Chapter 11: Environmental Safety

Health care considerations for changes in Hearing

-face the pt when speaking -speak clearly, but do not yell -notice when pts do not react to warning sounds

Class D extinguishers:

-release a sodium chloride powder that when heated forms a crust -the crust excluded air and fire is smothered

Class B extinguishers:

-release carbon dioxide (CO2) that 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

R-remove patients:

-remove any pt who is in danger -ambulatory pts can walk to safety -others may need wheelchairs or can be pushed in beds -never use elevators during a fire, instead, carry non-ambulatory pt in a linen sling, held at each end by a health care professional, while descending steps

Workplace violence Prevention Measures for Employees: Takes these steps if you can't defuse the situation quickly

-remove yourself from the situation -call security for help -report any violent incidents to your management

Class C extinguishers:

-same as class B, because carbon dioxide is used, which is nonconducting and provides a smothering action

General guidelines for emergency disaster plan:

-stay calm. There will be a great deal of those of chaos and confusion in a severe disaster, but panic can escalate the fear and related difficulties. 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 who is 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

Psychosocial hazards

-stressors in the workplace causing workplace anxiety and emotional fatgue Examples: -providing constant emotional support -coping with emergency situations -inadequate staffing -lack of supervisor support -frequent schedule changes, bio-terrorism

Bioterrorism-related agents:

-there are many -most likely biological weapon would be: anthrax, smallpox, botulism, or plague -use transmission precautions -generally not transmitted person-to-person, so exposure can be contained by proper precautions

Environmental Hazards

-unsafe conditions in the workplace Examples -slip, trip, and fall hazards -cramped work spaces, inefficient equipment maintenance -fire and electrical hazards

Ergonomic (musculoskeletal) Hazards

-unsafe workplace design and lack of appropriate client- and material-handling tools and equipment contribution 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

How to Extinguish Class C fires:

-use Class C, BC, ABC extinguisher

How to Extinguish Class D fires:

-use Class D extinguisher or smother with dry sand

How to Extinguish Class B fires:

-use class B, BC, ABC fire extinguishers

How to Extinguish Class A fires:

-use water -class A fire extinguisher -class ABC fire extinguisher

PASS

-used to respond promptly and correctly 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 P- pull the pin A- aim the nozzle at the base of the fire S- squeeze the handle S- sweep back and forth along the base of the fire -how to respond to each type of fire due to the fact fire extinguishers vary for different fire -using the wrong extinguisher can result in spreading a fire rather than putting it out -know the emergency evacuation routes

Workplace violence Prevention Measures for Employees: Signals associated with Impending Violence

-verbally expressed anger and frustration -body language such as threatening gestures -signs of drug or alcohol use -presence of a weapon

Oxygen Hazards:

-when pt is unable to take in adequate oxygen on his or her own, the physician may order the administration of oxygen

A- activate alarm:

Activate the fire alarm and notify the facility telephone operator/receptionist

Changes in mental function

Change the Risk: -confusion and forgetfulness can impair good judgment and decrease awareness of common dangers

Changes in Blood Vessels

Change the Risk: -dizziness when attempting to stand and increases risk of falls

Weakness from Illness or Injury

Change the Risk: -more prone to falls

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 Examples: can step on sharp objects and not be aware of injury

Taking Medications

Change the Risk: -side effects of some medications cause dizziness, visual disturbances, and other problems that increase the risk of injury

Changes in Hearing

Change the Risk: -unable to hear warning or approaching carts and equipment

Changes in Vision

Change the Risk: -unable to see unsafe conditions and/or unable to judge distances

Bioterrorism-related agents: smallpox

possible to be transmitted person to person, use airborne/contact precautions

Bioterrorism-related agents: Botulism

- not possible to be transmitted person to person, use standard precautions

Class A fires:

-Most common type of fires -ordinary combustibles, such as: paper, cloth, rubber, plastic, wood, trash, or mattress fires

The National Institute for Occupational Safety and Health

-NIOSH -defines workplace violence as "violent acts directed toward persons at work or on duty" -in health care the most common workplace violence is client aggression toward caregivers

Emergency disaster Plan

-OSHA requires health care facilities to have them for handling large numbers of pts in the events of a catastrophic event such as:an earthquake, a flood, a tornado, a hurricane, or bombing -it is a health care professionals responsibilities to be familiar with the requirements and understand their roles such as: -whether you should report to work -how to protect yourself and your pts -your specific duties -how to get communications and updates -always remain calm to help you think clearly, and provide needed stability to those who are confused, injured, and frightened -be efficiently and cooperatively

Physical hazards

-agents that can cause physical injury and tissue damage Examples: -radiation -noise -explosive objects or substances (oxygen)

To Avoid Electrical hazards:

-always be thoroughly familiar with any equipment before attempting to use it independently for the 1 time. Know and follow all safety precautions -review and follow the manufacturer's operating instructions. The health care professional should not use shortcuts or experience with unfamiliar equipment -Never use electrical cords that are not completely intact, use plugs that have been altered(have 3rd prong removed), or use excessive force to insert 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 form the wall because this places you at risk. -Instead, turn the main source pf power off immediately and be prepared to administer emergency care and call for help

Less obvious triage system:

-always in place in the emergency department

Precautions for Oxygen use cont:

-an oxygen tank should be secured to prevent it form falling over. Do not place it in the sun light or near heat. The stem-and-valve assembly on the tank is fragile and 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. -facilities do not 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 most apt to create static electricity

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 (linen, sharps, trash) -decontaminated on-site, or removed by a licensed removal facility for decontamination -it is the health care professional's responsibility to follow the facility's policies and procedures in the proper handling, containment, cleaning up of spills, and disposal of infectious waste -any direct contact with waste that puts the worker at risk for infection should be reported per facility policy

Workplace violence

-any physical assault or verbal abuse that is incurred during the course of performing one's duties at work Examples: -being pushed, hit, or restrained -spoken to in a loud or demanding manner -cursed at or berated; can be listed under physical or psychosocial hazards depending on the nature of the violence

Class A fire extinguishers:

-are water based -contain pressurized water or aqueous film-forming foam (AFFF)

Bioterrorism

-attempts to contaminate food source, and develop weapons for the purpose of dispensing biological organisms -functions of disaster plans is the incorporation of a biological exposure readiness plan - step 1 of this plan is to become aware of and report a suspected bioterrirosm-related outbreak -if such attack is suspected, the Federal Bureau of Investigation (FBI) would be immediately notified -may not be possible to wait for deification 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

Slowed reflexes

-automatic reactions that cause us to pull away from danger Change the Risk: -unable to move away quickly from danger (removing hand from hot surface or from under hot water or unable to stop in time to avoid collision)

General Safety Guidelines

-best approach of safety is to focus on prevention

Cleaning up broken glass

-best to pick up with brush or broom and dustpan and placed in puncture-resistant wrap or container, prior to placing in a plastic bag -when spill involves bodily secretions or blood; follow standard precautions by using gloves, and disposing of waste in special bags designated for bio-hazardous waste

Bioterrorism-related agents: Plague

-bubonic, not possible to be transmitted person to person, use standard precautions -pneumonic, possible to be transmitted person to person,use droplets precautions

Class D fires:

-burning metals(not typically seen in the health care environments)

C- contain the fire:

-contain the fire by closing all windows and doors -follow facility procedure of turning off oxygen and electrical equipment

Bioterrorism-related agents: Anthrax

-cutaneous, possible to be transmitted person to person, use standard precautions -gastrointestinal, not possible to be transmitted person to person,use standard precautions -pulmonary, not possibleto be transmitted person to person,use standard precautions

Rationale for contain the fire:

-decreases the amount of air available to the fire -drafts (air currents) cause fire to spread more rapidly -prevents explosions and further fueling of the fire

Workplace violence Prevention Measures for Employers: Administrative controls

-design staffing patterns to prevent personnel from working alone and to minimize pt waiting time -restrict the movement of the public in hospitalls by card-controlled access -develop a system for altering security personnel when violence is threatened

Workplace violence Prevention Measures for Employers: 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 pts 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 pt or bullet-resistant and shatter-proof glass enclosures in reception areas, arrange furniture and other objects to minimize their use as weapons)

Hospital Violence

-differ from workplace violence in general -results from pts and occasionally from family members, who fell frustrated, vulnerable and powerless

Cautions for Class D fires:

-do not use any of the other types of fire extinguisher on this type of fire

Cautions for Class C extinguisher:

-do not use water or Class A, unless the electricity has been disconnected -electrical fires are particularly hazardous because the possibility of electrocution is present

Triage:

-effectively manage disaster response rests on an established triage system (select) -specially trained personnel follow established triage guidelines to assess pts conditions and determine where they should be sent and what treatment they should receive -also used in emergency room when multiply pts need medical care

Effects of Violence

-effects go further than the actual injuries and psychological trauma -may also have negative organization outcomes, such as low worker morale, increased job stress, increased worker turnover, reduce trust of management an coworkers, and a hostile working environment -both employer and employee have a responsibility to decrease violent occurrences

Class C fires:

-electrical fires, (ex. electrical equipment, fuse boxes, wiring, and appliances) -use class C, BC, ABC extinguisher

Workplace violence Prevention Measures for Employees: Be alter

-evaluate each situation for potential violence when you enter a room or begin to relate to a pt or visitor -be vigilant throughout the encounter -don't isolate yourself with a potentially violent person -always keep an open path for exiting- don't let the potentially violent person stand between you and the door

E- extinguish the fire or evacuate the area:

-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 exist clear at all times -maintain an exit at all times-never let the fire get between you and exit -if smoke is present, workers and pts 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 -always check the temperature of a door before opening it. 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 touch, stay in the room (lie on the floor for more oxygen and less smoke) and place wet towels or blankets under door

Class B fires:

-flammable (easily set on fire; same as inflammable) and combustible liquids, such as gas, oils, paint, solvents, and cooking fat fires -do not use water or class A extinguisher, because most burning liquids will float on top of the water , which spreads the fire further

Radiation Hazards

-health care professionals in areas where x-rays or radiation therapy are used must practice safety precautions to prevent exposure to radiation waves and particles -excessive radiation can put employee at risk for tissue damage, contracting cancer, or becoming sterile (unable to have children) or may lead to infants being born with birth defects -Employees must wear safety monitoring film badges that record the amount of radiation exposure

Chemical Hazards:

-hundreds of chemicals are used in health care examples: -cleaning solutions, anesthesia, and drugs used for chemotherapy -cause harm if swallowed, inhaled, or absorbed through the skin or mucous membranes -OSHA requires all health care facilities to have an exposure control plan and material safety data sheets (MSDS) includes the 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

Health care considerations for Changes in Vision

-identify yourself when approaching or entering the room -provide unobstructed walkways -place items needed by pts within their visual field -explain the location of items orally

Guidelines for handling Chemicals:

-if the container is not properly labeled or if it cannot be read clearly, do not use it -recheck labels 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 -never mix any two chemicals together without first verifying compatibility(can not combined without unfavorable results) -avoid contact with the eyes and skin and do not inhale -take precautions not to splash or spill solutions -wear PPE as indicated -make sure chemicals are used only for their intended purpose -store chemicals as directed on the labels.

OSHA

-in addition to infection control measures, has many regulatory requirements that apply to other workplace safety issues

Fires

-in health care facilities can result from a number of hazard such as: -damage equipment -overload circuits -defects in heating systems -spontaneous combustion -improper trash disposal -smoking *it is important for you to familiarized yourself with the recommended policies and procedures for the health care facility in which you work -require three things to start: oxygen or air, an item that will burn to supply fuel (trash, linen, chemicals) and a source of heat (sparks, flames, matches)

Personal safety practice

-include ways to move safely within and dress for the workplace -work with pt, provide protection for oneself and others -determine what, when, and how to report any accidents that do occur

Health care considerations for Taking Medications

-instruct pt and family about reporting symptoms immediately -monitor pts carefully when administering medications and do not leave them alone immediately afterward; watch for possible reactions

Health care considerations for changes in Blood Vessels

-instruct pts to get up slowly -assist pts as necessary

Incident report

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

During Emergency

-it is critical to stay calm -number of decisions must be made, and clear thinking is needed to properly assess the problem -if safety is at risk, leave area and sound the alarm -if fire is small and contained and your safety and that of others are not at risk: determined which type of extinguisher is appropriate to use and proceed with the proper handling procedures *remember that your safety and that of others come first

Protecting Yourself and Others

-it is essential to apply safety practices that consider the well-being of others -follow the standard precautions -do not open more than one file cabinet drawer at a time to prevent tipping -do not have file cabinet doors open because someone may hit his or her head or trip -do not place food in a refrigerator that contains lab specimens or medications -do not wear uniforms in non-work setting -keep floors clear by immediately picking up dropping objects, Use OSHA standards when cleaning up glass, spilled specimens, and liquids

Infectious (biological) Hazards

-may cause infections through inhalation, direct contact with skin or mucosa, skin puncture, or through ingestion (eating and drinking) Examples: -bacteria -virus -fungi -other living microorganisms

Chemical Hazards

-may have toxic effects through inhalation, adsorption through the skin or mucous membranes, or ingestion -some irritate the skin on contact -Ex: Chemotherapeutic agents, disinfectants, cleaning solutions, alcohol, anesthesia

Environmental Safety

-means to identify and correct potential hazards that can cause accidents and injuries -health care professionals must understand and follow workplace safety policies and procedures that reduce hazards and prevent accidents, and know how to handle incidents correctly if they do occur

Precautions for Oxygen use:

-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: hair dyers, heating pads, space heaters, fans, radios, electrical shavers, and handheld computer games -never use flammable liquids, such as alcohol, oils, adhesive tape remover, nail polish, or nail polish remover

Moving safety

-movements that create the potential for accidents such as falls -never run, even in an emergency ; move swiftly in a fast pace -stay to the right of the hallway, be cautious when approaching intersections in other to prevent collisions. -pay attention to warning mirrors on corners -remove any loose rugs from the 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 stairs -never carry uncapped syringes or sharp instruments in hallways or between rooms

Triage personnel:

-multiply victims, the available services a over strained -triage personnel must determined who to treat first, what lab or diagnostic tests receive priority, what procedures to perform immediately, and who to send to surgery -reassess pt who are waiting for services to determine if their condition has changed and if their priority needs to be updated

Guidelines for handling Chemicals cont:

-never place chemicals in direct heat -do not pour toxic (poisonous, flammable, foul smelling, or irritated chemical 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 under cool water for at least 5 minutes. -Splashes in the eye should be rinsed a minimum of 15 minutes, preferable with normal saline. -report any accidents immediately to the supervisor and seek medical assistance for evaluation and follow-up

Cautions for Class A extinguisher:

-no special precautions -follow proper sequence of operation (PASS) require with all extinguishers -do not stand too close to fire -take care with extinguisher -wash skin as soon as possible after extinguishing fire -the chemical is corrosive and will damage computers and electrical equipment

Cautions for Class B extinguisher:

-no special precautions -they are not noncorrosive and do not damage computers and other electrical equipment but are heavy and have a shorter discharge range

Workplace Violence

-not limited to physical assault, but also includes verbal abuse -according to 2005 estimated by the Bureau of Labor Statistics (BLS); 5% of all establishments surveyed had an incident of workplace violence in the past 12 months -hospital nurses,nursing assistants, EMTs, hospital safety officers are higher risk of becoming victims of workplace violence (all health care providers) -range from offensive or threatening language to homicide

Health care considerations for Weakness from Illness or Injury

-observe pts carefully -provide extra assistance -instruct the family about extra precautions needed

Rationale for remove patients:

-places pt safety first -fires can travel through elevator shafts, cables can be damaged; and elevators can get stalled between floors if power fails.

Health care considerations for Altered Neurological function

-play increased attention to physical signs of injury -give extra assistance, as needed -do not leave pt alone on treatment table or under any conditions where falls might occur

Workplace violence Prevention Measures for Employees: Maintain behavior that helps diffuse anger

-present a calm; caring attitude -Don't match the threats -Don't 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)

Rationale for extinguish the fire or evacuate the area:

-prevents burns cause by sudden burst of flames escaping room when door is opened -wet towels decrease the smoke entering the room

Fires Procedures cont.

-procedures vary at individual facilities -there are general guidelines such as RACE -in case of major fire, follow all instructions carefully.Your duties may include assisting pts into wheelchairs or onto stretchers. Advise ambulatory(able to walk) pts about evacuation routes -a policy that many facilities have is that no personal electrical equipment can be brought into the hospital because the possibility of it being defective is a fire risk. Larger facility will have environmental personal that verify the equipment

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

Workplace violence Prevention Measures for Employers: Behavior modification

-provide all workers with training in recognizing and managing assaults, resolving conflicts, and maintaining hazard awareness

Health care considerations for Changes in mental function

-provide family with information about medications, home health resources, and safeguarding the hime

Health care considerations for Slowed reflexes

-provide pt and family with information about possible unsafe behaviors and ways to safeguard the home

Working Safely with Patients

-pt safely is always a primary concern -focusing on the task at hand and thinking through pt care activities are essential ways to promote safety -do not perform any procedure on pts until you have received adequate training and do not alter the correct procedure (avoid shortcuts) -observe and note conditions in pts that might increase their risk of accident and injury -be positive you have the correct pt -always identify your pt by checking his or hers wristband; -you can ask pt to tell you their full name -form of identification: state their name, their birth date -always verify that the pt has give consent, because pts have the right to refuse any procedure or medication -observe pts closely and report any changes immediately or assist them as needed -do not leave pts 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 pt's reach -keep the work area clean, and organized for efficient proper storage location

Rationale for activate alarm:

-pulling the fire alarm sends an alarm call to the fire station -the facility telephone operator's are often key to communication, and exact location of the fire

Guidelines for disposal of radiological waste:

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

Class ABC fire extinguishers:

-release a multipurpose dry chemical (monoammonium phosphate) that blankets the burning area and interrupts the chemical chain reaction -leave a white powdery residue irritating to skin an eyes

Dressing for safety

-working in health care requires specific types of clothing and grooming to ensure the safety of both workers and pts -wear long hair tied back or up to prevent contact with contaminated materials or the contamination of clean materials -do not wear earnings that extend beyond the earlobe so that they cannot be grabbed or caught -wear enclosed shoes with no more than a 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

RACE:

R-remove patients A-activate alarm C-contain the fire E-extinguish the fire or evacuate the area