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Mac’s Safety Space: Joint Commission standards on mop and rag laundering

Q: We’re concerned about whether the way our mops and rags are laundered are up to Joint Commission standards. At this point, we’re laundering them ourselves in bleach in our washer. The temperatures are hot, but not 160 degrees. Are these mops and rags considered “linen” and do they have to be washed up to the same standards as the rest of the linen?

Steve MacArthur: The quick and dirty response (small pun intended) is that The Joint Commission has no standards relative to the processing of mops and rags, and even the CDC Guidelines for Environmental Infection Control make no specific mention of these items, and as far as a time and temperature equation (temperatures greater than 160 degrees F for more than 25 minutes), they indicate that that applies only when hot-water laundry cycles are used.

They do make chemical detergents for warm-water laundry cycles (less than 160 degrees), so that might be a consideration as well. That said, as they nominally do not come into contact with patients, I don’t think that there would be a compelling reason to consider mops and rags as “linen,” so they could probably tolerate a somewhat lesser level of sanitization, but what that level is would have to be determined.

A couple of things spring to mind. One avenue would be to contact the vendor from whom you obtain mops and see whether there are manufacturer recommendations for laundering the mops. The rags, unless you are purchasing them as a specific consumable, are probably the vestiges of patient linens past their usefulness in that context.

Not being sure what type of washing machine you are using for this process, it might be of value to consider the purchase of a commercial-grade washer. From personal experience, few things “kill” a household-grade washing machine faster than washing mops, particularly in bleach. Also, with a commercial washer, you can probably provide a sufficient time and temperature mix that would perhaps even suspend the need for bleach (bleach is no friend to fabric, I can tell you). Certainly the commercial route is an expensive start-up, but you can probably figure out whether the return on investment is worth it.

Massachusetts facility fined for electrical safety issues

Northeast Hospital Corp., located in Beverly, MA, is facing a $63,000 fine after an investigation by OSHA.

The investigation was prompted by a worker’s complaint that hospital employees didn’t have or use personal protective equipment when handling electrical equipment.

OSHA also found that the hospital’s electrical protective equipment wasn’t tested regularly and electrical safety procedures were not executed properly.

OSHA issued a repeat citation for failing to prove unused openings in electrical panels and cabinet motor control centers had been closed since being cited in May 2010

The facility has 15 business days from the day of its citation, February 15, to comply with hospital safety standards.

What practices does your facility follow in electrical safety? Let us know in our comment section.

Mac’s Safety Space: Don’t let go of the coat

I was traveling recently through the middle of the country and had to witness some sort of lock down of one of the gated areas at the airport. I’m not sure what had happened (it was a very cold and blustery morning, so if they were conducting a drill, props to them for not taking the easy route). At any rate, this resulted in a considerable back-up for the security screening process, prompting the use of a gate area that was either completely decommissioned or was awaiting refurbishment.

The security screening area for this “alternative” gate was not equipped with all the latest bells and whistles, but the TSA folks were making the best use of it that they could under the circumstances, and pretty much all the travelers were being well-behaved (could have been unpleasant). After making our way through this checkpoint, we were put on a bus and driven around to the gate area that had been locked down, so my experience was one of a well-oiled machine, but the experiences of some other folks was somewhat less so.

First off, when we arrived at the “good” gates, there were security and other folks on hand to direct us back into the terminal, which was very good, but at least a couple of those folks were a little underdressed for the occasion. In chatting with one of those folks, he indicated that he had really not expected to have to be standing out in the cold for any length of time and so had only worn a suit coat and trousers.

I immediately thought of all the emergency response plans I’ve seen (particularly lockdown plans) in which various members of the extra staffing folks are pressed into service to help out with perimeter door positions, etc.

So the question I have for you good folk is this: If you have to respond during weather that might best be described as “crappy” (I suppose the technical term could be inclement, but that term just doesn’t seem to do justice to the endless possibilities of conditions that can be engendered by crappy), do you have foul weather gear for the folks who might have to lend a helping hand?

Security staff are likely to have access to some of this equipment, but if you had to pull off a sustained response, can you keep folks appropriately warm, dry, and safe? Winter is certainly upon us, and if 2010-2011 is anything like last year, pretty much everyone, north to south, is going to get a taste of the wintry mix. Brrrrrrrrr!

Hey, put that camera away

Laurie Shifler, who delivered her baby at Meritus Medical Center in Hagerstorn, MD, was banned from taking photos during delivery due to the hospital’s health and safety rules.

Meritus implemented photo and video restrictions during birth in November, after learning that other hospitals in the area had the same ban. Photos of newborn babies are allowed once the medical team has given approval, typically within seconds of birth, reports The New York Times. The hospital also requires cell phones to be turned off.

Shifler was outraged by the hospital’s request, telling The Times that it’s her right and her decision to take photos of her own flesh and blood. The hospital, however, is concerned about the privacy of its medical staff, saying many of them don’t want to be plastered all over YouTube or Facebook, as well as the potential for distraction and for the photographs and videos to be used in litigation.

Does your hospital implement restrictions on photography and videography during births? Let us know in our comment section.

Mac’s Safety Space: When equipment retires …

I was doing some work recently when I came upon an interesting situation. During the course of the building tour, we came upon a couple of syringe pumps that had been due for inspection in January, 2010, so they were a little past due. Of course, these devices were in a variety of locations: a staff locker room, a cabinet in a soiled utility room, and one (at least at the time of my visit) was hiding in plain sight, right next to the only one of these beauties that had an up-to-date inspection. So, we contacted the folks in clinical engineering who gathered up the offending items and whisked them away for preventative maintenance (PM). So far, no really big deal, but here’s where things got a little interesting.

One of my favoritest things to do is to look through the Environment of Care Committee (EC) meeting minutes to see what’s been going on, what challenges have been faced, etc. In looking at the minutes from early in 2010, I noted an item regarding the retirement of the very same syringe pumps we had found because the manufacturer was no longer supporting the device. So, in follow-up discussion, it was noted that the pumps that had been found were PM’ed and returned to service, which on the face of it seemed OK.

But then I got to thinking—if the EC Committee had officially retired these devices, should they not also have a say in their reinstatement? From an operational standpoint, probably no big deal, but once again donning my risk management hat, the question in my mind becomes this: if something not-so-good happens with a patient using one of these pumps, whether it is directly related to pump function or not, what kind of liability does the organization assume in having returned them to service without at least going back through the process that determined they were worthy of retirement to start with?

I stewed on it for a couple of days and eventually contacted these folks to encourage them to remove the pumps from service until they could really “look under the hood” and make an informed decision. Again, maybe no big deal, but you have to be careful in this extraordinarily litigious world.

OSHA fines Maine hospital for workplace violations

OSHA fined a Maine psychiatric hospital $11,700 last month for failing to provide its employees safe workplace conditions.

The investigation at Acadia Hospital in Bangor, was prompted by an employee complaint in July 2010 of an increase in patient assaults and injuries to staff because of the hospital’s no restraints policy, reported the Bangor Daily News. The report, released by OSHA on January 22, calls the violations serious, indicating 115 physical assaults on staff since January 2008.

Injuries included broken teeth, broken glasses, bites, and contusions, and the report found staff had been punched, kicked, and hit by violent patients. OSHA determined the injuries were the result of a workplace that wasn’t up to safety standards. The report demands specific means of decreasing violence toward employees, including better patient screenings, improved communication amongst hospital staff, and increased staff and security training.

How does your facility handle violent patients?

Mac’s Safety Space: Fire alarm standards

Q: It has long been understood that the EOC standards allowed for actual fire alarms to be counted for up to 50% of a facility’s required fire drills. Out of random curiosity, I tried looking up that standard today and was not able to find the information in EC.02.03.03. Does the standard no longer exist or am I looking in the wrong location?

Steve MacArthur: As information documented in The Joint Commission standards, there is no mention of this under EC.02.03.03. I suspect that the concept is derived from the allowance for an organization to use a “real” emergency toward compliance for the emergency exercise requirements; and the 50% figure is derived from the allowance (under EC.02.03.03 EP #3) which requires at least 50% of the quarterly fire drills to be unannounced.

Strictly speaking, you could use actual fire alarms as however many of the required drills so long as you can appropriately document an evaluation of fire safety equipment, fire safety building features, and staff response to fire, during that event.

Generally speaking, in my experience it is very tough to conduct the same level of evaluation for an unplanned event as you can for a planned drill, but that’s not to say that it’s not possible to do so. Ideally, you wouldn’t be having enough actual alarms to meet the minimum of 12 drills that sort out appropriately by shift—that could make for a very chaotic environment. But again, it really comes down to being able to honor the purpose of the drill, which is to evaluate the performance of people, systems and equipment— as long as you have that documented you should be just fine and dandy.

OSHA investigates 3,000-pound equipment fall that injures two

A 3,000-pound piece of equipment fell onto two men in an Illinois hospital on January 19 and has spurred an investigation by (OSHA).

The accident happened at Advocate Good Samaritan Hospital in Downers Grove, IL, where two hospital workers were injured in a narrow maintenance corridor, reported The Chicago Tribune. The investigation is still ongoing.

A hospital spokeswoman reported the organization is unsure of the cause of the accident and that it plans to execute all recommendations given by OSHA after the investigation.

Advocate Good Samaritan has been in the spotlight before with OSHA, in 2002 and in 1993. In 2002, OSHA inspectors found blocked doors and walkways, but the hospital was not fined. In 1993, OSHA found that workers were exposed to patients infected with tuberculosis, and were not given the appropriate number of respirators, reported The Chicago Tribune.

How does your facility help prevent accidents like this? Let us know in our comment section

Mac’s Safety Space: Safety committee meetings

Q: How often do you believe a safety committee should meet? I have always believed monthly, and have always thought the minimum should be every two months? I was recently asked whether quarterly was acceptable. I don’t think so. What do you think?

Steve MacArthur: First, a bit of history. Prior to the 2009 changes to the EC standards, (which included the establishment of the Emergency Management and Life Safety Chapters) the requirement for meeting frequency was indeed no less frequent than every other month.

However, beginning in 2009, the frequency requirement was removed (I believe it was most likely in response to smaller facilities for whom even the bi-monthly frequency was onerous) and replaced with the tacit expectation that each organization will, through a risk-assessment process, determine the appropriate frequency. That said, while there is certainly no regulatory requirement prohibiting quarterly meetings, my inclination would be to discuss the change as a function of the risk assessment process and then include an ongoing evaluation of that decision as a function of the annual evaluation process. That way they can’t cite you for not having made a “correct” determination.

I guess it all boils down to whether or not your committee can effectively manage risk in the physical environment meeting on a quarterly basis. It may be that you don’t really experience a lot of improvement opportunities, failure modes, etc. and that will work. There are certainly enough not-particularly-useful meetings in the mix as it is, so if you find that the meetings are not useful (and ensuring that this is because of the level of activity within the organization and not the level of interest on the part of participants), it is certainly worth looking at.

Mac’s Safety Space: Return of the thin white glove

The gloves come off – wait a minute, there’s another glove underneath! As is my custom when embarking on the journey into the new year, when I get my new copy of the TJC accreditation manual, I like to compare and contrast last year’s tome to this year’s.

Generally speaking, there are not many big ticket changes (I think that 2012 is going to be the bigger, and maybe even a generally big, year for change), and we’ll discuss the removal of the performance elements that keyed on long-term care settings and a few items of what I would loosely term a relaxing of restrictions. However, as an old environmental services (EVS) hand (my first 17 years in healthcare!), I was intrigued to note that EC.02.06.01 EP 20 (Areas used by patients are clean and free of offensive odors) was elevated to a Direct Impact finding. Now, I will admit in all candor, that I had a very difficult time figuring out how that particular expectation could be considered anything but a direct impact on the patient experience, and so feel somehow vindicated that cleanliness is now, potentially, a little more prominent on the radar screen.

I recall the days when any regulatory survey involved a fair amount of the old white glove inspection, with frequent chastisements for less-than-ideal cleaning. As I used to tell folks in orientation, it is very difficult, if not impossible, to effectively prevent and/or control infections in a dirty environment. Even in my consulting practice, I am always aware of how well the EVS staff is taking care of business. It may not get a lot of press, but it is a very important part of the healthcare process.

And so, it remains to be seen whether this is nothing more than an accounting adjustment, so to speak. But it may be a harbinger of an increased focus on cleanliness. I, for one, can’t say that I’m unhappy about it–we should be providing a clean environment to our patients. We would expect nothing less–nor should they.

Keep it clean out there!