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If you are a clinic attached to a hospital system, my money is that you already have a pretty solid smoking policy in place. For one, it’s unhealthy and encouraging your visitors and staff to kick the habit sets a good example for everyone. Plus, it’s a fire hazard: many despite the strictest of rules, many patients are still injured or killed every year because someone had to sneak a smoke.
But like enforcing any rule, no-smoking policies are not always easy to monitor as there will always be someone who tries to skirt the rules. Well, get ready, because it looks you’ll be breaking out the rule book again to revise your smoking policies.
The Joint Commission, in an article published in the February 11 edition of its monthly Joint Commission Online newsletter, issued a recommendation that hospitals review their smoking policies to make sure the rules are clear that they include electronic cigarettes as well as traditional tobacco cigarettes.
The changes being recommended are based on the Joint Commission’s Environment of Care (EC) standard EC.02.01.03, which says that hospitals shouldn’t allow smoking on facility grounds, while allowing certain exceptions for smoking in specific circumstances. In other words, you should be doing the best you can to encourage people not to smoke, but most facilities still set aside separate rooms away from treatment areas—an outside visitor’s lounge, for example—to allow for those who need to find a place to smoke.
Smokers—like anyone with a vice—will always find ways to get around the rules. The Joint Commission’s recommendation comes on the heels of a recent CDC ad campaign warning that the use of electronic cigarettes are no safer than regular cigarettes, and that adolescents who “vape” are more likely to try to the real thing. In fact, the latest CDC claims show that teen use of e-cigarettes has tripled in just one year, despite a general decline in smoking.
The devices work by using a small battery to send an electric current to atomizer, which then vaporizes a liquid nicotine solution to be inhaled by the user. Although considered safer than regular cigarettes, there have been a small number of cases in which the devices have exploded because the batteries were overcharged or put in wrong.
Banning smoking altogether from hospital grounds has historically been a difficult thing to do. It’s hard to tell people what to do, especially those who are addicted to nicotine, and a hospital can be a stressful place. Smokers may need to find a place where they can find solace in an occasional smoke.
If you are looking to make your hospital smoke-free, the Joint Commission published a 28-page booklet, Keeping Your Hospital Property Smoke-Free: Successful Strategies for Effective Policy Enforcement and Maintenance that could be helpful—and may help you follow their recommendations that could look good during the next survey. Among other recommendations, TJC suggests:
- Make your non-smoking campaign more about general wellness, as opposed to another strict rule
- Get the support of all your leaders
- Allow for a phase-in of the rule; it won’t happen overnight
- Let smokers have a say in how the policy is implemented
- Make sure you have your wording straight. Do you want to have a “smoke-free” hospital, or a “tobacco-free” hospital?
- Monitor areas that could become places where visitors and employees might “sneak” a smoke. Alleyways, parking lots, and hidden areas should be kept clean and clear of butts and other debris to send the message that smoking is not allowed without being confrontational.
At the end of the day, you will have to decide as an institution whether smoking will be allowed your facility’s grounds, but as far as the Joint Commission is concerned, the better a job you can do to keep a non-smoking environment, the better you will look at survey time.
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
Q: We are based in Colorado. Do our red bins for biohazard waste need to be locked in a closet or if it is OK to keep them behind a closed door that is not necessarily locked?
A: There is no specific OSHA regulation that requires medical waste to be locked in a closet, and in looking at the Colorado state public health regulations, it appears that there is no specific requirement to keep medical waste in a locked closet on that count either. If there is a relationship with a local hospital, it may be worth checking with them to see if there is a specific requirement (if there is one anywhere, it would be in the state regulations as there are none at the national/federal level), but it looks like a closed door will suffice.
Now, I will complicate things just a little bit by saying that if you have clinic settings that provide care and services to at risk populations like pediatric and/or behavioral health patients, then you might be better off locking the closet to ensure their safety. It’s definitely a judgment call, but there are certainly instances in which erring on the side of caution is more than appropriate.
Steve MacArthur is a safety consultant for The Greeley Company, a division of HCPro. He brings 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro’s Hospital Safety Director’s Handbook and is contributing editor for Briefings on Hospital Safety.
An investigation by the Colorado Department of Public Health and Environment indicates that as many as 8,000 dental patients may have been exposed to bloodborne pathogens from unsafe injection practices.
Do how staff members dress in summertime create worker safety or patient safety problems. Take the OSHA Healthcare Advisor Weekly Poll and let us know.
Kaiser’s South Bay Medical Center will pay $73,615.40 in fines for unlawful disposal of medical waste.
Move over hepatitis B, C, and HIV, and make room for MRSA infections as a consequence of unsafe injection practices.
A July 16 post on the CDC Safe Healthcare blog by Dr. Michael Bell, associate director for infection control at the Division of Healthcare Quality Promotion, discusses two recent outbreaks in Arizona and Delaware where the use of medication from single-dose/single-use vials for multiple patients resulted in “staph/MRSA infections in at least 10 patients receiving injections for pain relief.”
A jury found against a hospital and awarded $4.7 million in damages in a patient wrongful death suit. The reason, nurses were found negligent in following the hospital’s latex-allergy policy and protocol, according to Outpatient Surgery, July 12. Patients, however, are not the only persons at risk to latex allergies in healthcare settings.
According to OSHA, 8-12% of healthcare workers are latex sensitive, and between 1988 and 1992 there were 1,000 reports of adverse health effects from exposure to latex, including 15 deaths due to such exposure.
In your facility, do you educate healthcare workers and provide them with training materials about latex allergies?
Take the OSHA Healthcare Advisor Weekly Poll and let us know. Also a free Worker Latex Exposure Safety Checklist is available for downloading on the Tools page.
Concerns voiced by staff at an oncology clinic can help protect your workers, who may also handle hazardous drugs.
NIOSH posted a new Health Hazard Report prompted by a request from a Florida oncology clinic where staff members complained about upper respiratory irritation, headache, fainting, diarrhea, and loss of appetite.
For the settings in your healthcare organization that are at low risk for TB exposure, do you follow CDC guidelines and not do annually tuberculin skin tests (TSTs) on staff and volunteers?
Take the OSHA Healthcare Advisor Weekly Poll and let us know.
The Advisory Committee on Immunization Practices (ACIP) recommends that healthcare workers “with reasonably anticipated risk for exposures to blood or infectious body fluids receive the complete Hepatitis B vaccine series and have their immunity documented through postvaccination testing.” OSHA Healthcare Advisor asked its readers what percentage of their workers met ACIP recommendations? Here are the results:
Checking the political pulse of OSHA Healthcare Advisor Readers, are you pleased with the decision of the U.S Supreme Court to uphold the constitutionality of the Affordable Care Act, or in the parlance of our time, Obamacare.
Take the OSHA Healthcare Advisor Weekly Poll and let us know.