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Take a lesson about chemicals from janitor’s death

By: July 9th, 2014 Email This Post Print This Post

We hear it every day like a broken record – wear your PPE and know what you are doing when you are working with hazardous chemicals in the workplace. Unfortunately, too many people don’t listen and they end up paying the ultimate price.

I’m reminded of this today as I read more about the janitor in an elementary school in Plymouth, Massachusetts who was apparently overcome and died from exposure from an as-yet unknown chemical on Monday morning.

If you’re just learning about this, 53-year-old Chester Flattery, the head custodian at Manomet Elementary School, was found dead by the school secretary at about 8 a.m.  That employee and 12 other people – many of them police officers, firefighters and other first responders who were exposed – had to also be taken to the hospital for treatment.

The investigation is still ongoing, but reports say Flattery had been at work for an hour before anyone else and that he may have been applying a floor sealant at the time of his death. School is not in session and there is a lot of maintenance work that goes into getting the building ready for next year.

Now, we all in workplace safety world know he was supposed to be wearing a respirator, eye protection, and other protective equipment. I have been a teacher in an elementary school, and I have seen these guys hard at work getting the school ready, even as I was getting my own classroom ready for students.

Most of the time, they are in regular street clothes as they go about their duties and I am willing to bet Flattery was no exception. As someone who had been working there since 2007, he was probably just doing what he always did – this time the fumes were too much for him and no one was there to help him until it was too late.

It almost happened to me. Back in college, I worked as a pool director at a country club in Connecticut, responsible for maintaining the proper chemical levels. One morning, I went into the supply closet looking for chlorine pellets, not knowing that one of my lifeguards hadn’t tightened the cover of the bucket properly the night before, allowing rain water to seep in. When I took the cover off, I got hit with a cloud of chlorine gas that knocked me off my feet and burned my throat. Happily, I was able to get to fresh air quickly and was fine. But no one was around and I was not wearing any kind of protection. I was lucky, and I never made the same mistake twice.

In the healthcare field, you can take a lesson from this tragedy. Don’t assume that just because you have done a job for a long time, you can ignore the rules. OSHA has bloodborne pathogens and hazardous chemical standards for a reason. If you are working with patients, wear your gloves, use your safety sharps, and lift safely.

If you are in a lab and work with chemicals, make sure you know the hazards of what you are working with and how to handle it properly, as well as any first aid information – it’s why OSHA says you must have SDS safety sheets on site. And always be sure someone is around, because it may save your life.

Guest Column: Be Personally Protected

By: July 8th, 2014 Email This Post Print This Post

The following is an occasional series of guest blogs by experts in the medical clinic safety field. If you would like to be featured in this blog as a guest columnist, please email Managing Editor of Safety John Palmer at jpalmer@hcpro.com.

In some laboratories, the use of Personal Protective Equipment (PPE) may be confusing to staff. However, a look at OSHA’s Bloodborne Pathogens and Chemical Hygiene Standards should make clear the requirements for proper PPE selection and use.

Both standards speak clearly to the necessity of PPE when working in the laboratory. Different PPE is needed for different tasks. Lab coats are always necessary in the lab for protection against blood and body fluid splashes or chemical splashes. Plastic aprons may also be used as extra protection in areas where gross tissue work is performed. Lab coats should be buttoned, the sleeves should not be rolled up, and they should be knee-length.

Gloves are needed when handling blood, body fluids, or chemicals, but different gloves may be used for different tasks. Many labs are turning away from using latex gloves because of allergic reactions by staff. Nitrile gloves have become the norm in recent years. However, make sure you have the correct gloves for the duties being performed. Some manufacturers make nitrile gloves that act as a barrier against blood and body fluids, but they do not provide protection against chemicals.  While these will be fine while running a CBC in hematology, they won’t provide enough protection when changing the stainer. Be sure to use chemical-resistant gloves for this and other tasks (gram stains, handling chemistry reagents, pouring acids, etc.). Check the package if you are not sure about the proper use of gloves.

Goggles or face protection is important PPE that is widely under-utilized. Do you carry open specimens in the lab? What about carrying a rack of specimen tubes to or from an analyzer? That is a task that creates a risk for exposure, and face protection should be used. Are you pouring a chemical? Protection is necessary. Help your staff avoid all exposures to the eyes or mucous membranes.

The OSHA standards mentioned above also require that PPE is removed before leaving the laboratory. Do not wear lab coats or gloves to another location outside the laboratory. Does a procedure need to be performed in another area that requires PPE? If so, bring fresh PPE with you for use in the treatment area and dispose of it before returning to the lab.

In a laboratory, all areas should be considered hazardous, bio-hazardous, or contaminated. Do you have a desk area in the lab where only paperwork is done? I have always said that if there is an area in the lab where there are no patient specimens or chemicals, then one could consider the area “clean.” However, that does not mean that food or drink can be consumed there or that no PPE is needed. Remember, you are still in the walls of a laboratory, and accidents may occur. It is acceptable to label the area as “clean” so that gloves are not needed for the computer or phone, but a lab coat would still be required.

Remember, if an OSHA inspector arrives, he will be looking to see that all aspects of safety regulations are being followed. Keep your employees safe and keep your facility from unnecessary fines by using PPE where and whenever needed.

Dan Scungio, MT (ASCP), SLS, also known as “Dan the Lab Safety Man,” is a Laboratory Safety Officer for Sentara Healthcare, a multi-hospital system in the Tidewater region of Virginia.

What do OSHA inspectors look for in healthcare settings?

By: February 6th, 2013 Email This Post Print This Post

OSHA inspectors are usually interested in (and legally entitled to) review of:

  • The bloodborne pathogens exposure control plan
  • The hazard communication program/MSDSs
  • Posters and logs (e.g., “It’s the Law” poster and sharps injury logs)
  • Hepatitis B vaccination records
  • OSHA yearly training records
  • General safety records

*This is an excerpt from The OSHA Training Handbook for Healthcare Facilities by Sarah E. Alholm, MAS.

Reporting a patient fatality to OSHA

By: January 16th, 2013 Email This Post Print This Post

Q: We had a patient experience a fatal reaction to an injection. We understand we have to do an incident report for our risk management, but didn’t know whether we need to complete an OSHA incident form since it wasn’t a safety incident per se but rather an unexpected allergic reaction.

A: Since OSHA is only concerned with employee safety, you do not have to report a patient fatality to OSHA. However, since the fatality was associated with a drug (injection), voluntary reporting to the FDA under the MedWatch program does apply. A patient death is considered a “serious adverse reaction,” and the FDA states it should be reported. The report is made on form FDA 3500. It is voluntary to file this report, but I encourage you to do so, as the MedWatch is how the FDA tracks the safety of pharmaceutical products on the market. If the FDA were to get a number of reports on a particular lot of product, a recall could be initiated. For more information, see www.fda.gov/safety/medwatch/default.htm.

*This is an excerpt from The OSHA Training Handbook for Healthcare Facilities by Sarah E. Alholm, MAS.

Adding “Negative Nellie” to the safety committee

By: January 9th, 2013 Email This Post Print This Post

Q: Our office’s “Negative Nellie” wants to be on the safety committee. I am sure she would see plenty of horribly dangerous issues. She seems to have problems with how everything else works, after all. She makes working toward change impossible. I’m afraid if I say no, she’ll bad-mouth safety to everyone. What can I do?

A: First, consider whether it makes sense for her to be on the committee based upon her job position. If it totally doesn’t make sense, explain to her nicely that you have a limited amount of space and really need clinical (or fill-in-the-blank) people on the committee. If it does make sense for her role to join the committee, work hard to make sure it doesn’t become a complaint venue. Set clear ground rules that emphasize finding solutions, not just listing problems. Work hard to make her feel heard and understood. Employees may get frustrated if they don’t feel their concerns are being taken seriously and call OSHA just to be heard. These types of calls are the top reason an inspector will come knocking at your door.

*This is an excerpt from The OSHA Training Handbook for Healthcare Facilities by Sarah E. Alholm, MAS.

Organizing the MSDS

By: December 11th, 2012 Email This Post Print This Post

Q: I am trying to standardize and simplify the organization of the MSDS in our organization. Many products that we use have a constituent in them that may be hazardous. In a true emergency, the employee may not know what hazardous substance is in the product but should know to look it up in the MSDS manual. An example is laboratory test kits that may contain a diluent or extraction solution. In that case, do you organize the MSDS by the manufacturer’s brand name, or by the common name of the product? What are you suggestions/guidelines?

A: My recommendation is to organize alphabetically based on the common names, since in an emergency this is where staff members will look first for information. OSHA requires that the name on the actual container label match up with the name on the MSDS, so do a spot check of this, too. If you use an identical product from multiple manufacturers, you don’t have to file an MSDS for each company. A single representative MSDS is okay as long as the information is complete and your staff members know which product it’s for.

*This is an excerpt from The OSHA Training Handbook for Healthcare Facilities by Sarah E. Alholm, MAS.

Portable fire extinguishers

By: December 3rd, 2012 Email This Post Print This Post

Q: How should I mount and mark portable fire extinguishers? Is it mandatory for fire extinguishers to be mounted on the wall or poles? Do they need to have a sign? Do they need to be painted red?

A: According to OSHA’s Fire Protection standard (29 CFR 1910.157), “the employer shall provide portable fire extinguishers and shall mount, locate, and identify them so that they are readily accessible to employees without subject the employees to possible injury.” So yes, please mount your portable extinguishers within 75 feet of employee work areas, 50 feet for class B or C extinguishers. Also, use appropriate labels/signs so the extinguishers can be identified. Regarding painting the extinguishers, in the United States they are usually red, but this is not a requirement. The color of the extinguisher often depends on its contents. For example, sometimes dry chemical extinguishers are yellow to distinguish them from carbon dioxide extinguishers (red), especially if both types are used in the same area.

Finally, obtain the MSDS for the fire extinguisher you use in your facility and keep it on file.

*This is an excerpt from The OSHA Training Handbook for Healthcare Facilities by Sarah E. Alholm, MAS.

Pamphlet racks in exit routes?

By: November 26th, 2012 Email This Post Print This Post

Q: In exit hallways, if there are items that are attached to the walls, such as computers or pamphlet racks, is this a problem? There is still about four feet of space to exit.

A: It could be a problem, but if there actually is four full feet of space, it’s probably not. OSHA states: “Objects that project into the route must not reduce the width of the exit route to less than the minimum width requirement.” Exit hallways must be 44 inches wide, so measure carefully how far your computers and pamphlet racks extend into the corridor.

*This is an excerpt from The OSHA Training Handbook for Healthcare Facilities by Sarah E. Alholm, MAS.

View the OSHA Emergency Exit Routes fact sheet here:
www.osha.gov/OshDoc/data_General_Facts/emergency-exit-routes-factsheet.pdf

 

 

Who needs to wear lab coats?

By: November 20th, 2012 Email This Post Print This Post

Q: Are medical doctors and nurse practitioners obligated to wear lab coats when seeing patients?

A: It depends. PPE in the form of fluid-resistant garments (gowns or lab coats) is required to be worn by employees whenever the procedure being performed may be reasonably anticipated to splash or spray blood or OPIMs.

Lab coats may or may not be considered PPE, depending on whether the fabric they are made out of is fluid resistant. If lab coats are fluid resistant and provide coverage in the form of high necks, etc., they can be considered PPE. The lab coats would have to be worn during procedures in which a splash/spray exposure could be expected. If the procedures performed cannot be reasonably anticipated to result in splashing or spraying blood or OPIMs, body protection garments are not called for.

The requirement to wear PPE also depends on whether the providers are employees of a corporation or if they are owners of a practice. As employers (if the providers were the owners), the requirements of the Bloodborne Pathogens standard placed upon employees technically do not apply. However, we encourage employers to abide by OSHA requirements to reinforce the important of safety in the facility.

*This is an excerpt from The OSHA Training Handbook for Healthcare Facilities by Sarah E. Alholm, MAS.

Who should attend safety meetings?

By: November 12th, 2012 Email This Post Print This Post

Q: I’m planning safety meetings for our staff (not yearly retraining). Are clerical employees required to attend every meeting if only medical issues are being discussed? Is a quarterly meeting okay?

A: No, clerical employees do not need to sit through meetings solely on clinical safety items. Quarterly meetings are good, but don’t overlook all the opportunities you already have at your normal staff meetings. Take a couple of minutes to talk about a safety-related topic. Timely events and examples really hit home. You’d be surprised how many poeople in your office can’t describe where to find the fire alarms or how to operate the eyewash station. Just three to five minutes at the start of the meetings really reinforces a safety-first attitude. For maximum impact, keep these mini-presentations short and to the point. You may not even need another quarterly staff safety meeting!

*This is an excerpt from The OSHA Training Handbook for Healthcare Facilities by Sarah E. Alholm, MAS.

Hello from the new Managing Editor

By: October 29th, 2012 Email This Post Print This Post

Greetings, OSHA Healthcare Advisor readers!

My name is Will Kilburn, and I’m the new managing editor for several of HCPro’s safety newsletters and ezines, including Medical Environment Update, Briefings on Hospital Safety/Healthcare Security Alert, OSHA Healthcare Connection, Infection Control Weekly Monitor, and Hospital Safety Connection.

In addition to sending news and information out to you, I’ll also take an active role in the conversation between HCPro and you: Posting and moderating discussions on the OSHA Healthcare Advisor Blog as well as Mac’s Safety Space, and monitoring the OSHA Compliance Hotline to make sure your questions get answered by one of HCPro’s experts.

Over the next few months, I’ll also be asking for your opinions and ideas about what we at HCPro do, and how we can do it better. If you have comments, story suggestions, or requests for healthcare safety-related material, please let me know by emailing wkilburn@hcpro.com or calling 800-650-6787 x3714.

Ask the expert: Training for an electronic MSDS system

By: October 22nd, 2012 Email This Post Print This Post

Q: We use an electronic MSDS access system. Are there any special training requirements we need to know about?

A: The most important training requirement beyond those listed in the standard would be teaching staff members how to use the electronic system to access the required information (how to launch the program, any login requirements (e.g. a password), how to navigate the system to find the desired document, etc.) According to OSHA Hazard Communication standard (29 CFR 1910.1200), MSDSs must be “readily available,” so I wouldn’t be surprised if an OSHA inspector asked one of your staff members to demonstrate the use of the system. Another aspect you’ll need to include is how to get an MSDS in the event of an electronic system failure, such as a power outage. Is there a backup generator to power computers on the system? Is the information available by phone? Are there (current) paper copies of the MSDSs somewhere in the office?

*This is an excerpt from The OSHA Training Handbook for Healthcare Facilities by Sarah E. Alholm, MAS.

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