Archive for: Notes from the field
Not many things really leave me speechless. This situation did just that. I will start by saying this was a space the practice was using for 9-12 months while new office space was being built.
I had completed the facility safety part of my mock OSHA Inspection and was ready to ask questions about cleaning and disinfecting instruments.
I was told the office performed pap smears and some minor surgical procedures. I also knew they did some waived lab testing in the practice.
Usually the instrument disinfecting is done in the lab, so I asked the medical assistant to take me to that area. As we walked down the hall, it looked to me like we were headed to a door that was clearly marked “Restroom.”
When I perform my mock OSHA Inspections, I always ask the practice about their sterilization and disinfecting procedures. Recently I was walking down the hall in an office and I saw a staff member wiping some type of tube or wire down with a cloth.
Let’s just say, I was more than curious about what I had just witnessed. At that point, I hadn’t questioned the staff on what instruments and equipment they were using in the office.
The tubing was actually a laryngoscope that had just been used for a procedure. When I questioned the medical assistant, she told me she was disinfecting the instrument with the disinfecting cloth.
Keep in mind, these cloths are specifically manufactured to be used as a surface disinfectant, such as for a counter top.
She told me that was how she had been instructed to disinfect the laryngoscope.
I asked her what her next step would be and she replied she would rinse the scope with soap and water and dry before the next use.
My next question was: Had she read the manufacturer’s instructions on how to properly disinfect this instrument?
She replied, “No.”
ALWAYS READ THE INSTRUCTIONS!
I invited the medical assistant to sit down and chat with me. First of all, this scope is classified as semi-critical and should be disinfected with a high level disinfectant such as glutaraldehyde or a peroxide-based solution, I explained.
The first step in the process is to clean the scope to remove all visible debris. The scope is manually cleaned with low foaming enzymatic cleaner. Next, thoroughly rinse the scope and let air dry before placing in the high level disinfectant.
Never use disinfectant impregnated wipes as the sole means of decontamination.
The majority of laryngoscope blades are disposable. If they are reusable, follow the manufacturer’s instructions to either autoclave or use a high level disinfectant. And remember, the scope handles are considered contaminated, and must be properly cleaned between patients.
Keep in mind, the CDC has recently issued strict and specific guidelines for infection prevention in outpatient settings. Proper handling and disinfecting of instruments between patients is imperative.
See the High-Level Disinfection of Reusable Instruments and Devices section of the CDC Infection Prevention Checklist for Outpatient Settings: Minimum Expectations for Safe Care. It’s a good source.
In the past few months, I have been in eight physician offices that are still using non-safety needles, lancets, or scalpels. I have heard every excuse in the book for not switching to safety devices.
I am totally shocked that one medical assistant (MA) had no clue that safety needles were supposed to be used when giving an injection. The first thing she said was “why didn’t my supply vendor tell me this?”
In the past year I have performed over 100 mock OSHA inspections. I have heard every excuse in the book for not complying with OSHA regulations and CDC guidelines applicable to healthcare settings.
Many times the excuse for noncompliance is that someone told them to do/not to do whatever it is we are discussing. I am going to share some of the bad advice that physician offices have been given by consultants, experts, and even colleagues.
Sometimes medical offices are so focused on workplace hazards like bloodborne pathogens that they forget about other areas of OSHA compliance.
Recently as I was doing one of my mock OSHA inspections, I asked the manager if I could see the office’s emergency action plan (EAP). She had no clue what I was talking about.
When I do a mock OSHA inspection, I always look at the sharps containers. I check to make sure discarded sharps items have not exceeded the fill line. If the sharps container is clear, I can easily see what’s inside. Otherwise, I try to look down into the container.
I look for scalpels that do not have sheaths over the blades, non-retractable lancets, and needles that are non-safety engineered.
On a recent inspection, I knew that the practice I was inspecting was using all safety devices, so what I found was very surprising!
The year is still new enough for another resolution or two, so be sure you commit to completing all of your required OSHA paperwork.
During my mock OSHA inspections, one area where I usually find deficiencies is the lack of an annual sharps evaluation. OSHA’s Bloodborne Pathogens standard (section [c][iv][B]) requires that once a year, clinical staff members need to evaluate the sharps used in the office.
During a recent mock OSHA inspection, I asked the office manager if I could review the written workplace violence prevention plan. She walked me to the front office area and said, “We don’t need anything written down, we just get this out.” Under the receptionist counter was a baseball bat.
“Are you serious?” I said in amazement.
During my mock OSHA inspections, I always ask to see the practice’s OSHA manual. I have seen manuals that haven’t been touched for so long that I could blow dust off them.
Sometimes no one in the practice can find the manual. During an inspection last week, the OSHA manual was a collection of notes from previous OSHA seminars. I even saw one of my handouts from a seminar I taught years ago. The manager thought she could just put the power point hand-outs in a notebook and call it her OSHA manual.
In addition to doing mock OSHA Inspections, I provide annual OSHA training to physicians and their staff. Last week I was in an office that did not have any safety needles, lancets, or scalpels.
I was almost done with my mock OSHA inspection in an OB/GYN office, and the last section of my survey covered decontaminating and disinfection.
One of the physicians was leaving an exam room holding a metal vaginal speculum in a paper towel. I could not believe what I was seeing! Luckily I didn’t collide with him, but I saw him soon enough to follow up on my concern.
This incident came back to me recently when I heard someone say a cell phone had fallen into a sharps disposal container.
Several years ago, I was in an office when the medical assistant ran up to me saying she had just lost her engagement ring. She was hysterical!