“Mandatory Education and Training” MEAT 1

1. “Mandatory Education and Training”MEAT 1 2015

2. Tuberculosis (TB) TB is caused by a tiny germ (mycobacterium tuberculosis) that is spread through the air when people with active disease cough, sneeze, sing or laugh. Nearby people may inhale these germs and become infected. Clothing, bedding or other personal items that a person may touch do not spread TB. Common symptoms of TB are: • Cough that last for more than 3 weeks • Coughing up blood • Fever • Night sweats • Unexplained weight loss • Chest x-ray showing evidence of TB in lungs.

3. Question 1: TB is spread through the air when someone with active TB disease coughs, sneezes, sings or laughs. A. True B. False

4. TB: Airborne Precautions When an inpatient is suspected of having TB: • They are placed in Airborne Precautions in a negative pressure isolation room with the door kept closed. • Air in room is exhausted to outside and not mixed with air in the hospital. • In ambulatory care settings, patients should be isolated from other patients. • All patients should be instructed to cover their mouth with a tissue when they cough or sneeze. • Patients should not leave their room unless it is medically necessary and if this is the case, they must wear a surgical mask. • Patients are kept in Airborne Precautions until TB is ruled out or they are consider non-infectious. • Staff must wear a CAPR (Controlled Air Purifying Respirator), PAPR (Powered-Air-Purifying Respirator or a N-95 Respirator before entering a TB isolation room. • Only N-95 Respirators require fit testing.

5. Question 2: When a patient is suspected of having TB, they should be instructed to covering their nose and mouth when sneezing or coughing. A. True B. False

6. Question 3: When caring for a patient in Airborne Precautions, one should wear a CAPR, PAPR or a N-95 respirator. A. True B. False

7. Question 4: Patients should wear a surgical mask if they need to go outside of the negative pressure room. A. True B. False

8. Question 5: Patients suspected of having TB are placed in Airborne Precautions in a negative pressure isolation room with the door kept closed. A. True B. False

9. TB: Someone is Diagnosed • Patients diagnosed with TB are treated with several medications. • After taking TB medications for about 2 weeks, patients are not considered to be infectious. • 3 Daily Acid Fast Bacilli (AFB) smears should be ordered. • Airborne precautions can be discontinued after all the AFB smears are negative. • The patient must take TB medications for at least 6 months to totally clear the disease. • If patients don’t take their medication as prescribed, the TB germ may become resistant. • TB patients are monitored by Public health to ensure they take their medications properly.

10. TB: Skin Test • The Centers for Disease Control and Prevention (CDC) recommends that we have a yearly TB skin test (PPD) if we have patient contact. • If PPD test is positive, employee is infected with TB germ. • If no symptoms are present, the body was able to stop the bacteria from growing and that is called latent TB. Persons with latent TB cannot spread TB. • If you have a positive TB skin test, you will be asked if you have any signs and symptoms of TB. • People who have latent TB can take TB medications to prevent developing TB disease.

11. Corporate Compliance McLaren Bay Region and local affiliates are committed to conducting business in an ethical and legal manner through the development of a compliance program. Education and training are key elements of this plan. The Board of Directors is committed to ensuring that all employees, volunteers, physicians, contractors and vendors (workforce members) associated with Bay Region understand the rules that govern our actions and the conduct of business. General compliance education and training is conducted at new employee orientation and at least annually thereafter. Periodic compliance education will be offered to workforce members. Each employee must annually receive between 1-3 hours of compliance training as outlined in his or her Department Compliance Plan. Attending the Annual MEAT Training, is part of this annual training requirement. Department meetings, and/or continuing education sessions fulfill the balance of the annual training requirements. Specialized compliance training will be provided to departments/individuals that work in identified risk areas, e.g., coding, billing, laboratory and finance. New employees will receive compliance and HIPAA training as part of their general orientation

12. Question 6 All employees are required to receive between 1-3 hours of compliance training each year. a. True b. False

13. Question 7 Specialized training is provided employees in high risk areas such as: a. Coding b. Billing c. Finance d. All of the above

14. Corporate Compliance Department directors are responsible for ensuring that all employees in their department/area receive the required annual amount of training. A report is submitted annually to the Compliance Officer on the percent of compliance with orientation, annual and specialized training programs. All employees have an obligation to actively participate in annual compliance training by: • Attending staff meetings • Reading compliance information distributed by your department representative • Recognizing potential compliance problems in the course of your daily activity • Reporting suspected violations • Asking questions

15. Question 8 Who is responsible for ensuring all department employees receive the required amount of training? a. Department Director b. Compliance Representative c. Department Supervisor d. Compliance Officer

16. Question 9 How can employees actively participate in their compliance training? a. Attend staff meetings b. Read information distributed by the department compliance representative c. Recognize potential compliance problems d. All of the above

17. Corporate Compliance • All employees have an obligation to report suspected violations. Any employee can report a suspected compliance violation by: • Contacting your director or supervisor • Contacting your department compliance representative • Contacting the compliance officer • Calling the Compliance Hotline (894-3945) • Reporting is confidential. Under no circumstances will any person, who in good faith reports a possible violation, be subject to any form of reprisal. • Mike Jamrog is McLaren Bay Region’s Corporate Compliance Officer and Privacy Officer.

18. Question 10: You can be subject to reprisals if you report possible compliance violations. a. True b. False

19. Hazard Communication Hazardous chemicals are located in many areas of our facilities. As a health care employee, it is important that you understand your responsibilities when working with hazardous chemicals. By doing so, you are protecting our patients, yourself, and your fellow employees from potential injury.

20. MiOSHA’s Hazard Communication Program • Often referred to as “Right to Know” designed to protect employees from exposure to hazardous chemicals in the workplace. • There are 5 main components to the hazard communication program: - employee education - container labeling - safety data sheets (SDS) - inventory list - personal protective equipment (PPE).

21. Question 11: The MSDS acronym stands for: A. Security Safety Data Sheet B. Safety Data Sheet

22. Question 12: MiOSHA’s hazard communication program is often referred to as “Right to Know”. A. True B. False

23. Question 13: There are 5 components to hazard communication programs: employee education, container labeling, material safety data sheets, inventory list and person protective equipment. A. True B. False

24. Safety Data Sheets (SDS) • Contain pertinent information on hazardous substance such as the chemical name, hazardous ingredients, precautions for safe use, required safety equipment for use, first aide procedures, and spill and disposal procedures. • Where applicable, SDSs are located in every department. • A master SDS book is kept in Risk Management (Bay Region East, West and Bay Special Care). They are also available under McLaren’s home page under “Bay Region” – “Safety Data Sheets”. • SDSs specific to your area are kept in your department SDS book and are available 24 hours a day/7 days a week.

25. Question 14: SDSs are available 24 hours a day/7 days a week in your department. A. True B. False

26. Emergency Preparedness External Disaster: It’s one or more events that occur outside of the hospital and result in a large number of casualties coming to the Emergency Department. Examples include: fire, explosion, tornado, transportation accident, civil disorders or chemical spills. Internal Disaster: It’s one or more event within the hospital that severely reduce the ability of one or more essential services to function normally. Examples include: internal fire, utility disruption, chemical spill or bomb threat.

27. Question 15: An external disaster is one or more events that occur outside of the hospital and result in a large number of casualties coming to the Emergency Department. A. True B. False

28. Question 16: Examples of an internal disaster would include: internal fire, utility disruption, chemical spill or bomb threat. A. True B. False

29. Code Red – Fire Code Weather Alert – Tornado/Severe Weather Watch Code Weather – Tornado/Severe Weather Warning Code Blue – Cardiac Arrest Adult Code Blue Pediatric – Cardiac Arrest Pediatric Command Staff Alert – Potential External Disaster Code Triage External – External Disaster Code Triage Internal – Internal Disaster Code Yellow Alert – Bomb threat has been received Code Yellow – Suspicious item has been found Code OB – OB Emergency Code Pink – Infant Abduction Code Purple – Pediatric Abduction Code Orange – Hazardous Material Response Code Green – Biological/Chemical Response Code Silver – Active Shooter/Hostage Situation Dr. Strong – Additional personnel needed Code Walker – Missing Patient Rapid Response Team – Multi-disciplinary emergency team Stroke Response Team – Stroke patient Dr. Heart – Acute Myocardial Infarction Condition H – Family/Patient initiated Rapid Response Trauma Team – Priority 1 Patient in ED Code Clear – All Clear McLaren Bay Region Emergency Codes

30. Your Responsibility During a Code • Know your role/responsibility for each code. • Participate in all code announcements as if they were real. • Know your department’s initial response procedures. • Know your departmental evacuation plan. • Know the number to call in case of an emergency (East & West Campus – “2-2-2-2-2” or Off Site “9-1-1”

31. Hazard and Vulnerability Analysis (HVA) McLaren Bay Region is required to complete a Hazard and Vulnerability Analysis (HVA) each year. Based on our HVA, the following are the tops risks identified for our hospital: • Ice Storm • Severe Thunderstorm • Blizzard • Fire, Internal • Flood, Internal

32. Question 17: Which one of the following risks has been identified as a high risk at McLaren Bay Region? A. Earthquake B. Hurricane C. Blizzard

33. Prevention of Injuries (Lifting) • Keep the load close to your body • Keep your head, shoulders and hips in a straight line • Lift with your legs, not your back • Avoid twisting as you lift • Get assistance with lifting when needed • Always use lifting equipment • Never overfill trash/linen bags

34. Question 18: When you lift a patient, equipment, trash or a heavy object; you should: A. Keep the load close your body B. Lift with your legs, not your back C. Get assistance with lifting when needed and/or use lifting equipment. D. All of the above

35. Slips/Trips/Falls • Wipe spills promptly • Be observant of wet floors and icy parking lots • Wear proper footwear • Watch where you walk • Report unsafe conditions immediately, i.e., spills, icy sidewalks, etc.

36. Handling of Needles and Sharps • Dispose of needles and sharps immediately after use in proper sharp containers • Use the safety features on sharps correctly to eliminate exposures to blood/body fluids • Use caution when activating the safety device on all used syringes and butterflies. • Do not recap needles • Empty sharp container when ¾ full • Do not discard expired medications in the sharp containers • Wear appropriate personal protective equipment • Use caution when placing sharps into sharp containers

37. Reporting of Injuries • If you are injured while on duty, report the injury immediately to your department/manager/supervisor. All injuries should be reported no matter how significant they may seem to you. • The Manager/Supervisor, Employee Health Service or Human Resources will authorize initial medical examination/treatment. • Document the injury by completing the employee section of the “Employee Incident Report” form as soon as possible or by the end of your shift. • “Employee Incident Report” forms are available from your Manager/Supervisor or Employee Occupational Health Service.

38. Question 19: If you are injured at work, what is the first thing you should do? 1. Report the injury immediately to your Manager/Supervisor 2. Keep working 3. Go home

39. Reporting Bloodborne Exposures If you have a percutaneous (needle), mucous membrane or open wound exposure to blood or body fluids from another person, NOTIFY YOUR MANAGER/SUPERVISOR IMMEDIATELY. If a small puncture or laceration, milk the wound so it bleeds freely then wash with copious amounts of soap and water; mucous membranes, rinse with copious amounts of water; eye splash, irrigate with copious amounts of water. Advise your Manager or Supervisor of source patient’s name so they can order laboratory testing immediately on the patient. Contact Employee Health as soon as possible so you can receive counseling and begin prophylactic treatment if appropriate.

40. Question 20: If you have a percutaneous (needle), mucous membrane or open wound exposure to blood or body fluids of another person, you should: 1. Notify your Manager/Supervisor immediately. 2. Milk the wound so it bleeds freely, then wash with large amounts of soap and water, rinse mucous membranes with large amounts of water, irrigate eye splash with large amount of water. 3. Tell your Manager or Supervisor the name of the patient or person you were exposed to so their blood can be tested for HIV and Hepatitis. 4. All of the above

41. Bloodborne Pathogens Health care workers could be exposed to bloodborne pathogens by accidental needlesticks and splashes. The most common bloodborne pathogens (BBP) are Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV). Because BBP can cause serious, even fatal diseases, MIOSHA (Michigan Occupational Safety and Health Administration) has written rules and regulations about BBP; these rules can be found in Human Resources, Infection Control and Employee Health Service offices. Along with the MIOSHA rules, McLaren Bay Region has written an Exposure Control Plan for BBP, available on the Bay Region Intranet (Administrative policy #211).

42. Question 21: HIV, Hepatitis B and Hepatitis C are bloodborne pathogens. A. True B. False

43. Bloodborne Pathogens (BBP) HIV causes AIDS which disables the body’s immune system to fight off infections. HBV and HCV infects the liver and may lead to fatal illnesses such as liver cancer. These BBP can be found in blood, blood products (plasma), semen, vaginal secretions, amniotic fluid, fluids surrounding the brain, spine, heart, joints, chest, abdomen and other fluids containing visible blood. BBP are transmitted by: • needlestick injuries • infected body fluids that has contact with breaks in the skin (cut, scrapes) • splashes in the mouth, nose or eyes from blood or body fluids that are infected with BBP • sex • using dirty drug needles • pregnant woman can pass a BBP to her baby Since healthcare workers could be exposed to a BBP, they must follow Standard Precautions. This means treating all blood and body fluids as if they are infected with a BBP and use safer practices and sharp devices to protect from exposures from occurring.

44. Bloodborne Pathogens (BBP) Personal Protective Equipment (PPE), such as gloves, goggles, gowns, and masks are available throughout McLaren Bay Region work sites. PPE should be worn any time contact with blood and body fluids is possible. PPE should be discarded after removed. Other important work practices are: hand hygiene before and after removing gloves, use safe sharp products and devices with safety features when ever possible, and use protective resuscitation devices when providing rescue breathing. Sharps containers are available throughout Bay Region. Place needles, broken glass or sharp objects into sharp containers. Change sharp containers when ¾ full. Do not recap needles. Never reach into trash containers to retrieve item or compress contents. Take special care when handling, collecting or transporting blood or other potentially infectious materials. These materials must be stored in leak-proof containers clearly labeled with red or orange biohazard labels to protect others from exposures. To clean a blood/body fluid spill, wear gloves, use disposable towels and hospital disinfectant to wipe spills up. If you have not already received Hepatitis B vaccine, consider being vaccinated. The series of three injections is provided to Bay Region employees with no cost.

45. Question 22: All blood and body fluids are considered infectious for bloodborne pathogens. A. True B. False

46. Bloodborne Pathogens • If exposure to blood/body fluid occurs, wash area with soap and water and report the incident to your supervisor immediately for proper follow-up testing and treatment. It is important that we know how the incident occurred and what device was involved. • The Safe Sharp Task Force studies all sharp related injuries looking for trends and makes recommendations for safer medical devices and monitoring of safety devices. In addition to key management personnel, the task force members include Nursing Practice Council members, laboratory and other front line staff that are potentially exposed to injuries from sharps.

47. Question 23: Exposures to BBP should be reported to your supervisor immediately. A. True B. False

48. Question 24: McLaren Bay Region has a Safe Sharps Task Force that includes front line staff. A. True B. False

49. Medical Equipment Employees who utilize medical equipment play a major role in assuring that medical equipment operates correctly and safe to use. It is the user’s responsibility to know the proper operation of their equipment and to be aware of signs or symptoms that indicate problems with operation and safety. Typical signs and symptoms could be cracked or damaged cords, cables, sensors and accessories. Other symptoms might include excessive noise, vibration or burning smells. There are also things that can be done to help assure that equipment remains in good condition. Always grasp the plug to remove it from the wall outlet—never pull the cord. Don’t set fluids near or on electrical equipment. Use caution when utilizing elevators not to bump into things or tip over equipment. Elevators can be especially rough on equipment being transported. When a piece of medical equipment is found to be in need of repair, it is important that the device be tagged defective to prevent further use. The tag should include the name and phone number of the person reporting, and include a brief description of the problem. Portable equipment is to be delivered to the designated repair drop off location while non-portable items need to have a work order request called into the call center.

50. Question 25: Whose responsibility is to know if equipment is operating properly during routine operation? a. Department supervisor. b. Patient. c. Employee operating the equipment. d. Administrator.