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Be prepared

As the flu season commences, the specter of Ebola Virus Disease (EVD) and its “presentation” of flu-like symptoms is certainly going to make this a most challenging flu season. While (as this item goes to press) we’ve not seen any of the exposure cases that occurred in the United States result in significant harm to folks (the story in Africa remains less optimistic), it seems that it may be a while before we see an operational end to needing to be prepared to handle Ebola patients in our hospitals. But in recognition that preparedness in general is inextricably woven into the fabric of day-to-day operations in healthcare, right off the mark we can see that this may engender some unexpected dynamics as we move through the process.

And, strangely enough, The Joint Commission has taken an interest in how well hospital are prepared to respond to this latest of potential pandemics. Certainly, the concept of having respond to a pandemic has figured in the preparation activities of hospitals across the country over the past few years and there’s been a lot of focus in preparations for the typical (and atypical) flu season. And, when The Joint Commission takes an interest in a timely condition in the healthcare landscape, it increases the likelihood that questions might be raised during the current survey season.

Fortunately, TJC has made available its thoughts on how best to prepare for the management of Ebola patients and I think that you can very safely assume that this information will guide surveyors as they apply their own knowledge and experience to the conversation. Minimally, I think that we can expect some “coverage” of the topic in the Emergency Management interview session; the function of establishing your incident command structure in the event of a case of EVD showing up in your ED; whether you have sufficient access to resources to respond appropriately over the long haul, etc.

Historically, there’s been a fair amount of variability from flu season to flu season—hopefully we’ll be able to put all that experience to work to manage this year’s course of treatment. As a final thought, if you’ve not had the opportunity to check out the latest words from the Centers for Disease Control and Prevention (CDC) on the subject, I would direct your attention to recent CDC info on management of patients and PPE.

I suppose, if nothing else, the past few weeks of our encounter with Ebola demonstrates something along the best laid plans of mice and men: it’s up to us to make sure that those plans do not go far astray (with apologies to Robert Burns).

Uniformly clean

Reaching in once again to the viewer mailbag, we find a question regarding the laundering of staff uniforms. In this particular instance, this organization is moving from a business casual dress code for medical staff to providing scrubs (three sets each) to promote uniformity of attire (sorry, I couldn’t resist the pun). Now that the decision has been announced, there’s been a little pushback from the soon-to-be scrub-wearing folks as to whether the organization has to launder the scrubs if they become contaminated with blood or OPIM (the plan is for folks to take care of their own laundering).

So, in digging around a bit I found an OSHA interpretation letter that covers the question regarding the laundering of uniforms is raised and includes the following response:

Question 6: Is it permissible for employees to launder personal protective equipment like scrubs or other clothing worn next to the skin at home?

Reply 6: In your inquiry, you correctly note that it is unacceptable for contaminated PPE to be laundered at home by employees. However employees’ uniforms or scrubs which are usually worn in a manner similar to street clothes are generally not intended to be PPE and are, therefore, not expected to be contaminated with blood or OPIM. These would not need to be handled in the same manner as contaminated laundry or contaminated PPE unless the uniforms or scrubs have not been properly protected and become contaminated.

To my way of thinking, if the scrubs were to become contaminated, which would appear to be the result of the scrubs not having been properly protected (I’m reading that as “not wearing appropriate PPE), then the tacit expectation is that they would be handled in the same manner as contaminated laundry or contaminated PPE and since it is inappropriate for PPE to be laundered at home, then provisions would need to be made for the laundering of contaminated scrubs/uniforms. Now, you could certainly put in place safeguards, including the potential for corrective actions, if you have a “run” on folks getting their uniforms contaminated. It’s certainly possible that, from time to time, a uniform might become contaminated, but the proper use of PPE should keep that to a minimum.

How are folks out there in radio land managing scrubs that are used as uniforms (as opposed to being used as PPE)? Are you letting folks take care of their own garments or doing something that’s a little more involved? Always happy to hear what’s going on out there in the field.

And if I can take a moment of your time, I’d like to take this opportunity to remember my late colleague David LaHoda. This is the type of question he loved to answer and I loved helping him help folks out there in the great big world of safety. David, you are missed, my friend!

In your eyes – the light, the heat … the chemicals?

A couple of weeks ago, a client was asking me about who should be performing the weekly checks of eyewash stations. A clinical surveyor consultant had given them the impression that this should be the responsibility of maintenance staff. Now, I’m not sure if this direction was framed as a “must” or a “would be a good idea,” but what I can tell you is that there is no specific regulatory guidance in any direction on this topic. I do, however, have a fairly succinct opinion on the topic—yeah, I know you’re surprised to hear that!—which I will now share with you.

Certainly we want to establish a process to ensure the checks will be done when they need to be done. I agree that maintenance folks are typically more diligent when it comes to such routine activities than clinical folks often are. However, from an end-user education standpoint, I think it is way more valuable for the folks who may have to use the device in the area to actually practice its operation. If they do have a splash exposure, they would have a moderately increased familiarity with the location, proper operation, etc., of the device. Ideally, the eyewash will never have to be used because all our engineering controls and PPE will prevent that splash (strictly speaking, the eyewash is a last resort for when all our other safeguards have failed or otherwise broken down.

I’m also a believer (not quite like Neil Diamond, maybe more like Smashmouth) that providing for the safety of an organization is a shared responsibility. Sure, we have folks who call ourselves safety professionals help guide the way. But real safety lives at the point of care/point of service, where everyone works. So it’s only appropriate that each one of us take a piece of the action.

Alleged fire safety worries, other lapses spell big trouble for a hospital

There was an attention-getting article in this week’s issue of our Hospital Safety Connection e-newsletter about a California hospital that got fined 100 grand by the state for low humidity levels in an OR, which raised concerns that electrosurgical instruments could spark and ignite a fire in the dry air.

I have to admit that in my years of covering life safety, I never [more]

With OR humidity, follow CMS and risk assessment findings

There is a great deal of not-quite-controversy relative to humidity concerns in operating rooms (OR) because of the personal comfort aspect.

The American Institute of Architects’ 2001 Guidelines for Design and Construction of Hospital and Healthcare Facilities indicate a temperature range [more]

9/16 webinar on how IC ties into employee safety

7823_largeWe’ve got a great Webinar coming up on Wednesday called “Developing an Effective IC Program to Ensure Employee Health and Safety,” which takes place at 1 p.m. Eastern. You can also order it on-demand and watch it at your convenience if the initial broadcast time doesn’t fit into your schedule.

Among the topics our experts will discuss include how employee health ties into:

  • CDC guidelines and OSHA standards for staff member immunization
  • Personal protective equipment and respiratory protection
  • Screening and exposure protocols

This show is part of our series, Infection Prevention Core Training.

Questions raised at one hospital about adequate PPE supplies

Hi everyone, it’s Scott Wallask. My colleagues over at OSHA Healthcare Advisor blogged this week about a hospital that was butting heads with some employees regarding personal protective equipment.

The workers don’t believe the hospital has supplied enough PPE, which raises the question of what would happen to the absentee rate at this facility if a pandemic occurred. The hospital disagrees with the employees’ contention. It’s a though provoking blog post.

Gloves don’t have to be one-size-fits-all

Hi everyone, it’s Scott Wallask checking in after a bit of an absence to welcome my new son in the world. During my stay at the maternity unit of the hospital, I saw a simple but effective way to further encourage hand glove use. [more]

Does OSHA have a new bloodborne bard?

I just had to pass along this post from our sister blog, OSHA Healthcare Advisor, as it actually connects William Shakespeare’s prose to OSHA “regualtory speak” in the bloodborne pathogens standard.

I’m not a big Shakespeare fan, but this one had me laughing out loud a few times. Well worth a read.

Use of safety vests by snow-clearing workers hinges on risk assessment

I was recently asked by a safety officer whether staff members who cleared snow from parking lots or mowed lawns need to wear reflective safety vests.

That is a very interesting question, and I do believe it provides me with yet another example [more]