Healthcare Safety

1. Healthcare Safety

2. Agenda • 1:00 Intro, Safety, Back & Ergonomics • 1:50 Break • 2:00 Slip/Trip/Falls & Workplace Violence • 2:50 Break • 3:00 Bloodborne Pathogens & TB • 4:00 Chemical Exposures • 4:30 Questions/Answers

3. OSHA Guidelines - Overview Covers a broad spectrum of workers (nearly 8 million): • Psychiatric facilities • Hospital emergency departments • Drug treatment centers • Community care and mental health facilities • Pharmacies and long-term care facilities

4. Background • The nursing home industry is one of America’s fastest growing industries. • In 1994, approximately 1.6 million workers are employed at 21,000 work sites. • By the year 2005, industry employment will rise to an estimated 2.4 million workers.

5. In 1994, over 221,000 nonfatal occupational injuries and illnesses – nursing facilities In 1999, 2,637 non-fatal assaults on hospital workers – a rate of 8.3 assaults per 10,000 workers 27.0 assaults per 10,000 workers - nursing In 2003, over 221,500 nonfatal occupational injuries and illnesses – nursing facilities In 2003, a rate of 8.5 assaults per 10,000 workers - hospitals 22.4 assaults per 10,000 workers - nursing Bureau of Labor Statistics (BLS) Data

6. Jobs with the Most Injuries • Nursing aides, orderlies, and attendants accounted for 70% of lost time injuries

7. Major Sources of Injuries and Illnesses • Resident handling strains - 60% • Falls - 15% • Contact with objects & equipment – 12% • Assaults & violent acts by persons – 6% • Exposure to harmful substances – 4% • Others – 3%

8. Cause of Injury Source: 1994 BLS Survey of Occupational Injuries & Illnesses, unpublished table.

9. 1994 221,200 nonfatal injuries and illnesses 1,648,800 annual aver. employment 83,450 cases with days away from work 2003 221,500 nonfatal injuries and illnesses 2,776,500 annual aver. employment 69,400 cases with days away from work BLS Update - Nursing

10. Components of Safety Process • Management • Hazard Analysis • Inspections • Hazard Reporting • Accident Investigation • Hazard Controls • Safety and Health Training

11. Hazard Analysis • Job Safety Analysis • Workplace Observations

12. Inspections To identify new or previously missed hazards and failures in hazard controls. An effective safety and health program will include regular site inspections.

13. Hazard Reporting A system that enables employees to notify management of conditions that appear hazardous, without fear of reprisal.

14. Accident and Record Analysis • Accident Investigation • Data Analysis

15. Accident Investigation An effective program will provide for investigation of accidents and “near miss” incidents, so that their causes, and the means for their prevention, are identified.

16. Data Analysis Analysis of injury and illness records for indications of sources and locations of hazards, and jobs that experience higher numbers of injuries. This function is usually handled by the Safety Committee.

17. Hazard Prevention and Control • Hazard & Exposure Control • Maintenance • Medical Surveillance Program

18. Hazard Control • Workforce exposure to all current and potential hazards should be prevented or controlled by: • engineering controls, wherever feasible and appropriate • work practices and administrative controls • personal protective equipment

19. Maintenance An effective safety and health program will provide for facility and equipment maintenance, so that hazardous breakdowns are prevented.

20. Medical Program An effective safety and health program will include a suitable medical tracking program where it is appropriate for the size and nature of the workplace and its hazards.

21. Emergency Response Emergency preparedness - There should be appropriate planning, training/drills, and equipment. First aid/emergency care should be readily available to minimize harm if an injury or illness occurs.

22. Emergency Response Resources • Safety and Health Topics – OSHA • Emergency Preparedness and Response • OSHA 3152 Hospitals and Community Emergency Response

23. Safety and Health Training Most effective when incorporated into other training about performance requirements and job practices. It should include all subjects and areas necessary to address hazards at the site.

24. Contractor Safety An effective safety and health program protects all personnel on the worksite, including contractors. It is the responsibility of management to address contractor safety.

25. General Duty Clause Section 5(a)(1) of the OSH Act requires that “Each employer shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.”

26. General Duty Clause (Cont’d) The general duty clause is used only where there is no OSHA standard that applies to the particular hazard involved.Examples of workplace hazards to which the general duty clause may apply include occupational exposure to ergonomics and workplace violence.

27. General Duty Clause (Cont’d) Four elements are required for issuing general duty clause violations: • The employer failed to keep the workplace free of a hazard to which employees of that employer were exposed • The hazard was recognized • The hazard was causing or was likely to cause death or serious physical harm • There was a feasible and useful method to correct the hazard

28. Safety and Health Hazards in Healthcare • Strains, Sprains & Back Injuries • Slips, Trips & Falls • Workplace Violence • Bloodborne Pathogens • Tuberculosis • Others (toxic chemicals, lasers & X-rays)

29. Sprain/Strain & Back Injuries • Patient handling • Transfers • Falling patients • Combative patients

30. Physical Therapy

31. Sprain/Strain & Back Injuries • Dietary • Large containers of food • Awkward work positions • Carrying trays, etc during cleaning

32. Laundry

33. Sprain/Strain & Back Injuries • Maintenance and Housekeeping • Equipment handling • Awkward work positions • Reaching • Stooping

34. Back Injury Solutions • Perform work task evaluation • Patient handling checklist • How often and how hard • Work task analyzer • Equipment checklist • Facility design checklist • Trained lifting team • Mechanical lifting devices • Gait or transfer belts • Total-body lift

35. Back Injury Solutions (Cont’d) • Stand-assist lift • Draw sheet • Slide board • Slippery sheet with handles • Shower-toilet chair with wheels • Training on safe work practices • Return to Work program

36. Guidelines for Nursing Homes • OSHA released 3/13/2003 recommended elimination manual lifting of residents when feasible • Developing process & program to protect workers • Patient lifting & repositioning activities • Activities other than patient lifting • Training • Additional information and program components

37. Ergo Program Development • Program Administrator should be an individual or group that is responsible for the process • Accountability in place for supervisors • Identifying stressors in their areas • Implementing the controls in their areas

38. Ergo Training • Training for all personnel at risk of an musculoskeletal disorder (MSD) covers: • Identification of ergonomic stressors • How to control the stressor • How to report problems • Signs and symptoms of MSDs

39. Ergo Training (Cont’d) • For new employees before assignment • Existing personnel in several sessions or as part of routine training • Format should be such that all can understand and the employees should be able to demonstrate understanding of training • Training updated as changes occur in workplace

40. Additional Ergo Program Components • Worksite analysis • Emphasis on resident handling • OSHA guide has decision tree flow chart to assist with procedures including bed-to-chair, chair-to-toilet, chair-to-chair or car-to chair • Recordkeeping • Return to Work process

41. Prevention of Slips, Trips and Falls

42. Slips • Floors • Terrazzo or tile can be very slippery when wet • Clean up spills immediately & barricade wet areas until dry • Entrance ways are very susceptible • Post warning cones when raining

43. Trips • Carpet - tears can catch shoe or heel • Rugs or mats - can curl at edges or have bumps in the middle • Keep paths clear

44. Falls • Use ladders in good condition and in prescribed manner • Don’t stand on top of chairs or desks for an elevated task • Use caution when walking stairs

45. Slips/Trips/Falls • Areas of concern: • Dietary department • Tiled/terrazzo floors • Employees and general public • Maintenance department • Parking lots

46. Dietary

47. Slips/Trips/Falls • Dietary • Liquids/wet solids on the floor during food preparation • Time crunch • Footwear

48. Employee Training Appropriate Footwear Environmental Factors Floor Maintenance & Inspection Walking Surfaces Housekeeping Slip/Trips/Falls Prevention

49. Appropriate Footwear • Management should clearly define what footwear is appropriate for the workplace. • Inappropriate footwear may contribute up to a fourth of the reported same level slip/fall incidents

50. Appropriate Footwear (Cont’d) • Rules of thumb: • Soft rubber soles for dry surfaces, not wet or greasy • Hard rubber soles for greasy, but not dry or wet surfaces • Synthetic soles for many conditions, but may not be recommended for oily surfaces