment will be given during an emergency. "To select"

Changes in blood vessels

*Change the Risk* Dizziness when attempting to stand and increased risk of falls. *Health Care Considerations* Instruct patients to get up slowly. Assist patients as necessary.

Workplace violence hazard

Any physical assault or verbal abuse that is incurred during the course of performing one's duties at work.o *Examples* Being pushed, hit, or restrained; spoken to in a loud or demeaning manner, cursed at or berated; this type of hazard could also be listed under physical or psychosocial hazards depending on the nature of the violence.

Infectious (biological) hazard

May cause infection through inhalation, direct contact with skin or mucosa, skin puncture, or through ingestion (eating or drinking). *Examples* Bacteria, viruses, fungi, and other living microorganisms.

Chemical hazard

May have toxic effects through inhalation, absorption through the skin or mucous membranes, or ingestion. Some irritate the skin on contact. *Examples* Chemotherapeutic agents, disinfectants, cleaning solutions, alcohol, anesthesia.

Reporting for Safety

Properly reporting unsafe conditions and 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, frayed electrical cords, and side rails or signal lights that do not work. • Report any accidents or injuries immediately and complete an incident report.

Prevention

The best approach to safety.

RACE

1. Remove patients 2. Activate the alarm 3. Contain the fire 4. Extinguish the fire *or* Evacuate the area.

Multiple victims in an accident:

Available services are over-strained, so triage personnel must determine who to treat first, what lab or diagnostic tests receive priority, what procedures to perform immediately, and who to send to surgery. They continually reassess patients who are waiting for services to determine if their condition has changed and if their priority needs to be updated.

Compatibility

The ability to be combined without unfavorable results.

Altered neurological function

*Change the Risk* Shaking or tremors can affect balance and increase the risk of falls; decreased sensation can prevent normal warning signals (ex: stepping on sharp object and not being aware of injury). *Health Care Considerations* Pay increased attention to physical signs of injury. Give extra assistance, as needed. Do not leave patient alone on treatment table or under and conditions where falls might occur.

Taking medications

*Change the Risk* Side effects of some medications cause dizziness, visual disturbances, and other problems that increase the risk of injury. *Health Care Considerations* Instruct patient and family to report symptoms immediately. Monitor patients carefully when administering medications and do not leave them alone immediately afterward; watch for possible reactions.

Changes in hearing

*Change the Risk* Unable to hear warnings or approaching carts and equipment. *Health Care Considerations* Face the patient when speaking. Speak clearly, but do not yell. Notice when patients do not react to warning sounds.

PASS

1. Pull the pin 2. Aim the nozzle at the *base* of the fire 3. Squeeze the handle 4. Sweep back and forth along the *base* of the fire.

General Guidelines to be followed when an Emergency Preparedness Plan is in effect:

• Stay calm. Everyone involved will benefit from an approach by the health care professional that communicates control of the situation, competence, and compassion. • Know who is in charge and report your availability. • Report to the person in charge at regular intervals for further directions or changes in assignments. • If unsure about what to do in a particular situation, ask someone in authority. • Communicate clearly and be cooperative. • Use telephones only for official business, not for personal calls.

Infectious waste

*Any item or product that has the potential to transmit disease.* Must be handled using standard and transmission-based precautions, placed in containers or bags labeled as to type of waste (ex: linen, sharps, trash), decontaminated on site, or removed by a licensed removal facility for decontamination.

Excessive radiation exposure

Can put the employee at risk for developing tissue damage, contracting cancer, becoming sterile, or infants being born with birth defects. Employees at risk 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.

Emergency Code System

Code Red - Fire/smoke Code Blue - Respiratory/Cardiac Arrest Code Gray - Combative or Abusive Behavior Code Pink - Infant Missing Code Purple - Child Missing Code Yellow - Bomb Threat Code Orange - Intruder with Weapon or Hostage Code Silver - Internal or External Disaster

Protecting Yourself and Others

Health care environments contain many potential hazards. It is essential to apply safety practices that consider the well-being of others. • Follow standard precautions. • Do not open more than one file cabinet drawer at a time to prevent tipping. • Do not leave cabinet doors open; someone may hit his/her head or trip. • Do not place food in a fridge that contains lab specimens or medications. • Do not wear uniforms in nonwork settings. • 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 and placed in a puncture-resistant wrap or container, prior to placing in a plastic bag. Bodily secretions or blood are best cleaned up by using gloves and disposing of waste in special bags designated for biohazardous waste.

Environmental Safety

Identifying and correcting potential hazards that can cause accidents and injuries.

Material Safety Data Sheets (MSDS)

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

Working Safely with Patients

Focusing on the task at hand and thinking through patient care activities are essential ways to promote safety. • Do not perform any procedure on patients until you have received adequate training and do not take shortcuts. • Observe and note conditions in patients that might increase their risk of accident and injury. • Be absolutely positive you have the correct patient. Always identify your patient by checking his/her wristband against the patient's record. Some health care settings do not have wristbands, so ask them for their full name and/or birthdate. • Always verify that the patient has given consent, because patients have the right to refuse any procedure or medication. • Observe patients closely and report any changes immediately or assist them as needed. Do not leave patients unattended on treatment tables. • Leave the bed in a low position, side rails up (if needed), wheels locked, and place the call signal, telephone, and bed controls within the patient's reach. • Keep the work area clean, dry, and organized for efficient use. Place all supplies and equipment in their proper storage location.

Environmental hazard

Unsafe conditions in the workplace. *Examples* Slip, trip, and fall hazards; cramped working space, inefficient equipment, and inadequate equipment maintenance; fire and electrical hazards.

Moving safely

Movement creates the potential for accidents, such as falls. • Never run, even in an emergency; you can move swiftly without running if the situation warrants a fast pace. • Stay to the right in hallways and be cautious when approaching intersections in order to prevent collisions. Pay attention to warning mirrors on corners. • Remove any loose rugs from floors to prevent tripping or slipping. • Open doors slowly to avoid injury to someone on the other side. • Use handrails when climbing or descending stairs. • Never run up or down the stairs. • Never carry uncapped syringes or sharp instruments in hallways or between rooms.

Radiological waste

Must be placed in a special container and labeled as "radioactive." It should never be placed in the trash, incinerated, placed in a bag with other waste products, or put down a drain. Only a licensed removal facility can remove these wastes from the health care facility.

Emergency Preparedness Plan

Policy and procedures to be followed when an event occurs that has the potential to kill or injure a group of people.

Psychosocial hazard

Stressors in the workplace causing workplace anxiety and emotional fatigue. *Examples* Providing constant emotional support, coping with emergency situations, inadequate staffing, lack of supervisor support, and frequent schedule changes; bioterrorism.

Ergonomic (musculoskeletal) hazard

Unsafe workplace design and lack of appropriate client- and material-handling tools and equipment contributing to increased risk of musculoskeletal disorders. Poor lighting, excessive vibration, and noise are also considered ergonomic hazards. *Examples* Activities that require lifting heavy loads; twisting, bending, reaching, and holding body parts and other materials for long periods; standing for long periods; pushing, pulling, awkward postures, and repetitive motions; high detail work in dimly lighted area; noisy environment.

Dressing for safety

Work in health care requires specific types of clothing and grooming to ensure the safety of both workers and patients. • Wear long hair tied back or up to prevent contact with contaminated material or the contamination of clean materials. • Do not wear earrings that extend beyond the earlobe so that they cannot be grabbed or caught. • Wear enclosed shoes with no more than 1- to 1 1/2 -inch heel to prevent injury to the feet. • Limit jewelry to a smooth wedding band. • Keep fingernails short. The longer the nail, both natural and artificial, the more likely it is that bacteria reside under its free edge.

Physical hazard

Agents that can cause physical injury and tissue damage. *Examples* Radiation, noise, explosive objects or substances (ex: oxygen)

Bioterrorism

One of the functions of an emergency preparedness plan is the incorporation of a biological exposure readiness plan. The first step is to become aware of and report a suspected bioterrorism-related outbreak. If such an attack is suspected, the Federal Bureau of Investigation (FBI) would be immediately notified. It may not be possible to wait for definitive evidence to determine if there is a biological threat, so the best approach would be to base the suspicion on epidemiological factors, such as a sudden and rapid increase of disease in a normally healthy population, large numbers of people with the same symptoms, or other atypical or unusual presenting factors.

Class D

*Burning metals* Use Class D extinguisher or smother with dry sand. These extinguishers release a sodium chloride powder that, when heated, forms a crust. The crust excludes air and fire is smothered. *Cautions* Do not use any of the other types of fire extinguishers on this type of fire.

Changes in mental function

*Change the Risk* Confusion and forgetfulness can impair good judgment and decrease awareness of common dangers. *Health Care Considerations* Provide family with information about medications, home health resources, and safeguarding the home.

Weakness from illness or injury

*Change the Risk* More prone to falls. *Health Care Considerations* Observe patients carefully. Provide extra assistance. Instruct the family about extra precautions needed.

Slowed reflexes (automatic reactions that cause us to pull away from danger)

*Change the Risk* Unable to move away quickly from danger *Health Care Considerations* Provide patient and family with information about possible unsafe behaviors and ways to safeguard the home.

Changes in vision

*Change the Risk* Unable to see unsafe conditions and/or unable to judge distances. *Health Care Considerations* Identify yourself when approaching or entering the room. Provide unobstructed walkways. Place items needed by patients within their visual field. Explain the location of items orally.

Bioterrorism agents

*Disease | Transmitted person-to-person? | Type of Precaution recommended* • Anthrax, cutaneous | Possible | Standard • Anthrax, gastrointestinal | No | Standard • Anthrax, pulmonary | No | Standard • Botulism | No | Standard • Plague, bubonic | No | Standard • Plague, pneumonic | Yes | Droplet • Smallpox | Yes | Airborne/contact

Employer workplace violence preventative measures

*Environmental designs:* • Develop emergency signaling, alarms, and monitoring systems. • Install security devices such as metal detectors to prevent armed persons from entering. • Install other security devices, such as cameras and good lighting, in hallways. • Provide security escorts to the parking lots at night. • Design waiting areas to accommodate and assist visitors and patients who may have a delay in service. • Design the triage area and other public areas to minimize the risk of assault (provide staff restrooms and emergency exits, install enclosed nurses' stations, install deep service counters to increase distance from patients or bullet-resistance and shatterproof glass enclosures in reception areas, arrange furniture and other objects to minimize their use as weapons). *Administrative controls:* • Design staffing patterns to prevent personnel from working alone and to minimize patient waiting time. •• Restrict the movement of the public in hospitals by card-controlled access. • Develop a system for alerting security personnel when violence is threatened. *Behavior modification:* • Provide all workers with training in recognizing and managing assaults, resolving conflicts, and maintaining hazard awareness.

Class B

*Flammable/Inflammable and combustible liquids: gas, oil, paint, solvents, and cooking fat fires.* Use either Class B, BC, or ABC fire extinguishers Class B extinguishers release carbon dioxide (CO2) which forms a cloud of dry ice or snow. The cloud displaces air and cuts off the fire's oxygen supply, thereby providing a smothering action. *Cautions* Do not use water or a Class A fire extinguisher on a Class B fire because most burning liquids will float on top of the water, which spreads the fire further. Class B extinguishers - no special precautions; they are noncorrosive and do not damage computers and other electrical equipment, but are heavy and have a shorter discharge range.

Class A

*Most common type of fires: ordinary combustibles; paper, cloth, rubber, plastic, wood, trash, mattress.* Use either water, or Class A or ABC extinguishers. Class A extinguishers are water based and contain pressurized water or aqueous film-forming foam (AFFF). Class ABC leave a white powdery residue irritating to skin and eyes. Do not stand too close to the fire. Take care when using extinguisher, and wash skin as soon as possible after extinguishing fire. Class ABC extinguishers release a multipurpose dry chemical (monoammonium phosphate) that blankets the burning area and interrupts the chemical chain reaction. *Cautions* Class A extinguishers - No special precautions; follow the proper sequence of operation (PASS) required with all extinguishers.

What to do when you discover a fire:

*Remove* any patient who is in danger. Ambulatory patients can walk to safety; others may need wheelchairs or can be pushed in beds. Never use elevators during a fire; instead, carry nonambulatory patients in a linen sling, held at each end by a health care professional, while descending steps. *Activate* the fire alarm and notify the facility telephone operator/receptionist. *Contain* the fire by closing all windows and doors. Follow facility procedure for turning off oxygen and electrical equipment. *Extinguish* small fires with an extinguisher. Stand 6 to 10 feet from the nearest edge of the flame and aim at the base of the fire. For large fires, follow or start evacuation procedures. - Keep exits clear at all times. - Maintain an exit at all times—never let the fire get between you and the exit. - If smoke is present, workers and patients should crawl or move close to the floor toward the exit. - A damp towel or similar cloth may be used to cover the mouth and nose for breathing. - If a door is hot to the touch, do not open it. - If you are trapped in a room and the door is hot to the touch, stay in the room (lie on the floor for more oxygen and less smoke) and place wet towels or blankets under the door.

Employee workplace violence preventative measures

*Watch for signals that may be associated with impending violence:* • Verbally expressed anger and frustration • Body language such as threatening gestures • Signs of drug or alcohol abuse • Presence of a weapon *Maintain behavior that helps diffuse anger:* • Present a calm, caring attitude • Do not match the threats • Do not give orders • Acknowledge the person's feelings (ex: I know you are frustrated). • Avoid any behavior that may be interpreted as aggressive (ex: moving rapidly, getting too close, touching, or speaking loudly). *Be alert:* • Evaluate each situation for potential violence when you enter a room or begin to relate to a patient or visitor. • Be vigilant throughout the encounter. • Do not isolate yourself with a potentially violent person. • Always keep an open path for exiting - do not let the potentially violent person stand between you and the door. *Take these steps if you cannot diffuse the situation quickly:* • Remove yourself from the situation • Call Security for help. • Report any violent incidents to your management.

Safety practices for electrical hazards

• Always be thoroughly familiar with any equipment before attempting to use it independently for the first time. • Review and follow the manufacturer's operating instructions. The health care professional should not use shortcuts 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. If the health care professional is not trained in the repair of a particular piece of equipment, he/she should never attempt to repair it. • Never use electrical cords that are not completely intact, use plugs that have been altered (ex: have third prong removed), or use excessive force to insert a plug into an outlet. • 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 been accidentally dropped in water can be life threatening. Always dry hands, clean up any spilled water, and remove the power source. • If someone is being shocked (electrically), do not touch the person or pull the plug from the wall because this places you at risk. Instead, turn the main source of power off immediately and be prepared to administer emergency care and call for help.

General Guidelines for Chemical Handling:

• If the container is not properly labeled or if it cannot 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 its proper location. • Never mix any two chemicals together without first verifying compatibility. • Avoid contact with the eyes and skin and do not inhale. • Take precautions not to splash or spill solutions. • Wear personal protective equipment (PPE) as indicated. • Make sure chemicals are used only for their intended purpose. • Store chemicals as directed on the labels. For example, does the chemical require room temperature storage or refrigeration; can it be stored on the counter or does it require a dark environment. Never place chemicals in direct sunlight or close to heat. • Do not pour toxic (poisonous), flammable, foul-smelling, or irritating chemicals down the drain. Instead, place them in the specified container as per the policy and procedure manual. • If you spill any solutions, clean up immediately according to established procedures and dispose of the debris properly. • If a chemical does come in contact with the skin, rinse immediately with *cool water* for at least 5 minutes. Splashes in the eye should be rinsed for a minimum of *15 minutes*, preferably with normal saline. Report any accidents immediately to the supervisor and seek medical assistance foe evaluation and follow-up.

Oxygen Hazards

• Most facilities have signs stating "Oxygen in Use" that are posted as specified in the facility policy. • 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, and handheld computer games. • Never use flammable liquids, such as alcohol, oils, adhesive tape remove, nail polish, or nail polish remover. • An oxygen tank should be secured to prevent it from falling over. Do not place it in the sunlight or near heat. The stem-and-valve assembly on the tank is fragile; if mishandled, the cylinder can become a missile as the pressurized gas is suddenly released. • Smoking is not allowed when oxygen is in use, and smoking materials must be removed from the room. Fortunately, most facilities no longer allow smoking at any time, due to the health risk to the person and others. Always be alert for those who disregard the rules. No lighted matches or open flames should be permitted in the area. • use cotton blankets, gowns, or clothing. Wool and synthetics are more apt to create static electricity.

To respond promptly to a fire, you must be knowledgeable in the following areas:

• The location of fire alarms and extinguishers • How to use a fire extinguisher - carry the extinguisher upright. To help remember the proper sequence of operation, think PASS. • How to respond to each type of fire - fire extinguishers vary for different types of fire. Using the wrong type of fire extinguisher can result in spreading a fire rather than putting it out. • The emergency evacuation routes. • What procedures to follow - although procedures may vary at individual facilities, there are generally accepted guidelines to use when a fire occurs. Think RACE. • In case of a major fire, follow all instructions carefully. Your duties may include assisting patients into wheelchairs or onto stretchers. Advise ambulatory (able to walk) patients about evacuation routes. • Many facilities have a policy that no personal electrical equipment can be brought into the hospital because the possibility that it may be defective is a fire risk. Larger facilities will have environmental safety personnel who verify the safety of facility equipment. Check the policy manual to determine if the environmental safety personnel will also check personal equipment. If so, they will attach a tag verifying the completion of the safety check.

Examples of procedures in Emergency Preparedness Plans:

• Whether you should report to work • How to protect yourself and your patients • Your specific duties • How to get communications and updates