A February 25 report from the CDC suggests that the prevalence of Clostridium difficile, or C. diff, a bacterial infection of the gastrointestinal system primarily found in hospitals, is much higher than once thought, affecting up to half a million people annually.
Perhaps even more disturbing is the study’s revelation that up to 150,000 people who had not previously been in the hospital came down with C. diff in 2011. Of those, about 80% had visited a doctor’s or dentist’s office in the 12 weeks before their diagnosis. CDC officials say the revelation is so concerning that they’re starting a series of “case control studies” to try to assess nationally whether people are getting C. diff in medical offices.
If you’re a safety professional or someone in charge of infection control at a medical clinic, by now you’re asking yourself what you can do to help reduce the risk of an outbreak of C. diff. Our safety experts have shared a list of things you can do to prepare.
Know your audience. Not all medical clinics are the same, and therefore neither will your patients. In order to know what your risk is, it helps to do an assessment. A gastroenterologist’s office, for example, is more likely to have a higher likelihood that a patient with C. diff could walk through the doors, says McDonald. Also, do your patients have ties to local hospitals—that is, are they likely to have been in a hospital recently, and maybe they are visiting you as a follow up? That’s an immediate red flag.
Ask the tough questions. You’ve heard this one before: in order to know who’s coming through your doors, you have to ask what they have. Ideally, this is done on the phone when making an appointment for the patient. Have they been hospitalized recently? Are they experiencing diarrhea? Are they on antibiotics or other medication? These questions can help you assess the situation very quickly, and too often intake procedures are lacking in thoroughness.
Schedule wisely. This is where having this advance notification can be handy. While you can’t necessarily turn away patients who may be a C. diff hazard, you can try to keep them away from other patients. These patients can be scheduled as the first or last appointment of the day, and extra precautions can be taken to make sure the room is wiped down afterwards and any staff seeing these patients should take care to wear proper PPE, such masks and gloves. Even better, have someone go through the patient treatment rooms several times a day disinfecting high-tough areas.
Use the proper disinfectant. That being said, you can’t use just any household cleaner and expect it to kill C. diff. Proper procedures include using a sporicidal disinfectant approved by the EPA, not Lysol or another household disinfectant found on the shelves at Home Depot. Another thing to consider is contact time indicated by the manufacturer of cleaning solutions. If it says to keep it wet for two minutes, it has to stay wet for two minutes or it won’t be as effective. Also, if you have disinfectant wipes in a container that is left open the wipes can dry out and won’t keep the surface wet.
Assume everything is infected. You may think your infection control is, well, under control. Sure, maybe you do a good job of treating surfaces in your patient care areas. But take a walk around your waiting room and you’ll see carpets, upholstered couches, water dispensers, and magazines that can easily be contaminated with C. diff spores from a patient—some of which are not easily wiped down and cleaned.
That’s not to say you shouldn’t make your clinic look presentable, but you should definitely be wiping down everything that is considered high-touch—rails, doorknobs, faucets in the bathroom, books in the waiting area.
The following is a guest blog from Linda Gylland, MLS (ASCP) QLS, a lab safety officer for Sanford Health in Fargo, North Dakota.
As a Laboratory Safety Officer, I am of course concerned about all lab-related activities being done in the safest environment, safest conditions, proper PPE, and complying with all safety regulations. Safety practices occur everywhere if you happen to pay attention.
My Dad, an 89-year-old retired farmer who still works just as much, likes to save copper from his farm shop/garage. He brings it to a company in Minneapolis who pays more per pound. I went with him last time and saw every worker in proper PPE, hard hats, gloves, steel-tipped boots, and some masks. It was great to observe. I told them I noticed their PPE compliance and gave them high praises.
On the other hand, there are times when the safest practices are NOT being met. Have you ever observed the busboy who clean tables at restaurants? On several occasions, I have seen them clean the table with a cloth, use the same cloth for the next table and the next and the next. In between tables, the cloth is used to clean the chair, the bench, sometimes the floor. The same cloth is then used on the table and the process is repeated. By the last table, the cloth is no longer wet. The crumbs are just being swept to the floor or to the chair, where that same cloth is flung to get rid of more crumbs. The cloth is thrown into the tray or tub of dirty dishes and is reused at the next table.
Your food arrives, you might cut your steak and it lands on the table or a piece of your baked potato goes over the edge of your plate to the table. You are hungry and want to eat every bite and so you do. What kind of “germs” or bacteria are on that table that is really not clean to the unsuspecting guests? Since I have observed this a few times, I do not take this lightly. I find the manager on duty and ask what kind of training the staff are given in clearing and cleaning tables. I let him/her know what I observed and mention the rules of general safety and the state health department. Restaurants need to maintain high health standards in order to be a successful establishment. Tables must be clean and disinfected before more people are served at that same table.
We recently returned from a family destination wedding in Cancun. I happened to observe great safety practices every day! Because of the intense heat and the UV rating of 13, workers outside wore hats with the connecting flap covering ears and neck. These same hats were worn by the driver of the Catamaran cruise. At the resort, some wore knee high boots while working in the water. Lifeguards were on duty at all times, and during the foam party there were 3 or 4 circling the pool area. I even saw one construction worker in the street wearing a cape (looked like Superman). Sunscreen was available for purchase everywhere. Bottled water was the norm. In the airport, screens describing MERS, Measles, and Ebola were abundant and easy to read and understand.
On the other hand, my mother just recently was fed up with the dirty bathroom that the “men” use. She quickly sprayed some Santeen toilet bowl cleaner into the toilet and was overcome by the fumes. The bathroom fan was on and so the vapors were easy to “inhale.” She immediately coughed, got a sore, scratchy throat and really didn’t feel so great. She moved to another room, got a drink of water and took a nap. I didn’t find out about this until 6 hours later when I happened to call my Dad. I asked him if he checked the MSDS? Of course he knows what a MSDS is because he uses many farm chemicals and knows what the hazards are. He did not think this product would have a MSDS, so I searched for it, and read the information to him. According to the MSDS, Hydrochloric Acid is the active ingredient and produces a vapor that is harmful when inhaled, especially in confined spaces with no open window. The MSDS does say to move to fresh air, dilute with water and get immediate medical attention. Some of these steps were actually followed, the immediate medical attention was not. Regardless, she was fine and still doesn’t understand why I was even concerned.
Since our weather has only three warm months, I reward myself with pedicures—sandals are not allowed in the lab of course, but after work, those fluid resistant/impermeable shoes are exchanged for sandals, and I want my toes to look nice. At my last pedicure, I noticed the gal was wearing gloves; I had never observed that before. I asked her why she did and no one else did. She replied, “I just hate to touch people’s feet; you don’t know where they have been.” The sink does contain warm water and soap/disinfectant, but she was taking an extra step of protection. I gave her an “A” for the day.
Every product can have a hazard and we need to know how to properly use them in all situations. We are lucky to have great safety options, to have inspectors to keep everyone in compliance; we have no reason to disobey the rules ever. Not only in the lab do we need to worry about contracting infections or injuries; we need to be observant at all times. With proper care and compliance, we can live life happily and free from diseases and injuries.
June 1, 2015 is the deadline that OSHA set for all employers to be in compliance with the new GHS chemical labeling regulations, which have been phased in over a three-year period to make the transition to the new system easier, especially for manufacturers, many of whom still have large stocks of inventory with old labels.
But for employers—and that means you as the laboratory or medical clinic—it’s a different story. By now you should have your books in order and your employees should know what an SDS is, and why it’s so different than what it used to be. If not, you’ve got a lot of work to do. We’ve put together a quick answer sheet for you to review, and to make sure you’ve made the right moves to be in compliance with the new GHS system.
What is GHS? Unless you really haven’t been doing your job as a safety officer (and you have, right?), this is a review for you. But the new GHS requirements were introduced by OSHA in 2012 that will require manufacturers of chemicals to switch from the traditional Material Safety Data Sheets (MSDS) to the new SDS system. The idea is to make identification of hazardous chemicals universally easier around the world, in any language, which at least theoretically, makes it safer for workers to handle and work with.
A major component of the new system is the updated Safety Data Sheets, or SDS, which replaces the older Material Safety Data Sheets (MSDS) that OSHA requires employers to have on record at job sites.
The sheets, which identify the chemicals and hazards associated with them, are divided into 16 sections, each dedicated to information about firefighting and first aid, storage, hazards, and what to do in the event of exposure to the substance. In addition, eight visual guides to workplace hazards called “pictograms” consist of a black hazard symbol on a white background with a red background, and are designed to be identified at a glimpse. They clearly identify hazards such as flames, carcinogens, corrosives, explosives, and environmental hazards.
What do my employees need to know? OSHA gave employers until December 1, 2013 to complete training with their employees on the new SDS system and pictograms. To be safe, employees need to recognize both sheets, and how to find information about handling chemicals safely as well as first aid information should there be an exposure in the workplace.
What are some training ideas I can use? Even if you did the proper training with your employees two years ago, if you don’t make the training an ongoing part of your safety program, your employees can forget the information.
Most safety experts suggest hosting a series of in-service trainings, to start. Get some donuts and coffee and introduce the new information such as pictograms to your employees. Make a fun quiz, or have your employees team to complete a scavenger hunt that requires them to identify pictograms on the new SDS. This also gives you a written record of their training you can then use to show to OSHA inspectors as proof of training.
Why are my chemical suppliers still sending old labels? In this case, chemical manufacturers had large stores of product that still had the old labels on them, along with original MSDS sheets corresponding to those products. If manufacturers had to change everything immediately, it would cost them a lot of money and waste a lot of chemicals, so OSHA gave them an extra two years to make the transition. That’s why your employees need to be trained to recognize both systems. Manufacturers have until June 2016 to complete their own transitions.
I can’t find SDS labels for the chemicals we use on the manufacturer’s web site. What’s next? Many manufacturers have been forward thinking enough to make sure they are providing the updated documentation for their products, even making them available on their website for easy download. But some safety managers who have been trying to update safety records have complained that they can’t find the proper SDS information for the chemicals they have in the workplace. In this case, you can wait for your suppliers to provide the updated documentation, but many safety folks have decided to take matters into their own hands and call vendors and suppliers to get the right information.
What if I don’t comply? OSHA’s GHS requirements are a law, so you really don’t have a choice. At best, you are opening your facility open to a major OSHA citation and fines. You also open yourself and your employees to injuries caused by not being up to date on information about the hazards associated with chemicals they are working with, as well as the first aid necessary to help out in an emergency.
For more information about the GHS requirements and ideas to help your facility comply, check out the following link on the OSHA website: https://www.osha.gov/Publications/OSHA3695.pdf
OSHA likes to tout itself as a governmental agency that looks out for workers in all industries. But they aren’t doing a very good job of announcing a huge change to guidelines that could help protect healthcare workers from the rising problem of workplace violence.
It took a couple of well-connected readers to let me know that OSHA earlier in April released an update to its Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers, known to many in the safety field as OSHA Rule 3148. Good luck finding any of this on the OSHA web site, by the way.
After an inquiry to OSHA public relations, I was sent the updated guidelines, which you should pay attention to if you are in charge of safety at your facility.
According to its own statistics, OSHA says in 2013 more than 23,000 significant injuries were caused due to assaults at work. More than 70 percent of these assaults were in healthcare and social service settings. Health care and social service workers are almost four times more likely to be injured as a result of violence than the average private sector worker, OSHA says. Further statistics show that about 27 out of the 100, or about 30% of the fatalities in healthcare and social service settings that occurred in 2013 were due to assaults and violent acts.
Under pressure to do something about this, the updated OSHA 3148 recommends that all healthcare facilities develop an effective workplace violence prevention program. Pay attention, because the word is that the Joint Commission is also following these changes closely.
The new OSHA guidelines are very specific in the types of workplace controls that employers should consider, especially when it comes to facility security and keeping track of employers. Examples include:
- The use of silent alarms and panic buttons in hospitals and medical clinics
- Providing safe rooms and arranging furniture to make sure there are clear exit routes for workers and patients
- Installing permanent or hand-held metal detectors to detect weapons, and providing staff training on the use of these devices
- Ensuring nurse stations have a clear view of all treatment areas, including the use of curved mirrors and installing glass panels in doors for better viewing, as well as closed circuit cameras to help monitor areas
- Using GPS, cell phones, and other location technology to help keep track of staff working with patients in off-site locations
- Protection front-end and triage staff using facility design elements such as deep counters, secure bathrooms for staff separate from patient treatment areas, and using bulletproof glass and lockable doors with keyless entry systems
In addition, the recommendations include employing administrative controls designed to track patients and visitors who have a history of violence, to better educate workers on the dangers and signs of impending violence, and to ensure better reporting procedures. Some of these recommendations include:
- Providing clear signage in the facility that violence will not be tolerated
- Instituting procedures that require off-site staff to log in and log out, as well as checking in with office managers periodically
- Keeping a behavioral history of patients, including identifying triggers and patterns
- If necessary, establish staggered work times and exit routes for workers who may be subjects of stalkers
- Keep a “restricted visitor” list for suspected violent people, such as gang members, and make sure all staff are made aware
Also, OSHA recommends that employers provide updated training for employees, including:
- Risk factors that cause or contribute to violent incidents
- Early recognition of escalating behavior or recognition of warning signs
- Ways to recognize, prevent or diffuse volatile situations or aggressive behavior, manage anger and appropriately use medications
- Proper use of safe rooms—areas where staff can find shelter from a violent incident;
- Self-defense procedures where appropriate
- How to apply restraints properly and safety when necessary
- Ways to protect oneself and coworkers, including use of the “buddy system”
For more information, the Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers can be found at https://www.osha.gov/Publications/osha3148.pdf
Hi folks –
As you know, from time to time, I will ask you for your feedback about various safety products and books that we are working on for you here at HCPro.
We are currently planning to publish a book about planning and conducting hospital emergency exercises and I could use your help with a little market research.
I would like to know what our customers would like to see in reading and utilizing such a book, and so I invite you to please take five minutes to complete this quick six question survey to let us know what you think.
As always, I appreciate your input, as we are constantly striving to create products that help you do your job better.
Have a great day!
Managing Editor, Safety