Archive for: General Safety and Health

CDC study: Excessive noise can contribute to high blood pressure and cholesterol

By: April 3rd, 2018 Email This Post Print This Post

Door alarms, heart monitors, surgical equipment, and Ted Nugent? Yes, Ted Nugent.

As I wrote in this month’s Medical Environment Update newsletter, excessive noise is an issue in the OR, where the eardrums of surgical team members are often bombarded by a bunch of different sources. Believe it or not, that sometimes includes classic rockers like the aforementioned Mr. Nugent, a popular playlist pick among surgeons.

Excessive noise in the OR can affect auditory processing among surgical team members, leading to miscommunication in critical moments and, subsequently, medical mistakes that affect patients plus needlestick injuries and slip-ups with a surgical knife.

I also focused on how it can expose surgical team members to hearing damage, too.

“[The surgical team is] like a construction crew,” Matthew Bush, MD, of the University of Kentucky, told me in a phone conversation. “Perhaps there are some people who have to use jackhammers and there’s other people who are using paintbrushes.” But in any case, that noise can add up, and “we need to be very conscious of that.”

Another thing to be wary of, according to a recent CDC study published in the American Journal of Industrial Medicine, is high blood pressure and high cholesterol.

“A significant percentage of the workers we studied have hearing difficulty, high blood pressure, and high cholesterol that could be attributed to noise at work,” Liz Masterson, MD, one of the study’s authors, said in a CDC press release. “This study provides further evidence of an association of occupational noise exposure with high blood pressure and high cholesterol, and the potential to prevent these conditions if noise is reduced.”

While the healthcare was not mentioned in that press release as an industry “with the highest prevalence of occupational noise exposure,” OR staff members often must work through loud bursts of noise that occur throughout many surgeries.

This is a concern that Lisa Spruce of the Association of periOperative Registered Nurses brought up during our recent chat about excessive noise, saying it “has been linked to impaired sleep, increased stress, physical discomfort, increase in blood pressure, heart rate, and breathing. And that all just has an effect on a person’s well-being.”

Spruce says some healthcare facilities have noise-related policies. And if yours doesn’t, she recommends forming an interdisciplinary team to evaluate noise in facilities and by individual types of surgery, and then determining what actions you can take to decrease noise levels, including exploring quieter alternatives for surgical equipment.

“I think we’re bringing more attention to [noise] as a problem where we haven’t in the past,” she said. “So, I think we are going to see more and more hospitals having policies and looking at it from a patient safety, and also a staff safety standpoint.”

Joint Commission shares 2017 standards compliance data for healthcare facilities

By: March 27th, 2018 Email This Post Print This Post

The Joint Commission (TJC) has released its lists, each based on the type of facility surveyed, of the requirements most frequently scored as “not compliant” during accreditation surveys and certification reviews during the 2017 calendar year.

The list of requirements scored as “not compliant” during 1,443 hospital surveys:

  1. LS.02.01.35: Systems for extinguishing fires are provided and its systems/devices are appropriately installed and maintained. (86%)
  2. EC.02.05.01: Utility systems are well designed, inventoried, monitored, and managed according to written procedures when disruptions in the utility system occur. (73%)
  3. LS.02.01.30: Building features are maintained which prevent the spread and fueling of fire and smoke. (72%)
  4. IC.02.02.01: Infection prevention and control activities are performed relative to the cleaning, storing, and disposing of medical equipment/devices. (72%)
  5. EC.02.06.01: Physical environment (e.g., lighting, temperature, ventilation, equipment, furnishings, space, etc.) is safe and functional. (70%)
  6. LS.02.01.10: Effects of fire, smoke, and heat are mitigated through the design and maintenance of building and fire protection features. (66%)
  7. EC.02.02.01: Risks related to hazardous materials and hazardous waste are managed as described in written policy. (63%)
  8. LS.02.01.20: Means of egress are maintained. (62%)
  9. EC.02.05.05: Testing and regular inspections of utilities are done. (62%)
  10. EC.02.05.09: Medical gas and vacuum systems are labeled, tested, inspected, and maintained. (59%)

The list of requirements scored as “not compliant” during 104 surveys of office-based surgery practices:

  1. IC.02.02.01: Infection prevention and control activities are performed relative to the cleaning, storing, and disposing of medical equipment/devices. (63%)
  2. HR.02.01.03: Individuals permitted by law and the organization to practice independently are granted by the practice initial, renewed, or updated clinical privileges. (61%)
  3. EC.02.04.03: Testing and regular inspections of medical equipment are done. (37%)
  4. MM.03.01.01: The hospital’s medications are stored in a manner which maintains their integrity, minimizes their diversion, reduces dispensing error, and promotes availability while following manufacturer guidelines, laws, and regulations. (34%)
  5. IC.02.01.01: Implementation of the written infection surveillance, prevention, and control plan is implemented by the hospital. (27%)
  6. NPSG.03.04.01: Medications, medication containers, and other solutions removed from their original container and placed into a container, both on and off the sterile field, are labeled as consistent with safe medication practices. (24%)
  7. HR.01.06.01: The organization has a competency assessment process in place. (23%)
  8. EC.02.05.07: Emergency power systems are tested, inspected, and maintained as required by the Life Safety Code®. (22%)
  9. WT.04.01.01: Quality control checks are performed as defined in the quality control plan for waived testing. (20%)
  10. MM.01.01.03: High-alert and hazardous medications defined by the hospital are safely managed. (18%)

Study: Antibiotic-resistant infections cost U.S. hospitals $2.2 billion annually

By: March 26th, 2018 Email This Post Print This Post

Editor’s note: A version of this blog post first appeared on the website for BLR’s Patient Safety & Quality Healthcare magazine.

A new study found that in addition to being a deadly killer of patients, and in some cases afflicting healthcare workers, antibiotic-resistant infections cost U.S. hospitals more than $2 billion each year. The study was conducted by researchers from Emory University and Saint Louis University and published in Health Affairs last week.

The researchers cite a Centers for Disease Control and Prevention estimate that antibiotic-resistant infections kill 23,000 Americans annually. The study used data from the Medical Expenditure Panel Survey to estimate incremental healthcare costs of treating these infections, which the researchers say is the first national estimate of the price tag for this treatment.

The study found that antibiotic resistance adds $1,383 to the cost of treating a patient with a bacterial infection. Taking the estimated number of these infections in 2014, the researchers say the national cost of treatment is $2.2 billion annually.

The findings point to “the need for innovative new infection prevention programs, antibiotics, and vaccines to prevent and treat antibiotic-resistant infections,” the researchers wrote.

New IAHSS guideline aims to help healthcare facilities respond to workplace violence

By: March 20th, 2018 Email This Post Print This Post

Looking to reduce the likelihood of workplace violence in healthcare, the International Association for Healthcare Security & Safety Foundation (IAHSS) released a new Threat Management guideline earlier this month stating that “healthcare facilities should establish a process and multidisciplinary team to identify, assess, validate, mitigate, and respond to threats of violence or other behaviors of concern.”

The multidisciplinary threat management team should, says IAHSS, identify threats and determine their seriousness and severity. Additionally, IAHSS recommends the team develop intervention plans that protect potential victims and address problems that precipitate threats, document the threat assessment process with privacy and confidentiality in mind, and conduct a review after addressing each threat.

The IAHSS guideline suggests the development of a threat management program “that is informed by data and research in this area.” To do so, IAHSS says that healthcare facilities should designate individuals who are responsible for, amongst other things, educating staff and promoting the reporting of threats; assessing all reports of concerning behavior; implementing timely response plans; and advocating for victims and offering support and counseling if needed.

IAHSS says all healthcare staff should get education —  based on their job function and potential risk — about identifying concerning behavior, reporting protocols, activating an emergency response, and documenting threats and incidents.

The new Threat Management guideline was initially developed by the IAHSS Council on Guidelines and incorporated feedback from IAHSS membership, the Emergency Nurses Association, and the American Hospital Association, according to a press release announcing the guideline.

“Implementing the intent of this guideline will be one of the least expensive and effective steps an organization can take to reduce the likelihood of violence,” Tom Smith, chair of the IAHSS Council on Guidelines, said in a statement. “The Threat Management Guideline establishes a framework for healthcare organizations to proactively identify and manage threats of violence. Input from our colleagues at the AHA and ENA helped us enhance the quality and value of the final product.”

The issuing of the guideline comes several months after a report by IAHSS, entitled “Mitigating the Risk of Workplace Violence in Health Care Settings,” encouraged healthcare facilities to take immediate steps to mitigate violent incidents.

Make us even better with your feedback… and maybe win $50 off any HCPro product

By: March 6th, 2018 Email This Post Print This Post

Feedback from safety professionals is essential to us at HCPro as we strive to develop products that help healthcare organizations like yours stay up to date and in compliance, keeping your workers safe. Please take just a few minutes to share your thoughts with us regarding ongoing and new challenges faced by you and your safety colleagues in 2018.

In gratitude for your participation in our survey, you have a chance to win $50 off any product in the HCPro Marketplace. Simply click on the link below to begin the survey. If the click-through does not work, please cut and paste the URL below into the address bar of your browser.

Here’s the link to the survey: https://www.surveymonkey.com/r/2J6FVNC

All your answers are confidential and anonymous. If you have questions related to this survey, please contact me at mvensel@hcpro.com. The deadline to fill out the survey is March 30, 2018.

TJC: Unintended retention of foreign body, falls most common sentinel events in 2017

By: March 1st, 2018 Email This Post Print This Post

The Joint Commission (TJC) on Wednesday released an updated list of its sentinel event statistics for 2017, and you’ll find some familiar medical miscues at the top.

TJC reviewed 805 reports of sentinel events, which it defines as unexpected events that result in death or serious physical or psychological harm to patients. That’s down slightly from a year ago, when they decreased from 934 in 2015 to 824.

The most frequently reported sentinel event was again the unintended retention of a foreign body (116), edging out falls (114). Rounding out the five most common were wrong patient, site, or procedure (95), suicide (89), or delay in treatment (66).

To view the latest sentinel event info, here’s a link to TJC’s quarterly reports.

New HHS fact sheet gives guidance for handling long-term patient surge

By: February 27th, 2018 Email This Post Print This Post

One of the deadliest flu seasons in recent memory has prompted the Department of Health & Human Services (HHS) to release a fact sheet that gives guidance on handling an influx of patients flocking to healthcare facilities for treatment of the flu and other seasonal illnesses.

While the latest briefing from the CDC suggests that this flu season has peaked, the fact sheet provides useful information healthcare facility emergency planners should consider when developing plans to deal with a similar surge of sick patients in the future. Note that this fact sheet states “these considerations are different than those of planning to handle surge from a no-notice, short duration event” like the recent mass shootings in Orlando, Las Vegas, and Parkland, Florida.

The HHS fact sheet states that “all hospitals must have an emergency operations plan” to deal with a long-term surge. Among the strategies it recommends are expanding normal clinic hours to limit the number of clinic patients coming to the ED, rescheduling elective procedures to free up beds, and setting up “surge sites” such as tents or mobile units located next to the ED.

It also recommends preventive steps that could minimize the surge during a severe flu season, including the use of telehealth, telephone prescribing, virtual information, community paramedicine programs, and risk communications and creating media campaigns encouraging vaccinations, handwashing, and other infection control practices.

The HHS fact sheet states that “there is little an individual hospital or health system can do to prevent patient surge from seasonal illness, but a region or healthcare coalition, in partnership with public health, can use coordinated strategies to help provide situational awareness to support patient surge management throughout the community.”

To download the fact sheet from the HHS website, click right here.

Our expert answers a couple of reader questions related to waste disposal

By: February 19th, 2018 Email This Post Print This Post

When you’ve got healthcare safety or standards questions, we’ve got answers. More specifically, we’ve got a stable of industry experts who are only an email away and are willing and able to give you the guidance you are seeking.

This time, we turned to Dan Scungio, MT(ASCP), SLS, the laboratory safety officer for Sentara Healthcare in Virginia, to answer a pair of waste disposal questions recently posed by our readers. Scungio, aka “Dan, the Lab Safety Man,” writes a monthly column for our monthly Medical Environment Update newsletter.

Question No. 1, from a blog commenter named Sarah Winters: “I am the nursing supervisor for a school district. At the end of every year, the nurses at the schools close and seal their full sharps boxes and transport them in their vehicles to [our] central office, where I then take them to EMS for disposal. A safety/health inspector has told us this is unsafe and violates the OSHA standard. I cannot find how that violates any OSHA regulation. Suggestions? Resources? Thanks.”

Answer from Dan, the Lab Safety Man: “OSHA does not directly regulate the transport of hazardous waste, but the U.S. Department of Transportation does. The DOT states that if you are not in the business of transporting hazardous materials, the process of sharps transport for the schools falls under the DOT’s Materials of Trade exemption. That means it is acceptable to transport used sharps in your private vehicle provided they are packaged in containers constructed of a rigid material that is resistant to punctures and securely closed to prevent leaks. That said, individual state regulations may supersede federal DOT rules, so it is important to know what the transport laws are in your specific state.”

Question No. 2, submitted anonymously via email: “Can we dispose of irrigation fluid from the anterior chamber of the eye in the regular garbage if not visibly contaminated with blood and is self-contained in a sealed bag?”

Answer from Dan, the Lab Safety Man: “Eye irrigation fluid may not be considered an infectious waste if it does not contain blood, but it is probably not a good idea to place it into the regular (non-hazardous) waste stream. It is important to consider those who handle the trash after it leaves your site. If there is breakage of a sealed container or bag that creates an exposure, that would create a scenario that will raise questions for the person exposed and a situation that should be avoided.”

Got a question you’d like answered? Shoot us a note at mvensel@hcpro.com.

How would Trump’s proposed 2019 budget affect OSHA? Barab weighs in

By: February 15th, 2018 Email This Post Print This Post

Jordan Barab, the former OSHA official under Barack Obama who still champions worker safety on his personal blog, has gone through the 2019 budget proposal that the Trump Administration unveiled earlier this week, the one that aims to slash by $18 billion the budget for the Department of Health and Human Services.

While OSHA’s overall budget is not among the ones President Trump is proposing to cut, Barab is still concerned, writing that, like last year, Trump “once again proposes to slash or eliminate important safety and health programs and agencies.”

Per Barab, if approved, the 2019 budget proposal would eliminate the Susan Harwood Training Grant Program and the Chemical Safety Board. However, given how Congress reacted to proposed cuts of those programs last time around — as Barab put it, they “had about as much lift as a Butterball Turkey when the administration floated these ideas” in his 2018 budget — he isn’t too worried it will actually happen.

“There’s a saying that there’s no education from the second kick of a mule. With a little lobbying and common sense, we can only hope that the Trump administration will get to witness that phenomenon” with these proposed cuts, Barab wrote.

Additionally, the 2019 budget proposal looks to eliminate two advisory committees dealing with whistleblower protections and federal employee safety and health, Barab wrote. They would be the Federal Advisory Council on Occupational Safety and Health and the Whistleblower Protections Advisory Committee.

As far as OSHA’s overall budget is concerned, Barab said it would, if approved, remain “mostly level,” with a $5.1 million increase from 2017 in enforcement and a $3 million increase in compliance assistance, mostly, Barab wrote, “to add Compliance Assistance Specialists who had been cut in previous years due to budget limitations” plus “eight staff to work exclusively on the Voluntary Protection Programs.”

OSHA, in its budget justification, says it has set a goal of 30,840 inspections for 2019, which is 5% less than the 2017 fiscal year, the most recent data available.

OSHA says it plans to focus on “the highest-impact and most complex inspections at the highest-risk workplaces.” One would think that list includes healthcare facilities. But in a recent article of our Medical Environment Update newsletter, Barab and industry safety experts expressed concern about how the loss of dozens of OSHA inspectors under Trump might affect healthcare workers.

We’ll circle back on this in greater detail, with original reporting on how it could affect you, in the event these cuts actually get pushed through this fall.

Group sues Trump administration, OSHA for failing to share 300A summary reports

By: February 14th, 2018 Email This Post Print This Post

One advocacy group is suing the Trump administration, claiming the Department of Labor (DOL) and OSHA are illegally withholding records about workplace injuries and illnesses, our colleagues over at OSHA Compliance Advisor wrote this week.

In each of the final three months of 2017, advocacy group Public Citizen submitted Freedom of Information Act (FOIA) requests for records submitted by employers under OSHA’s electronic injury and illness recordkeeping rule. The group says it intended to use the info to conduct research on job safety and health. Public Citizen claims its October and November requests were inappropriately denied.

That recordkeeping rule, finalized in May 2016, required employers with 250 or more employees and employers in some high-risk industries that have 20 or more workers to electronically submit their 2016 300A summary report to OSHA by December 31, 2017. OSHA was then supposed to make the data public to encourage employers to prevent injuries and illnesses and to advance research into workplace safety.

OSHA issued a response explaining why Public Citizen’s FOIA request was denied.

That response, via our colleagues writing for OSHA Compliance Advisor: “As stated in the preamble to the Improve Tracking of Workplace Injuries and Illnesses final rule (see 81 FR 29624), OSHA plans to use the establishment-specific data for enforcement targeting purposes. Disclosure of the data before and while it is being used to select establishments for inspection would in turn disclose OSHA’s techniques for law enforcement investigations. Thus, OSHA has determined the data submitted under the electronic reporting requirements are exempt from disclosure while they are being used for enforcement targeting purposes.”

Public Citizen appealed, arguing that the records are not exempt from FOIA because they were not compiled for law enforcement purposes, and that OSHA in its final rule in 2016 stated that it would publicly disclose these records to encourage workplace safety. The advocacy organization’s suit asks the court to find that failure to provide the records is unlawful and to order the DOL and OSHA to provide them.

Trump’s proposed budget would slash HHS

By: February 12th, 2018 Email This Post Print This Post

The budget for the 2019 fiscal year proposed today by the Trump Administration would slash by $18 billion the budget for the Department of Health and Human Services (HHS). If approved, that represents a 21% decrease from its 2017 budget.

According to The Hill, all but three HHS agencies are subject to budget cuts, the exceptions being the National Institutes of Health, the FDA, and the Indian Health Service. (Those three would receive modest bumps to their budgets in 2019.)

Per The Hill, CDC faces a $1 billion budget cut, the Substance Abuse and Mental Health Services Administration funding would decrease by $688 million, and the Administration for Children and Families would lose $4 billion — about 1/5 of its budget.

Furthermore, President Trump’s budget proposes cutting $1.7 trillion in funding for HHS programs, including Medicare, over the next decade, per USA Today, which said Trump also encouraged Congress (again) to repeal the Affordable Care Act.

“The president’s budget makes investments and reforms that are vital to making our Health and Human Services programs work for Americans and to sustaining them for future generations,” said new HHS Secretary Alex Azar, slated to testify about the budget in front of three congressional committees this week, in a statement.

Pentax duodenoscopes voluntarily recalled for design and labeling updates

By: February 7th, 2018 Email This Post Print This Post

The FDA announced today that it has cleared the updated design and labeling for Pentax ED-3490TK duodenoscopes and that the scopes will be recalled so the manufacturer can make design changes meant to reduce leakage of patient fluids — thus limiting the spread of infection — and update product operations manuals.

In 2015, the FDA issued a safety warning against Pentax and two other duodenoscope companies. The warning stated that a design flaw prevented the scopes, which are designed to be used on multiple patients, from being cleaned properly, creating an infection risk. Duodenoscopes are flexible, lighted tubes that threaded through the mouth, throat and stomach into the top of the small intestine (duodenum).

A subsequent Senate investigation revealed that dirty scopes were the direct cause of 25 infection outbreaks, sickening dozens of patients and leading to the death to at least 21 people. The FDA bore some of the blame for deciding to not alert the public to the threat until after its 17-month investigation into the matter.

After the manufacturers revised their reprocessing instructions, the FDA in 2016 deemed the duodenoscopes safe for healthcare facilities to use again.

The FDA stated in today’s news release that since then it has been working with the manufacturers to “modify and validate their reprocessing instructions to further enhance the safety margin of their devices,” and “show with a high degree of assurance that their reprocessing instructions, when followed correctly, effectively clean and disinfect the duodenoscopes.”

Specifically, the FDA asked that Pentax reduce the potential for leakage of patient fluids into ED-3490TK’s closed elevator channel and under the distal cap.

Now that Pentax has done this, the FDA recommends that facilities acknowledge their Urgent Medical Device Correction and Removal notification disclaimer icon and identify affected products, return the field correction response form, and indicate if they do not have any affected duodenoscopes or operations manuals, and remove and dispose of older operations manuals once the new ones are received.

For more information on today’s news, check out the FDA’s official release here.

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