Environmental Services Professional Training Course. Morning Schedule. (15 min.) Introductions (15 min.) Course Development and Objective, Pre-test, Overview of Occupational Hazards, Definitions
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(15 min.) Introductions
(15 min.) Course Development and Objective, Pre-test, Overview of Occupational Hazards, Definitions
(60 min.) Microorganisms & Infectious Agents (show 27 min. video before lecture/discussion)
(15 min.) Break
(75 min.) Infectious Waste (includes 22 min. video)
(40 min.) Cleaning for Health
(50 min.) Lunch
(40 min.) Hazardous Material Safety
(40 min.) Needlestick and Injury Prevention
(15 min.) Break
(30 min.) Spill Response
(60 min.) Regulated Medical Waste Transportation Requirements
(45 min.) Post Test and Course Evaluations
Course Objective - to provide environmental services professionals with the information they need to do their jobs safely.
When they enter patient rooms, they may become exposed to infectious diseases.
They risk exposure to bloodborne pathogens from dirty needles that are occasionally thrown away in the biohazard and general waste streams.
They work with chemicals that are often corrosive and dangerous if not handled properly.
They are a category of worker at risk of latex allergy from ongoing latex exposure.
They may become injured from slips, trips, and falls, or heavy lifting.
1. Bacterial agents - Tuberculosis (TB), Staphylococcus (staph), or Legionella
2. Fungal agents - Aspergillus (mold), Tinea (ringworm)
3. Viruses - Hepatitis B, Hepatitis C, HIV
4. Parasitic agents - Giardia and Trichomoniasis
5. Prions - Kuru and Creutzfeldt-Jakob Disease
6. Rickettsial agents - Rocky Mountain spotted fever and Lyme Disease
In order for an infectious agent to make a person sick, it must first come into contact with that person. This contact is called an exposure.
EXAMPLE 1 - Tuberculosis
In a 1995 publication, CDC researchers reported the results of a study that found the annual risk of contracting TB was higher for hospital housekeepers than nurses.
EXAMPLE 2 - Hepatitis B
There are two ways to reduce the rate of HBV transmission from needlestick injuries and they are:
1) To get a Hepatitis B vaccination
2) To report all needlestick injuries to the infection control nurse and accept post-exposure treatment.
Environmental services professionals can prevent the spread of infectious agents among patients and healthcare workers by protecting themselves in the following ways:
If puncture resistant gloves are worn, wash gloves between patient rooms to avoid transfer of microorganisms from one patient to another
Immediately report needlestick and other sharps-related injuries to the infection control staff
Human blood and blood products are wastes that can be found anywhere in the health care facility but most often they are found in the laboratory, operating rooms, and labor and delivery areas - these wastes include blood, serum, plasma, and other blood products.
Contaminated sharpsare wastes that can be found in areas where patients are treated and the laboratory - these wastes include hypodermic needles, syringes, glass pipettes, broken glass, and scalpel blades.
Miscellaneous wastes are those items that are probably contaminated with infectious microorganisms - they include contaminated materials found in the dialysis units, surgery and autopsy suites, and laboratory areas.
All infectious waste must be disposed of properly in accordance with a federal law known as the OSHA Bloodborne Pathogens Standard. Proper disposal means the following:
Biohazard Labeled Bag or Container
Hospitals produce approximately two million tons of solid waste per year. Of this amount, ten to fifteen percent is categorized as infectious and the rest is general waste made up of paper and paper board, plastics, food waste, metal, glass, wood and other materials. All of the solid waste is sent to landfills or incinerators for disposal.
Only about 10% of the waste is actually infectious ...
And 2% of the waste is pathological, requiring incineration.
According to the EPA, medical waste incinerators are the fourth largest known releasers of mercury to the environment.
Because of all of the environmental health problems caused by medical waste incinerators, the American Hospital Association and the EPA have reached an agreement to work together to reduce the amount of waste within the hospital system by half by the year 2010.
A number of actions can be taken to reduce the amount of solid waste within the hospital system that is sent in biohazard bags to medical waste incinerators for disposal.
Work with hospital administrators to develop policies that support biohazard bag reduction efforts.
Place and maintain biohazard bag containers only in those areas where infectious wastes are likely to be made.
Keep pathological wastes separate from the other infectious wastes.
Radiation - pollutants include both ionizing (e.g. radon) and non-ionizing (e.g. electromagnetic fields) types.
They are living organisms, or come from living organisms, and can be found under certain environmental conditions:
1. There must be a comfortable home or reservoir in which to hang out which is just about anyplace, and
2. They need nourishment just like us in the form of food and water.
What kind of food do these organisms “eat?”
Aspergillus is a fungus found in dust and is an example of a common biological contaminant that lives well in soil, water and decaying material. In health care facilities, it may be found
in the building ventilation system in areas where organic matter (dust) and water are present. Where would you expect to find this organism in a health care facility?Can this organism kill a patient?
Another deadly biological contaminant found in the healthcare facility is a bacteria named Vancomycin-resistant enterococci. (VRE). The reason why this bacteria is deadly is because it cannot easily be killed by antibiotics and many patients die once they become infected with it.
How do you think patients become infected with this bacteria?
If someone comes into the hospital carrying the VRE bacteria, then whatever that person touches may become contaminated with VRE. Deadly VRE can survive for weeks on environmental surfaces.
Patients may become infected with VRE by touching contaminated surfaces such as bedrails, sinks, faucets, and doorknobs, or coming into contact with health-care workers who do not wash their hands.
Environmental services professionals play a key role in controlling the spread of VRE throughout the healthcare facility by washing hands and wearing gloves properly, and diligently cleaning and disinfecting all environmental surfaces.
Surfaces with regular hand-contact are called high touch surfaces. High touch surfaces in patient care areas include items such as telephones, doorknobs, bedrails, light switches, faucets, and wall areas around the toilet. These surfaces must be cleaned and disinfected daily to protect the patient and reduce the spread of nosocomial diseases such as VRE.
Nosocomial diseases are illnesses that patients acquire during their stay in the hospital.
The primary goal of a health care facility cleaning program is to prevent the spread of nosocomial disease among patients and healthcare workers. Environmental services professionals play an important role in achieving this goal.
Daily cleaning reduces the amount of microorganisms in the patient care environment.
Suggestions for improving the general cleaning and disinfecting process:
Use a clean cloth or mop head each time a bucket of detergent/disinfectant is emptied and replaced with fresh, clean solution.
When dusting, it is important NOT to shake the cloth/mop because dust and fungal spores will then get in the air. If patients breathe in these spores, they may get sick and die.
When a patient is discharged from a special care area, throw away all disposable items, change any cubicle curtains, and disinfect all surfaces including chairs, tables, ledges, call lights, telephones, sinks, showers, and toilets.
It can not be emphasized enough. Environmental services professionals play a key role in preventing the spread of infectious agents among patients and healthcare workers.
Diligent housekeeping keeps microorganisms and other bio-pollutants under control and reduces the spread of nosocomial disease.
What is nosocomial disease?
Environmental services professionals routinely use chemical disinfectants to clean surfaces and kill infectious agents in patient rooms and other areas of the health care facility. If not handled properly, these chemicals can cause serious injuries such as eye damage, respiratory problems, chemical burns, or severe skin irritation. To prevent such injuries, the OSHA Hazard Communication Standard requires all health care employers to provide information and training to their employees about the hazards associated with the chemicals in their workplace.
Employers must provide training to their employees on the following topics:
The facility’s hazard communication labeling system, the hazard information provided by the MSDS, and how personnel can obtain and use the hazard information on the MSDS
In order to understand the hazard information provided by the MSDS, environmental services professionals must first learn something about the nature of chemicals. Chemicals are made up of single or multiple elements.
Water- two elements, two molecules of hydrogen and one molecule of oxygen (H20)
The most common chemicals in use are made up of three elements - carbon, hydrogen, and oxygen.
What are some chemicals used everyday in healthcare facilities?
Chemicals also come in different forms - solids, liquids, gases, or vapors, and can even be radioactive.
H-3, also known as Tritium, is an example of a radioactive material which is made up of three hydrogen molecules. It is often used by scientists in biomedical research laboratories.
Chemicals change from one form to another depending on temperatures and pressures. Water turns to ice when the temperature drops below 32 degrees F. When water is heated to the boiling point, it evaporates and turns into a vapor. Some chemicals evaporate at or below room temperatures becoming airborne vapors.
Gasoline is a common chemical that becomes an airborne vapor at and below room temperature. It is very flammable with a flash point of -45 degrees F.
In addition to being flammable, gasoline vapors are very dangerous because they are harmful to human health.
Any chemical can be harmful to human health. How harmful a chemical is depends on how much of it gets into the body and how toxic it is.
Example: The effects of formaldehyde exposure can either be sudden or long term. Formaldehyde is both corrosive and a suspected carcinogen.
It is very important to wear Personal Protective Equipment (PPE) when working with corrosive material.
OSHA has set guidelines for safe levels of exposure to many airborne contaminants including mists, gases, vapors, dusts, and fibers. These are known as Permissible Exposure Levels or PELs. The American Conference of Governmental Industrial Hygienists (ACGIH) has also set guidelines for safe levels of exposure to many contaminants. These are known as Threshold Limit Values or TLVs. If a safe exposure level has been identified by OSHA or the ACGIH for a particular material, then it will be provided on the MSDS.
Unsafe levels of exposure may occur in the work place at any time in the event of a spill or release of a hazardous material. It is therefore very important that workers know where hazardous materials are stored or used and how to detect a spill or release in their work place.
Some hazardous materials have warning properties that alert the worker to a potential exposure in the event of a release. Examples of warning properties include odor, headache, burning or tearing eyes, or coughing.
Not all hazardous materials have warning properties and in some cases the warning properties do not occur until after the employee has been exposed to a dangerous amount of material. In such cases, employers may install alarm systems that go off when levels of exposure are immediately dangerous to life and health.
Example: Ethylene oxide is a toxic gas that is used in many healthcare facilities to sterilize surgical instruments. It is considered a carcinogen and a reproductive hazard.
Some hospitals have eliminated the use of ethylene oxide altogether. They have found a less hazardous material to use in their sterilizers. Using a less hazardous material to do the same job is known as “substitution.”
If a substitute material cannot be found to do the job, a toxic or other hazardous material can be used safely in the work place as long as precautions and procedures are in place to protect the worker from exposure.
Safe work practices or precautions for using a particular chemical may be found in the MSDS or on the product label. Below are some common precaution statements found on product labels:
The MSDS will state what type of PPE the worker needs to wear to prevent exposure while handling the material. If an exposure does occur, the MSDS also provides health hazard and emergency first aid information.
To summarize, manufacturers must develop a Material Safety Data Sheet (MSDS) and provide it to people and organizations that purchase their products. Employers such as hospital organizations are then required to train their employees on the hazard information provided by the MSDS.
It is estimated that 600,000 to 800,000 needlestick and other percutaneous injuries occur annually among health care workers in the United States. About half of these injuries go unreported. Data suggests that at an average hospital, approximately 30 needlestick injuries occur per year for every 100 beds.
How many beds are in the hospital that you work at?
Of the reported needlestick injuries, approximately 41% occur for the following reasons:
To reduce the risk of needlestick and other injuries, the following control measures are recommended to protect the environmental services professional:
A mask and goggles or eye protection should be worn if there is a possibility of contact with infectious materials in your eyes, nose, or mouth.
Locate puncture resistant leak-proof containers for sharps and needle disposal in areas where they are convenient and likely to be used by health care providers.
Use a brush and dust pan to pick up broken glass which may be contaminated with blood or other body fluids.
Follow safe work practices (e.g., do not eat, drink, smoke, apply lip balm, or handle contact lenses where there might be exposure to blood or other potentially infectious materials).
Follow any recommendations made by the infection control staff after a potential exposure.
Environmental services professionals routinely respond to calls for assistance in cleaning up spilled materials on the patient wards and other areas of the hospital. The spilled materials often consist of human body fluids such as urine, blood, and feces that may or may not be infectious. Regardless of whether or not the material is actually infectious, any human body fluid must be considered potentially infectious.
The environmental services professional should receive training on the following topics:
An incidental spill is a release of hazardous material which does not have the potential to become an emergency within a short time frame. Incidental releases are limited in quantity, exposure potential, or toxicity and present minor safety or health hazards to employees in the immediate work area or those assigned to clean them up. An incidental spill may be safely cleaned up by an employee who is familiar with the hazards of the material.
It is up to management personnel to decide whether or not a spill is incidental.
8.0 Regulated Medical Waste Management, Disposal, and Transportation Requirements
There is a great deal of concern about the proper management of health care facility wastes. Environmental services professionals are responsible for picking up the waste at each point of generation and transporting it to the designated place of disposal or storage at the facility. If certain wastes are mishandled or improperly disposed of, health care facilities may be subject to fines. Some of the waste generated in the health care setting could be infectious and transmit disease if improperly handled or disposed of.
It is important that environmental services professionals receive training on the following topics:
Proper segregation, containment, and labeling of wastes in the health care facility
State or local regulations for medical and/or infectious waste disposal
OSHA regulates infectious waste in the workplace by enforcing the requirements of the Bloodborne Pathogens Standard. When environmental services professionals pick up infectious waste at each point of generation in the healthcare facility and transport it to the designated place of treatment or storage at the facility they must do so “in accordance with OSHA regulations”. What does this mean?
The infectious waste may or may not be treated on-site at the health care facility prior to shipment off-site for final disposal. If the waste is treated on-site at the facility so that it no longer poses the hazard of an infectious substance, then it is no longer considered infectious and may be transported off-site as general waste to a solid waste disposal facility (e.g. landfill, transfer station) regulated by state or local authorities.
If the waste is not treated on-site, then it is considered infectious and a DOT hazardous material, and it must be transported off-site in accordance with DOT shipping regulations for hazardous materials.
DOT regulations require that all infectious substances, including regulated medical waste, be prepared for shipment off-site by trained personnel. Specifically, personnel must receive initial and recurrent training (every two years) that meets the DOT training requirements in three subject areas.
1. General awareness/familiarization training to enable the employee to recognize and identify regulated medical waste as defined by DOT;
DOT Definition of Regulated Medical Waste - a waste, or reusable material, that contains an infectious substance and is generated in the diagnosis, treatment, or research of humans or animals
2. Function-specific training to familiarize the employee with the DOT shipping requirements related to the job that he/she performs;
3. Safety training concerning the specific hazards associated with regulated medical waste, safe handling of packages containing regulated medical waste, and the emergency response procedures and information required by DOT for every regulated medical waste shipment in the event of an accidental release.
DOT requires that personnel be tested after receiving the training on the three subject areas.
A record of current training must be kept by the health care facility for each employee that prepares regulated medical waste for shipment off-site to a treatment facility.
Each record must include the employee’s name, the most recent training date, a copy of the training materials, the name and address of the trainer, and a certification that the employee was trained and tested.
In accordance with DOT shipping regulations, regulated medical waste must be shipped in packages that are properly labeled and marked (see DOT brochure).
A shipping paper must also be prepared for every regulated medical waste shipment that leaves the health care facility.
A description of the regulated medical waste shipment must be included on the shipping paper as well as the name of the health care facility and an emergency response telephone number.
The total quantity of the medical waste being shipped off-site for treatment must also be entered on the shipping paper (see example).
It is important for environmental services professionals to understand that untreated regulated medical waste is considered an infectious substance and a DOT hazardous material. It must be transported from the health care facility in accordance with DOT shipping regulations.
If untreated regulated medical waste is improperly disposed of in the general solid waste stream and transported off-site to a transfer station or landfill, the healthcare facility will be subject to fines levied by the local government and the federal DOT.