Chapter 11Chapter 11

Safety and HealthSafety and Health

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Learning ObjectivesLearning Objectives

Understand the purpose of the Occupational Understand the purpose of the Occupational Safety and Health Administration (OSHA).Safety and Health Administration (OSHA).

Follow OSHA guidelines as they pertain to a Follow OSHA guidelines as they pertain to a medical practice.medical practice.

Develop a checklist for a medical practice’s Develop a checklist for a medical practice’s OSHA readiness.OSHA readiness.

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Learning Objectives (cont’d.)Learning Objectives (cont’d.)

Understand the priorities of an OSHA Understand the priorities of an OSHA inspection.inspection.

Identify and define OSHA violations.Identify and define OSHA violations. Understand and discuss the Clinical Understand and discuss the Clinical

Laboratory Improvement Amendments of Laboratory Improvement Amendments of 1988.1988.

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National Patient Safety GoalsNational Patient Safety Goals

Released yearly by the Joint Commission’s Released yearly by the Joint Commission’s Board of CommissionersBoard of Commissioners

As of 2008, there are 37 goals.As of 2008, there are 37 goals.

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Establishment of OSHAEstablishment of OSHA

Develop and enforce mandatory job safety and Develop and enforce mandatory job safety and health standards.health standards.

Maintain reporting and record keeping of job-Maintain reporting and record keeping of job-related injuries.related injuries.

Encourage employers and employees to Encourage employers and employees to reduce hazards.reduce hazards.

Provide for research in occupational safety.Provide for research in occupational safety. Establish separate but dependent Establish separate but dependent

responsibilities and rights. responsibilities and rights. Provide for state-level occupational safety and Provide for state-level occupational safety and

health programs.health programs.

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Bloodborne Pathogen StandardsBloodborne Pathogen Standards

Hazard communication planHazard communication plan Exposure control planExposure control plan Medical waste planMedical waste plan Housekeeping policyHousekeeping policy Personal protective measuresPersonal protective measures General safety precautionsGeneral safety precautions Fire safety planFire safety plan Staff development and in-service training Staff development and in-service training

programprogram

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Hazardous Materials in a Medical Hazardous Materials in a Medical OfficeOffice

Printer or copier cartridgesPrinter or copier cartridges Typing correction fluidTyping correction fluid Glass and surface cleanersGlass and surface cleaners Antibacterial soapsAntibacterial soaps Chemicals used for instrument cleaningChemicals used for instrument cleaning Furniture polishFurniture polish

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Exposure Control PlanExposure Control Plan

Components:Components: Exposure determinationExposure determination Compliance regulationsCompliance regulations HBV vaccinationHBV vaccination Postexposure evaluationPostexposure evaluation Hazards communication to employeesHazards communication to employees Record-keeping requirementsRecord-keeping requirements

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Exposure Control Plan (cont’d.)Exposure Control Plan (cont’d.)

Procedures and policy manual must cover:Procedures and policy manual must cover: Biohazard labelingBiohazard labeling Classification of exposure categoriesClassification of exposure categories Engineering controlsEngineering controls Exposure determinationExposure determination Needlesticks and cutsNeedlesticks and cuts Injury on the jobInjury on the job Incidence of exposure to blood/body fluidsIncidence of exposure to blood/body fluids HBV immunizationsHBV immunizations Protective equipmentProtective equipment

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Biohazard LabelingBiohazard Labeling

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Medical Waste PlanMedical Waste Plan

The plan should include:The plan should include:

Categories of wasteCategories of waste Disposal of sharpsDisposal of sharps In-service trainingIn-service training Medical waste containersMedical waste containers

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Medical Waste Plan (cont’d.)Medical Waste Plan (cont’d.)

The plan should include:The plan should include:

Preparation of medical waste for pick upPreparation of medical waste for pick up Weighing, storing, and tracking medical Weighing, storing, and tracking medical

wastewaste

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Engineering ControlsEngineering Controls

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Personal Protective MeasuresPersonal Protective Measures

Staff must be provided with:Staff must be provided with: GlovesGloves Eye shieldsEye shields Resuscitation bagsResuscitation bags Splash guardsSplash guards Protective jump suitsProtective jump suits Eye wash stationsEye wash stations

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Fire Safety PlanFire Safety Plan

Exits and signsExits and signs Fire drillsFire drills Floor plansFloor plans Hazardous areasHazardous areas Evacuation methodsEvacuation methods

Missing personsMissing persons Testing of sprinkler Testing of sprinkler

systemssystems Emergency Emergency

telephone numberstelephone numbers Fire preventionFire prevention

Office must have written policies andOffice must have written policies andprocedures regarding:procedures regarding:

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Fire Safety Plan (cont’d.)Fire Safety Plan (cont’d.)

Inspection of heat Inspection of heat and air conditioning and air conditioning systemssystems

Testing of fire Testing of fire alarmsalarms

ComplianceCompliance

Missing personsMissing persons Testing of sprinkler Testing of sprinkler

systemssystems Emergency Emergency

telephone numberstelephone numbers Fire preventionFire prevention

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Staff Development/In-Service Staff Development/In-Service TrainingTraining

Training must include:Training must include: Epidemiology and symptoms of HBV and HIVEpidemiology and symptoms of HBV and HIV Modes of transmission of HBV and HIVModes of transmission of HBV and HIV Exposure control planExposure control plan Standard precautionsStandard precautions HBV vaccineHBV vaccine Procedures to follow should exposure occurProcedures to follow should exposure occur Signs, labels, tags, color coding for biohazardsSigns, labels, tags, color coding for biohazards ComplianceCompliance

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Management ResponsibilitiesManagement Responsibilities

Provide a safe, healthful workplace.Provide a safe, healthful workplace. Be familiar with OSHA standards.Be familiar with OSHA standards. Educate staff.Educate staff. Inspect the office.Inspect the office. Minimize hazards.Minimize hazards. Be sure employees have PPE.Be sure employees have PPE. ID hazards.ID hazards.

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Management Responsibilities Management Responsibilities (cont’d.)(cont’d.)

Keep operating procedures.Keep operating procedures. Provide training.Provide training. Report accidents.Report accidents. Keep good records.Keep good records. Allow access to OSHA information.Allow access to OSHA information. Do not discriminate.Do not discriminate. Post citations.Post citations.

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OSHA InspectionsOSHA Inspections

Inspectors will:Inspectors will: check for posting of OSHA safety postercheck for posting of OSHA safety poster review OSHA log of injuries for the past three review OSHA log of injuries for the past three

yearsyears inspect for compliance with OSHA standardsinspect for compliance with OSHA standards comment on and note obvious hazards comment on and note obvious hazards inquire about the existence of a basic safety inquire about the existence of a basic safety

and health programand health program ask for OSHA manualask for OSHA manual

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OSHA Inspections (cont’d.)OSHA Inspections (cont’d.)

Five priorities of an OSHA inspection:Five priorities of an OSHA inspection:

1.1. Imminent dangerImminent danger

2.2. Catastrophes and fatal accidentsCatastrophes and fatal accidents

3.3. Employee complaintsEmployee complaints

4.4. Programmed inspectionsProgrammed inspections

5.5. Follow-up inspectionsFollow-up inspections

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Common Violations of Common Violations of Bloodborne Pathogen StandardsBloodborne Pathogen Standards

Improper storage containers for non-sharps Improper storage containers for non-sharps wastewaste

Inappropriate decontamination of work surfacesInappropriate decontamination of work surfaces PPE noncompliancePPE noncompliance HBV vaccine unavailableHBV vaccine unavailable Improper labeling of containersImproper labeling of containers Hand washing improperly performedHand washing improperly performed Written schedule for cleaning and Written schedule for cleaning and

decontamination not availabledecontamination not available

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CLIACLIA

The amendments to the Clinical Laboratory The amendments to the Clinical Laboratory Improvement Act (CLIA) issued performance Improvement Act (CLIA) issued performance requirements for laboratories.requirements for laboratories.

These amendments apply to physician office These amendments apply to physician office labs (POL) and require inspections by CMS in labs (POL) and require inspections by CMS in order to obtain certification.order to obtain certification.

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Disaster PlanningDisaster Planning

Identify potential risk.Identify potential risk. Store computer backup tapes off-site.Store computer backup tapes off-site. Store emergency supplies off-site.Store emergency supplies off-site. Develop an evacuation plan.Develop an evacuation plan. Develop a plan for patient care off-site.Develop a plan for patient care off-site. Ensure that insurance policy includes Ensure that insurance policy includes

disasters.disasters. Develop a plan for contacting patients, Develop a plan for contacting patients,

vendors, and employee’s families.vendors, and employee’s families.