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I had the pleasure yesterday of spending a day at the 2015 annual conference of the American College of Emergency Physicians (ACEP), which is being held here in my beautiful hometown of Boston.
Being in the safety business, I sat in on a session about active shooter response preparation in healthcare facilities, led by an emergency physician and security director with Carolinas Medical Center in Charlotte. I didn’t leave with that feeling like we have our collective act together.
Are we really ready for someone to come into our hospitals with a gun, bent on causing mass carnage?
First, let’s start with the numbers. From 2000-2007, there were “only” about 6 shootings a year. From 2007 to today, the numbers jumped to 17 per year.
Many facilities are following the government’s recommendations to “run, hide, and fight” when confronted with a gunman. That’s fine training, if you’re in an office building. Run first, hide when you can, and fight back as a last resort.
But that won’t fly in hospitals and clinics where people are counting on you to help them survive. Poll numbers I heard quoted estimate that at least 40% of healthcare staff wouldn’t leave their patients’ sides, even when confronted with a shooter.
Hospitals need to train their staff to stay alive. Most active shooter incidents end within 7 minutes, and doctors and nurses are then required to turn around and treat the wounded and prevent as much death as possible.
So my question is this: What are you doing to prepare for an active shooter in your facility? Do you have specific plans? Are you training your staff, and what resources are you using?
Please drop me a line at firstname.lastname@example.org and share your thoughts on this very real threat.
As part of our celebration of you, the safety professional, we asked readers to let us know what the greatest challenge was in their job as a safety professional, or to share funny or insightful stories about their best or worst day on the job. We got some interesting replies; read about some of them here.
Can’t a girl just get a straight answer?
“I was asked a question regarding outdates of absorbents on the shelf. Since they are seldom used, the containers last for years. Being a diligent safety officer, I know an answer is somewhere to be found. I saw the phone number of the manufacturing company, called it and was mystified by the message. I must have copied the number incorrectly, so I rechecked and redialed with the same message appearing. (It was referencing to another 800 number for a ‘WILD DATE NIGHT’).
I certainly couldn’t let it go at that, so continued my saga of the outdate mystery. I discovered this product was being sold and distributed by a different company, and was marketed as a disinfectant. Since it was an absorbent/deodorant and not a disinfectant, the company was sued $277,953 by the EPA and had to perform two environmental projects costing at least $107,000. The company had to distribute its remaining inventory and is no longer producing more of it. I called that company and found out ‘there is no outdate, just use it ‘til it’s gone.’
I never called the hot date line!”
– Linda Gylland, MLS (ASCP) QLS, lab safety officer for Sanford Health in Fargo, North Dakota.
A leg up on waste removal
“We are one of the remaining few hospitals in the southeast that still has an autoclave, shredder, and trash compactor on site for our bio-hazardous trash. We were in the process of feeding all of the biohazard waste over to a national company and halted the process when the Ebola outbreak was occurring.
Several years ago, we had another contracted company with environmental services. They conducted most of their education classes by video. So, you really did not know what the new employee got out of the education. We had hired several new guys to run the trash line. I guess they never really imagined ALL the types of things we put in the trash at a hospital.
One of the big, burly guys was working real hard to empty his cart from the first floor soiled utility closet. This closet was the drop-off for surgery and the delivery suites. He was throwing bag after bag into the shredder. He had overloaded it and the machine pulled the bags through but it kicked out a LEG.
The guy had no idea where or what that was about. He screamed all the way from the dock area, through the tunnel to the hospital, through the connection hall, to the EVS (environmental services) office.
‘A leg, a leg, a leg!’ is all he could say over and over. He thought somebody was trying to hide a body in the garbage. He had no idea what was in the trash of a hospital. It took several people to explain it to him but everybody was laughing because he was so scared.”
-Andrea Laird RN, MSN, CIC, infection preventionist practitioner for a 260-bed rural hospital in the southeast U.S.
A colorful, tasty way to celebrate safety
“Our safety committee has gone through some significant changes to become a robust, and more proactive committee. When I took over as the chair, the committee was primarily focusing only upon employee safety concerns as related to (worker’s compensation).
We now encompass three major areas of safety: patient, environmental, and employee. We have built a dashboard and set up a schedule of presentations each month to report, discuss and intervene as appropriate. We are reviewing and approving all organizational policies that relate to safety issues.
For this year’s Safety Week, the committee undertook a complete revision of our Emergency Code book, and we redid our eight emergency codes instruction sheets implementing situation action sheets (SAS) for each code, for each shift, and for our off-site offices as well as our campus entities.
Our committee members took the training out to each and every department of the organization (on and off campus), teaching to different codes each day of the week.
We involved sponsors, and were able to “reward” our attendees with a Lindt truffle wrapped in the color wrapper of each color code instructed each day. (i.e. blue wrapped truffles for ‘Code Blue,’ black for ‘Code Black,’ orange for ‘Code Orange,’ red for ‘Code Red,’ etc.)
It was a huge hit!
Employees were seeking us out when they missed a training, and are still talking about this year’s Safety Week.
We will have to find something extraordinary to do for next year’s Safety Week after the very positive response this year.”
– Nancy T. Wiggin, RN, M.Ed., C.P.P.S., NHA, Huggins Hospital, Wolfeboro, New Hampshire
Endoscopes and other diagnostic GI scopes are crucial devices that can save the lives of the nearly 500,000 patients every year who need the procedures they were designed for.
But if they aren’t properly cleaned and disinfected afterwards, the instruments can expose future patients to antibiotic-resistant diseases such as carbapenem-resistant Enterobacteriaceae, or CRE, that can kill up to 50% of infected patients, according to some experts.
You’ve heard the horror stories from hospitals who have dealt with recent outbreaks—don’t let your facility be the next statistic. Let infection control experts Peggy Prinz Luebbert, MS, (MT)ASCP, CIC, CHSP, CBSPD, and Terry Micheels, MSN, RN, CIC, show you everything your organization needs to know to ensure proper GI scope disinfection and protect the lives of your patients.
Register for “Proper GI Scope Disinfection: How to Avoid Becoming a Statistic,” a 90-minute webcast that will cover the critical steps of high-level disinfection that must be met each and every day. Don’t miss out on this opportunity to ensure your organization complies with requirements set by The Joint Commission and CMS.
For more information or to register, check out the HCPro Marketplace.
The National Safety Council, a safety advocate group that promotes safety in homes, workplaces, and communities across the country, has designated the month of June as National Safety Month. Specifically, the group has dedicated the month to several safety subjects, including emergency planning, preventing slips, trips, and falls, and ergonomics, We’re celebrating safety month by offering lots of free giveaways, raffles, and discounts on all your favorite safety products. Win a $100 gift certificate good for any product on the HCPro Marketplace by answering the following five trivia questions correctly.
Send your responses to Managing Editor John Palmer at email@example.com by June 19th. Winners will be chosen randomly from the responses received. Don’t forget to send along contact information so we can reach you if you are a winner.
- Under OSHA’s new workplace injury reporting requirements, what must be reported? List three ways that you can report workplace injuries and deaths to OSHA.
- According to OSHA, there are four ways that healthcare facilities pay the price when an employee gets hurt on the job. Name 3 of them.
- Name eight of the 16 GHS physical hazards, according to OSHA.
- Name three of the five healthcare settings that OSHA says is required to adhere to OSHA Rule 3148, which governs the need for a workplace violence prevention plan.
- According to OSHA, how many inspectors are available nationwide to complete worksite inspections?
Also don’t forget to use discount code SAF2015 to receive a 10% discount on any safety, accreditation or patient safety book!
Hi folks –
Boy, it’s fun to watch how sneaky OSHA can be. If you’ve been paying attention, you know that the agency has quietly passed changes to a few pretty important rules in the healthcare industry.
First, there was an upgrade to the Workplace Violence Prevention rule (3148), which basically is a rule that requires employers to have a plan in place. There was also a very well-done manual that went with it to help you out.
Then, in May, OSHA and NIOSH teamed up to provide a Respiratory Protection Toolkit for employers, which essentially is a warning that if you don’t already use respirators to help protect your workers against infections, you better start. And here’s the handy toolkit published to help you out:
I don’t doubt that these are great things. We all want a safer work environment. But what’s going on here? Well, in the opinion of one lawyer who I read in an online blog:
“The bottom line is that OSHA is coming. Accordingly, employers in the health care industry should act now to ensure that their employees are working in the safest possible conditions and that, when OSHA appears at their door, they can demonstrate their commitment to employee health and safety.”
Interestingly, the Joint Commission is taking note of these changes, and has issued their own recommendations right about the same time that OSHA is doing so.
I’d like to know what you think. Is OSHA about to get tough on the healthcare industry? Good luck getting them to say so.
The feeling out there is that OSHA doesn’t have enough inspectors, so they probably won’t inspect. Will that change? And will you do anything different in your job because of it?
Please drop me a line and let me know your opinions.
We’ve been telling you for some time now that you need to get a workplace violence prevention plan in place in your facility, and now it’s time for us to help you get started.
If you’re looking for a place to start, we have lots of downloadable tools and resources for you to use in your own facility. For instance, try the workplace violence assessment checklist as a place to start to determine the weak spots in your facility’s security. Next, give our safety tips poster to your employees during your next in-service training meeting.
According to Bureau of Labor Statistics, 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.
As a result, OSHA issued the update to OSHA 3148 in April, encouraging healthcare workplaces to develop a workplace violence prevention plan. It’s not so much an “encouragement” as it is a warning that inspectors will be checking to make sure you have a plan in place.
We’re here to help you do your job better and safer. Look to HCPro for all of your healthcare safety and security resources!
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.