Archive for: General Safety and Health
Dan Scungio, MT(ASCP), SLS, is a laboratory safety officer for Sentara Healthcare, a multihospital system in the Tidewater region of Virginia and otherwise known as “Dan, the Lab Safety Man.”
Every year I love to use autumn as the time to discuss fire safety. After all, many other organizations promote fire safety ever since October was designated as National Fire Prevention Month in 1922. This year, as always, I do want lab safety professionals to be “fired up” about safety, but there have been some questions about regulations in this area that need special discussion.
The College of American Pathologists (CAP) is the accrediting agency for many labs in the United States, and they have specific regulations about fire safety on their General Checklist.
One regulation states: “If the fire safety plan includes laboratory staff use of fire extinguishers, personnel are instructed in the use of portable fire extinguishers.”
If fire extinguishers are present in your laboratory, their purpose is to be used by the staff in the department, whether or not the safety plan includes staff using them or not. OSHA has something to say about this as well:
“If fire extinguishers are available for employee use, it is the employer’s responsibility to educate employees on the principles and practices of using a fire extinguisher and the hazards associated with fighting small or developing fires.”
The CAP checklist strongly recommends that staff have hands-on fire extinguisher operation that includes the actual use of the device (or a simulator). They do not indicate how often this training should occur. Many labs I have inspected only provide the training once, but OSHA states that it must be provided upon hire and annually thereafter. That makes sense, and lab staff should be ever-ready and able to extinguish a small fire should that become necessary.
Some facilities offer fire extinguisher training as they need to empty out their refillable extinguishers (typically CO2 extinguishers). However, if that does not happen where you are, you have other options. One is to contact your local fire authority. They may happily provide fire extinguisher training for your staff. Another option is to provide the training yourself. You may be able to obtain a test extinguisher or you may simply have to use a full extinguisher without actually discharging it. The important thing is to go through all of the steps of PASS (Pull, Aim, Squeeze, and Sweep) and to let the staff actually handle the fire extinguisher.
If you are providing the training, make sure you give some information about fires that people may not know. Describe the different classes of fires (A, B, and C) and the types of fire extinguishers used to fight them. Remind them not to use more than one extinguisher at a time so they do not blow a small fire onto another person. Tell them to always keep themselves between the fire and the exit. If the fire gets too big or out of control, make sure they leave the firefighting to the professionals.
Inspect your lab for fire risks. Are electrical cords frayed? This is a major cause of fires in the laboratory. Are items stored too close to the ceiling? This may block the action of your sprinkler system. Are ceiling tiles missing or out of place? This disrupts an important fire and smoke barrier. Who performs these inspections? You can, or your local fire authority can as well.
Autumn is a great time to raise fire safety awareness in your laboratory, but this is something that must be done all year. Drill your staff, make sure they know how to react to a real fire. Train them in the use of fire-fighting equipment. Walk your evacuation routes annually. Your staff truly cannot be too prepared.
Have you performed fire drills this year? Have your staff had hands-on fire extinguisher training? If not, it’s a great time to perform these tasks. Many people in history have lost their lives to fires, and laboratory fires are more common than you may think. Be aware, be ready, and ensure your staff remains safe if a fire situation does occur in your workplace.
If you’ve been paying attention to the news, Massachusetts General Hospital (MGH) just got hit with the largest fine ever involving allegations of drug diversion at a hospital. In the settlement, MGH agreed to pay the United States $2.3 million to resolve allegations that lax controls enabled MGH employees to steal controlled substances for personal use. MGH has also agreed to implement a comprehensive corrective action plan to prevent, identify, and address future diversions.
The settlement stems from a 2013 investigation following an MGH disclosure to the Drug Enforcement Administration (DEA) that two of its nurses had stolen large volumes of prescription medications from the hospital. Altogether, the two nurses stole nearly 16,000 pills, mostly oxycodone, an addictive painkiller, from automated dispensing machines that MGH used to store and dispense prescription medications.
Read the rest of the story here.
The settlement drives home the idea that drug diversion is a huge problem in America’s healthcare facilities, and we’d like to help you prevent such problems in your facility.
We’d like to know what precautions your clinic or hospital has in place to monitor and control prescription medication. We are considering producing a book that would help healthcare facilities in their fight against drug thefts.
Please drop me a line at email@example.com with your comments, and a few words about what you would like to see in such a book. What information would help you out in a book about drug diversion prevention?
Have a great day!
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.
Hi folks –
We are compiling a story of the most common safety and security concerns and dangers to hospitals and medical clinics during the summer months.
Please take a minute to share what you think is one of the biggest concerns, why it’s such a big deal, and what you suggest as a way to help mitigate the problem. It could be anything from making sure your employees are hydrated to keeping the doors shut so intruders don’t get in.
Thank you for all your help!
Have a great day.
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!
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
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.
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 firstname.lastname@example.org.
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.
According to the Leapfrog Group, U.S. hospitals are only incremental progress when it comes to dealing with accidents, errors, injuries and infections that hurt or kill their patients.
The national, independent non-profit assigns letter grades to about 2,500 hospitals across the nation, a grade known as the Hospital Safety Score, based on hospital safety data and reviewed by a panel of eight hospital safety professionals.
Maine edged out Massachusetts in the 2013 survey as the state with the safest hospitals, as 80 percent of that state’s hospitals received a grade of “A.” Completing the top five states were Minnesota, Virginia, and Illinois.
Read the entire article:
Many healthcare workers are at risk of being bullied, harassed, demeaned, ignored, or physically assaulted or injured when providing care, making it difficult to provide safe healthcare for patients, according to a new whitepaper from the Lucian Leape Institute at the National Patient Safety Foundation. The paper notes that both emotional and physical harm occur at higher rates in the healthcare workforce than in other industries, and disrespectful treatment of healthcare employees increases the risk of patient injury.
The authors of the report recommend the following strategies to shape safety culture and bring meaning to workers’ daily activities:
- Strategy 1: Develop and embody shared core values of mutual respect and civility; transparency and truth telling; safety of all workers and patients; and alignment and accountability from the boardroom through the front lines.
- Strategy 2: Adopt the explicit aim to eliminate harm to the workforce and to patients.
- Strategy 3: Commit to creating a high-reliability organization (HRO) and demonstrate the discipline to achieve highly reliable performance. This will require creating a learning and improvement system and adopting evidence-based management skills for reliability.
- Strategy 4: Create a learning and improvement system.
- Strategy 5: Establish data capture, database, and performance metrics for accountability and improvement.
- Strategy 6: Recognize and celebrate the work and accomplishments of the workforce, regularly and with high visibility.
- Strategy 7: Support industry-wide research to design and conduct studies that will explore issues and conditions in health care that are harming our workforce and our patients
When was the last time you reviewed your facility’s policies on the proper precautions for using alcohol-based hand rub (ABHR)? An unusual case in Oregon might encourage you to do so. A young girl was injured in a Portland (Ore.) children’s hospital due to an accidental fire caused by ABHR, olive oil and static electricity.
According to the state fire marshal, the patient had undergone an EEG exam and olive oil was used to remove the glue holding the electrodes to the scalp. The patient’s father speculates that the patient put ABHR on her shirt to remove olive oil that had dropped from her hair. When the girl attempted to create static electricity using her bed sheets, a spark ignited the fire.
Although this seems to be a once-in-a-blue-moon kind of case, it’s never a bad idea to review policies about ABHR placement, proper ventilation, and so on, and inform all staff members of potential hazards. ASHE, which reported on the incident, recommends that staff members ensure that ABHRs are used only as intended by patients and visitors.