Healthcare hazard control and safety management

TABLE OF CONTENTS Preface xiii Acknowledgments xv The Author xvii 1 Introduction to Healthcare Hazard Control .............................................................1 A. Introduction 1 B. Healthcare Employment Growth 1 C. Joint Commission on Accreditation of Healthcare Organizations 3 D. American Osteopathic Association 6 E. Canadian Council on Health Services Accreditation 7 F. Commission on Accreditation of Rehabilitation Facilities 8 G. College of American Pathologists Laboratory Accreditation Program 9 H. Institute of Medicine 10 I. American Health Care Association 11 J. American Hospital Association 11 K. Association of Occupational Health Professionals 12 L. Service Employees International Union 13 M. ECRI 13 Summary 13 For Review and Discussion 14 2 Healthcare Safety Management ..............................................................................15 A. Introduction to Safety Management 15 B. Management Efficiencies and Safety 16 C. Safety Leadership 22 D. Human Behaviors 25 E. Safety Cultures and Systems 27 F. Information Management 30 G. Risk Management 31 H. Quality Improvement 33 I. Employee Health 34 J. Worker’s Compensation Program Management 39 K. Chemical Dependency and Substance Abuse 42 L. Materials and Purchasing Management 45 M. Human Resources Management 45 N. Security Management 46 Summary 49 For Review and Discussion 50 viii Healthcare Hazard Control and Safety Management 3 Healthcare Hazard Control ....................................................................................51 A. Introduction 51 B. Management Approach to Hazard Control 51 C. Understanding Hazards 53 D. Understanding Accidents 59 E. Hospital and Healthcare Hazard Categories 68 F. Personal Protective Equipment 71 G. Respirators 75 H. Promoting Safety 85 I. Safety Orientation, Training, and Education 87 Summary 93 For Review and Discussion 94 4 Safety Regulations, Standards, and Organizations ..................................................95 A. Introduction 95 B. Federal Administrative Law 95 C. Occupational Safety and Health Administration 97 D. Environmental Protection Agency 113 E. Food and Drug Administration 118 F. National Institute for Occupational Safety and Health 120 G. Nuclear Regulatory Commission 121 H. Department of Transportation 123 I. Centers for Disease Control and Prevention 123 J. Agency for Healthcare Research and Quality 124 K. National Institutes of Health 125 L. Agency for Toxic Substances and Disease Registry 126 M. Occupational Safety and Health Review Commission 126 N. Health Resources Services Administration 126 O. Centers for Medicare and Medicaid Services 127 P. Department of Homeland Security 128 Q. Federal Emergency Management Agency 129 R. Americans with Disabilities Act 129 S. Clinical Laboratory Improvement Amendments 132 T. Voluntary Organizations 133 U. Trade and Professional Organizations 136 V. Other Safety-Related Professional Organizations 138 W. State, County, and Municipal Health Agencies 139 Summary 139 For Review and Discussion 140 5 Emergency Management and Fire Safety ..............................................................141 A. Introduction 141 B. Defining Emergencies 141 C. Emergency Management and Planning 142 D. Hazard Vulnerability Analysis 148 E. Drills and Training 150 F. Plan Evaluation and Revision 152 G. Evacuation Planning 154 H. Community Involvement 155 I. Hazardous Material Emergencies 156 J. Weather and Natural Disasters 158 K. Other Emergency Situations 163 Table of Contents ix L. Terrorism and Weapons of Mass Destruction 164 M. Decontamination Activities (Weapons of Mass Destruction) 170 N. Introduction to Fire Safety Management 173 O. Life Safety Code ® 174 P. Healthcare Facility Fire Safety Management 178 Q. Fire Prevention Activities 180 R. Interim Life Safety 184 S. Fire Confinement 184 T. Egress 186 U. Portable Fire Extinguishers 188 V. NFPA 99 (Healthcare Facilities) 191 W. Electrical Equipment Installations 191 X. Flammable/Combustible Materials 192 Y. Surgical Fires 194 Summary 197 For Review and Discussion 198 6 General and Physical Plant Safety.........................................................................199 A. Introduction 199 B. Office Safety 200 C. Ergonomics 203 D. Slip, Trip, and Fall Prevention 210 E. Plant Operations Safety 211 F. Tool Safety 216 G. Machinery Safety and Guarding 219 H. Compressed Air 220 I. Safety Signs and Color Schemes 221 J. Welding Safety 222 K. Electrical Safety 224 L. Painting Operations 228 M. Lockout/Tagout (29 CFR 1910.147) 230 N. Permit-Required Confined Spaces (29 CFR 1910.146) 234 O. OSHA Noise Standard (29 CFR 1910.95) 239 P. Utilities Management 242 Q. Plumbing Operations and Safety 246 R. Boiler and Heating Systems 248 S. Refrigeration and Air-Conditioning Maintenance 250 T. Ventilation 252 U. Indoor Air Quality 256 V. Mold in the Workplace 260 W. Vehicle and Forklift Safety 263 X. OSHA Helicopter Standards (29 CFR 1910.183) 267 Y. Landscape/Grounds Maintenance 267 Z. Construction Safety (29 CFR 1926) 269 Summary 273 For Review and Discussion 273 7 Managing Hazardous Materials ............................................................................275 A. Introduction 275 B. Hazardous Materials Exposure Risks 276 C. Emergency Shower and Eyewash Stations (OSHA Requirements 29 CFR 1910.151) 281 x Healthcare Hazard Control and Safety Management D. Hazardous Materials Storage 283 E. OSHA Hazard Communication 285 F. Compressed Gas Safety 289 G. Department of Transportation Hazardous Material Regulations 290 H. Healthcare Hazardous Materials 293 I. Other Hazardous Materials and Pesticides 308 J. Hazardous Drug Safety 309 K. Anesthetic and Other Gases 312 L. Waste Management 315 M. Responding to Hazardous Materials Spills and Releases 321 Summary 322 For Review and Discussion 323 8 Biological Hazard Control ....................................................................................325 A. Introduction 325 B. Infection Control Requirements 325 C. Centers for Disease Control and Prevention 327 D. CDC Standard Precautions 328 E. Bacteria and Viruses 330 F. Healthcare Worker Immunizations 331 G. Methicillin-Resistant Staphylococcus aureus 332 H. Disinfectants, Sterilants, and Antiseptics 333 I. Hepatitis and HIV 336 J. OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) 339 K. Tuberculosis 347 L. Biosafety Levels 351 M. Healthcare Opportunistic Infections 353 N. Biological Waste Management 359 O. DOT Infectious Substances Shipping Requirements 363 P. Special Infection Control Topics 364 Summary 365 For Review and Discussion 365 9 Safety in Patient and Clinical Areas ......................................................................367 A. Introduction 367 B. Safety Cultures 367 C. Patient Safety 369 D. Bed Safety 375 E. Fall Prevention 380 F. Use of Restraints 383 G. Healthcare Workplace Violence 386 H. Long-Term-Care Combative Resident Behavior 390 I. Medication Safety 392 J. Infant Abduction Prevention 396 K. Nursing and Clinical Departmental Safety 400 L. Surgical and Operating Room Safety 412 M. Lasers 417 N. Patient and Resident Moving and Lifting 422 Summary 433 For Review and Discussion 434 Table of Contents xi 10 Support Department Safety ..................................................................................435 A. Introduction 435 B. Environmental services 435 C. Laundry Safety 443 D. Food Service Department Safety 446 E. Facility Security Management 455 F. Radiology and Nuclear Medicine 458 G. Nonionizing Radiation 469 H. Laboratory Safety 472 I. Central Sterile Supply 479 J. Pharmacy Safety 483 K. Medical Equipment Management 495 L. OSHA HAZWOPER Training for Support Personnel 497 M. Support Department Ergonomics 498 Summary 500 For Review and Discussion 500 11 Glossary................................................................................................................503 12 Appendices ...........................................................................................................533 Appendix A. Acronyms 533 Appendix B1. Accident Investigation Report 539 Appendix B2. Near-Hit Report 540 Appendix C1. Key OSHA Bloodborne Pathogens Compliance Issues 541 Appendix C2. Sample OSHA Bloodborne Pathogens Standard Exposure Control Plan 544 Appendix C3. OSHA Bloodborne Pathogens Training Requirements and Sample Education Plan 551 Appendix C4. Barrier Precautions for Exposure to Blood or Body Fluids 557 Appendix D. OSHA Standards for Selected Areas or Departments 560 Appendix E. OSHA Hospital Health Hazards 566 Appendix F. OSHA Multi-Employer Citation Policy 570 Appendix G1. Germicide Effectiveness 573 Appendix G2. Leadership Tips for Healthcare Environmental Services Professionals 574 Appendix H. OSHA HAZWOPER (29 CFR 1910.120) Training Requirements 579 Appendix I. Model Laboratory Chemical Hygiene Plan 584 Appendix J1. Hazardous Materials Training Plan 589 Appendix J2. Model Hazard Communication Program 593 Appendix K. Overview of NFPA 1600, Managing Emergencies 596 Appendix L. Worker Safety Perception Survey 597 Appendix M. Safety Evaluation Profile (SEP) 600 Appendix N. OSHA General Industry Training Requirements for Healthcare 610 Appendix O. Key OSHA Compliance Issues for Dental/Medical Offices 618 Appendix P. Healthcare Resources for Emergency Management 620 Appendix Q. Back Injury Prevention Workplace Evaluation Tools 623 Appendix R. Patient and Resident Moving Guidelines 633 Appendix S. Partial List of NFPA Standards Relevant To Healthcare 636 Appendix T. Overview of DOT-Regulated Medical Waste Standards 637 Appendix U. CDC Hand Hygiene Recommendations Chart 640 xii Healthcare Hazard Control and Safety Management Appendix V. Sample Permit-Required Confined Space Program Elements 643 Appendix W. Patient Safety Plan Development Considerations 651 Appendix X. Sample Construction Infection Control Program Elements 654 Appendix Y. OSHA Recording of Work-Related Injuries and Illnesses 658 Appendix Z. Key OSHA Compliance Standards for Funeral Homes 662 13 Safety Checklists ...................................................................................................665 14 Agency Listings .....................................................................................................753 Alphabetical Listing 753 Website Quick Reference 757 Selected Disaster Resource Information 762 15 Bibliography .........................................................................................................763 Index.............................................................................................................................771