Occupational Safety for Nurses

Milestones In Home Care, Inc.
OSHA Guidelines for Nurses
& Annual In-Service Review

Federal and NYS law requires that all health professionals complete an annual OSHA in-service review.

Failure to complete an annual in-service will prevent a nurse from working.

==============================================

 

What is OSHA?

The Occupational Safety and Health Administration

OSHA, the Occupational Safety and Health Administration, is a United States Federal Agency which sets guidelines for actions to protect everyone from occupational hazards.

==============================================

 

EMPLOYEE RIGHTS UNDER THE OSHA STANDARD AND NYC LAW TITLE 3

Employee Rights Under the OSHA Standard: The purpose of the OSHA Hazard Communications Standard is to ensure that you understand the hazards of the chemicals you work with and know how to safely use those chemicals. Under this standard you are given certain rights as follows:

1. THE RIGHT TO request in writing and obtain information on hazardous chemicals you come in contact with.
2. THE RIGHT TO be informed of the hazardous chemicals used in your work
3. THE RIGHT TO have access to the Agency’s written hazard communication
4. THE RIGHT TO file a complaint with OSHA if you believe that you have been discriminated against by exercising your rights under the law.

The hazard communication program and Material Safety Data Sheet (MSDS) for your work area are available for your review. The plan is found in the Safety Manual.

==============================================

 

STANDARD-UNIVERSAL PRECAUTIONS

The concept of Standard/Universal Precautions is a set of guidelines recommended by the Centers for Disease Control.  The term is used by Occupational Safety and Health Administration (OSHA). The term refers to the practice, in medicine, of avoiding contact with patients’ bodily fluids, by means of the wearing of nonporous articles such as medical gloves, goggles, and face shields.  Use of personal protective equipment is now recommended in all health settings.

Standard/Universal Precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infections. Standard/Universal Precautions apply to (1) blood; (2) all body fluids, secretions, and excretions (except sweat), regardless of whether they contain visible blood; (3) non-intact skin, and (4) mucous membranes.

Milestones In Home Care mandates that you apply Standard/Universal Precautions with all patients, regardless of their diagnosis, and with contaminated equipment and materials.

STANDARD-UNIVERSAL PRECAUTIONS REQUIRES THAT YOU ALWAYS:

WEAR GLOVES when your hands may come in contact with blood, body fluids, or mucous membranes. For example, put on gloves when drawing blood, starting or handling an IV, doing finger sticks, suctioning-whether oral or nasal, handling contaminated instruments, cleaning blood or body fluid spills, handling, soiled linen or waste, and in all other situations where contact with blood or body fluids may occur.

WEAR GOWNS/APRONS when your skin or clothing may be soiled by blood or body fluids. Use the impervious gown if splashing or large quantities of blood are present or anticipated.

USE MASK/EYEWEAR if there is a possibility that you may be splashed, sprayed, or splattered with blood or body fluids. Eyewear includes goggles or safety glasses. Face protection is provided by wearing a face shield or eyewear and mask worn together.

WASH IMMEDIATELY after taking off your gloves. Hands and other skin surfaces should be washed immediately and thoroughly if contaminated with blood or other body fluids. Gloves are not a substitute for hand washing. Remember to wash your hands after all patient contact.

MANAGE SKIN CONDITIONS by using gloves and contact precautions if you have abraded skin, chapped hands, or dermatitis. If you have weeping dermatitis or open wounds that are draining, optimally you should refrain from all direct patient care and from handling patient care equipment until the condition is resolved. If this is not possible, utilize gloves, hand washing and contact precautions.

PREVENT INJURIES by disposing of sharps immediately after use. Place all needles, syringes and scalpel blades and other sharps only in designated puncture-resistant sharp containers.

NEVER RECAP NEEDLES.  Prevent injury to yourself and others by never leaving sharps on bedside tables, in your clothing pockets, or in mattresses, linen, or garbage cans. Correct co-workers who dispose of sharps inappropriately.

REPORT EXPOSURES IMMEDIATELY to your supervisor. All treatment of an exposed person is provided in Employee Health Services Monday through Friday during clinical hours: 9am to 4pm. On holidays and all other times treatment of an exposed person is provided in the Emergency Department and an Accident report documenting the exposure must be completed. If initial treatment is done in ED follow up will be done by Employee Health Services.

An exposure is defined as contact of the exposed person by:

• A needle stick or sharp puncture wound.
• An open cut, bum or abrasion contaminated by body fluids or tissues (blood, blood products, bloody fluids, semen, cerebrospinal fluid, amniotic fluid, menstrual discharge, pleural fluid, pericardia! fluid, inflammatory exudates, any other body fluid or tissue contaminated with blood).
• A splash to mucous membranes (e.g. eye, nose or mouth) with such materials.

If you have a needle stick or body fluid exposure you should follow the Procedures For Evaluation and Treatment of Occupational exposure to Blood or Body Fluids.

Some highlights of the procedures are as follows:

1. Clean the wound with soap and water or flush mucous membranes with water/saline.
2. Report the incident to your supervisor immediately.
3. The employee is required to complete and submit an occurrence report.
4. 4. If you’re stuck with a needle from a known person, the source will be asked to sign an informed consent to have HIV testing performed. You will be referred to your PMD.
5. Your treatment may include evaluation of your Hepatitis status. You may be Offered treatment for Hepatitis B exposure and Tetanus.
6. 6. You may be offered treatment for HIV prophylaxis.
7. All medical and other Hospital records pertaining to the exposed person’s exposure will be kept confidential in accordance with applicable New York State law. All “HIV­ Related Information” must have stringent confidentiality. Testing for the antibody mandates the strictest confidence both for you and the source of your exposure.

==============================================

 

ALCOHOL BASED HAND WASH

Alcohol based hand washes offer excellent protection against infections. They kill bacteria, viruses and fungi.  Alcohol based hand washes are well tolerated by users and are considered time savers compared to washing hands with soap and water.

Alcohol based hand washes are recommended for routine decontamination of hands. They may be used at frequent intervals as long as ones hands are not visibly soiled.

When decontaminating hands with an alcohol based hand wash: apply (golf ball size) to the palm of one hand and rub hands together, covering all surfaces of hands and fingers until dry.

 

==============================================

 

HEPATITIS B

HEPATITIS B IS A BLOOD BORNE PATHOGEN.

Hepatitis is an inflammation of the liver . It can be caused by a wide variety of agents including medications, alcohol, toxic or poisonous substances and infectious agents such as viruses. Signs and symptoms of hepatitis are:

• Fever: an increase in body temperature.
• Jaundice: yellowing of the skin and sclera(white part of the eye).
• Hepatomegaly: an enlargement of the liver .
• Malaise: feeling tired and listless.
• Dark-colored urine
• Joint Pain

How is Hepatitis B Transmitted?

Transmission or spread of Hepatitis B can occur after a needle stick or sharp injury; a splash or spray of blood or body fluids to the eyes, nose or mouth; unprotected sex with an infected partner; and from an infected mother to her baby. A patient may have Hepatitis Band not have signs or symptoms of the disease, or not know that she or he has Hepatitis B.

We break the chain of infection for Hepatitis B by following Standard/Universal Precautions, proper handling and disposal of sharps, and the Hepatitis B Vaccination Program.

The Hepatitis B vaccine is a non-infectious, yeast-based vaccine. It is not made from blood or plasma. It is a series of three injections given in the deltoid muscle at three separate visits. The vaccine is available free of charge to employees of Milestones In Home Care. More than 90% of those who are vaccinated will develop immunity to Hepatitis B. To ensure immunity, it is important for individuals to receive all 3 injections. It is recommended that an individual titer, or presence of antibodies to Hepatitis B be checked approximately 4 to 6 weeks after the 3^rd injection. Once an individual has a documented positive titer no further booster is warranted. The series may be repeated if the titer is negative after 3 vaccines. Any employee who wishes to receive the Hepatitis B vaccine should call us to set up an appointment.

The Occupational Safety and Health Administration’s (OSHA) blood borne pathogen regulations require that any employee who may have occupational exposure to blood or the potentially infectious material must show proof of immunity, receive the Hepatitis B vaccine or sign a refusal form. If you refuse the vaccine and sign the declination form, you may elect to receive the vaccine at a later date should you change your mind.

==============================================

 

HAZARDOUS COMMUNICATIONS

What is Hazardous Communications?

• A way for an employee to get information about chemical hazards in the workplace . The Hazard Communication Book is available in the office. It has chemical inventory lists and identifies the agency’ s HAZARD COMMUNICATION PLAN ON WHAT TO DO IF ANYTHING HAPPENS.

What are Hazardous Materials?

• Substances that are potentially dangerous to your health.

What do you need to know about Chemical Hazards?

• For your protection, to prevent injuries and illness.
• For your safety, some chemicals can cause fire and serious injuries. For your health, some could cause serious health problems.

Types of Hazardous Material:

• Infectious substances
• Radioactive materials
• Toxic chemicals
• Flammable liquids and medical gases

How do you get information on Chemical Hazards?

• Read container labels. [Report any torn or illegible labels to your supervisor.] Labels not only identify chemicals, but also have Hazardous Statements, i.e. warnings, precautions; antidotes; fire/spill/leak instructions and safe handling and storage.

Consult (M) Material (S) Safety (D) Data (S) Sheets = MSDS which are provided by the manufacturer on each product they produce.

MSDS’ contain information on chemical composition, treatment & antidote Manufacturer’s address and telephone number. Instructions on storage boiling point, melting point etc.

What can I do to protect myself?

• Educate yourself by reviewing Material safety Data Sheets and by reading hazard-warning labels.
• Practice safe work habits, i.e., wash hands after contact with each patient and after removing gloves.
• Avoid overstuffing the sharp containers. Never recap needles.
• Contact Poison Control when you have questions; save Poison Control Number: 800-336-6997.

 

==============================================

 

OXYGEN SAFETY

Oxygen itself does not burn, but its presence will support combustion and allow materials to burn that would not ordinarily burn at room temperature. Since oxygen and fuel (any combustible material) is always present, the best means to reduce fire hazards is the elimination of the source of ignition . Therefore, the following safety precautions should be observed when using oxygen.

1. Electrical equipment should be plugged in and running before oxygen flow is started. All oxygen connections should be checked to be sure they are tight and not leaking . Alcohol, ether or flammable liquid must not be used in the vicinity of oxygen use.
2. Avoid dropping clothing or linens onto oxygen lines, cylinders or equipment since fabrics saturated with oxygen ignite easily.
3. Any source of ignition must not be allowed in an area, where oxygen is used e.g., electrical equipment which arcs or sparks, sparking toys
4. Enforce a “No Smoking” policy at all times. If any inadvertent fire is caused by lighting a cigarette in the presence of Oxygen enriched materials , such as sheets, blankets, etc., flames will immediately engulf a patient
5. Oxygen cylinders must be secured upright in stands or on a dolly when not in use.

 

==============================================

 

FIRE/ELECTRICAL SAFETY     EQUIPMENT SAFETY 

ENVIRONMENT SAFETY     DISASTER RESPONSE

FIRE PLAN AND PROCEDURES

This plan and procedure is intended to provide a basic guide for actions to be taken if a fire occurs.

R.A.C.E PROCEDURE

R: RESCUE

A: ALARM

C: CONFINE

E: EXTINGUISH — EVACUATE

RESCUE those who may be in immediate danger away from SMOKE AND FIRE!

RATIONALE: It is most important to separate people from the fire. Therefore, it is necessary to remove patients or any person from the room that is on fire as a first step.

ALARM OTHERS, CALL 911

RATIONALE: Local Fire Department is notified.

CONFINE the fire by closing doors.

RATIONALE: The purpose of closing doors is to prevent the spread of fire and smoke. This containment will prevent fire, smoke and heat from penetrating the corridor area. Place wet linens at the base of door to prevent smoke contaminating the corridor. Toxic smoke can be more dangerous than the flames itself. A

Closed door creates a barrier between you and the fire because it confines the fire in a “compartment”. For instance, if a fire is in a patient room, closing the door to the room will assist in containing the fire and smoke.

NOTE: The converse is also true: A patient is protected inside his room from a fire outside his room for about an hour when the room door is closed.

EXTINGUISH / EVACUATE: Extinguish if possible and no danger exists.

Evacuate the surrounding area, along a horizontal axis to a safe area.

EVACUATION PROCEDURES

1. Patients should be evacuated by means of emergency exits.  Be familiar with all emergency exits from the home.

2. Check each environment prior to entering any exit or stairway.

3. Lead ambulatory patients down to the nearest and safest, uncontaminated exit/stair.

4. Non-ambulatory & helpless patients should be moved using the cradle drop method. Place patient on a blanket, which has been set on the floor. Pull the patient out along floor to safe

NON-AMBULATORY PATIENT EVACUATION: ONE PERSON TECHNIQUE

1. Remove top sheet/blanket from the bed.
2. Loosen bottom sheet around mattress.
3. Wrap the patient’s legs with sheet, mummify the leg area.
4. Roll both sides of sheet parallel to patients’ arms and head.
5. Slide patient to edge of bed and lower legs over the edge.
6. Hold onto both rolled sheet edges and slide the patient’s shoulders onto nurse’s thigh (the nurse bends her knees using her thighs as a slide so the patient is eased down from the bed) and slides the patient onto the floor.
7. Once the patient is on the floor, the nurse drags the patient to an area of refuge.

Equipment Safety

Capabilities, Limitations and Special Applications of Biomedical Equipment

The general rules of operating equipment and understanding capabilities, limitations, and special applications include:

• Be alert at all times
• Insure sufficient space for proper operation of each device or piece of equipment
• Be familiar with normal operating sounds
• Investigate and report to your supervisor any abnormalities with equipment use
• Be sure you are fully trained on equipment use including any special applications

Process for Reporting Medical Equipment Management Problems, Failures and User Errors

All equipment management problems should be reported to the Durable Medical Equipment Company.

CHAIN OF CUSTODY

If any equipment or device has been involved in a patient occurrence and there is suspected injury to a patient, Chain of Custody Procedures must be initiated.

The practitioner must preserve as evidence any device for potential liability.

The practitioner must notify their supervisor immediately.

Chain of Custody establishes a complete and sequential listing of persons who have handled the equipment or device that is suspected of being defective and or causing the injury.

ELECTRICAL SHOCK occurs when a source of voltage is present on the case and/ or power cord of a piece of equipment.

MACROSHOCK is caused by exposed wires; defective electrical plug, and /or power cord, or internal electrical short.

MICROSHOCK is caused by a relatively small current being present on the metal case or connector of the instrument due to the design of the piece of equipment and not necessarily due to malfunction.

Patients vulnerable to micro shock are:

1. Patients with moist or wet skin
2. Small Children
3. Sick adults
4. Patients in a wet environment

You can protect patients by ensuring that the equipment has a three-wire power cord and a three-prong electrical plug.

PRECAUTIONS FOR PREVENTING ELECTRICAL SHOCK

1. Close monitoring of all common hazards.
2. Check for signs of liquid spillage.
3. Use three-prong electrical plugs only.
4. Check for the presence of Durable Medical Equipment tag.
5. Become thoroughly familiar with the use of the equipment.

==============================================

 

­HIPAA: Health Insurance Portability and Accountability Act

HIPAA, the Health Insurance Portability and Accountability Act, is a US law designed to provide privacy standards to protect patients’ medical records and other health information provided to health plans, doctors, hospitals and other health care providers

 

YEARLY REVIEW OF EMPLOYEE SECURITY AND CONFIDENTIALITY AGREEMENT

As an employee of Milestones in Home Care (hereinafter “the Agency”), and as a condition of employment, every employee agrees to the following:

1. I understand that I am responsible for complying with the HIPAA policies, which were provided to me.
2. I will treat all information received in the course of my employment with the Agency, which relates to the patients of the agency, as confidential and privileged information.
3. I will not access patient information unless I have a need to know this information in order to perform my job.
4. I will not disclose information regarding the Agency’s patients to any person or entity, other than as necessary to perform my job, and as permitted under the Agency’s HIPAA Policies.
5. I will not log on to any of the Agency’s computer systems that currently exist or may exist in the future using a password other than my own.
6. I will safeguard my computer password and will not post it in a public place, such as the computer monitor or a place where it will be easily lost, such as on my nametag .
7. I will not allow anyone, including other agency staff, to use my password to log on to the computer.
8. I will log off of the computer as soon as I have finished using it.
9. I will not use e-mail to transmit patient information unless I am instructed to do so by the Privacy Officer.
10. I will not take patient information from the premises of the Agency in paper or electronic form without first receiving permission from the Privacy Officer.
11. Upon cessation of my employment with the agency, I agree to continue to maintain the confidentiality of any information I learned while an employee and agree to turn over any keys, access cards, or any other device that would provide access to the agency or its information.