Bourbonnais, IL Workers have a right to a safe workplace. The law - - PowerPoint PPT Presentation

Presented by

Steven S. Wilder Sorensen, Wilder & Associates Bourbonnais, IL

Workers have a right to a safe workplace. The law requires employers to provide their employees with working conditions that are free

• f known dangers. The OSHA law also

prohibits employers from retaliating against employees for exercising their rights under the law (including the right to raise a health and safety concern or report an injury.

 Management Commitment & Employee

Involvement

 Worksite Analysis  Engineering Controls and Work Practice

Controls

 Training  Recordkeeping

 Originally created for Long Term Care

 High injury rate  High turnover rate  Higher acuity

 Now seems to be model being “unofficially”

used across all areas of healthcare

 Expired 5/1/15.  Renewed for indefinite period this time.

 Bloodborne Pathogens  Slips / Trips / Falls  Tuberculosis  Ergonomics  Workplace Violence  Recordkeeping  Other Hazards (identified at time of survey)

 Comprehensive review to ensure:

 Written Exposure Control Plan meets requirements  Implementation of work practice and engineering

controls

 Identify procedures that require use of sharps  Confirm that all identified procedures have been

evaluated for the implementation of safer devices

 Determine whether the employer solicited feedback

from non-managerial employees responsible for direct care who are potentially exposed to injuries from contaminated sharps



Ensure that proper work practices and personal protective equipment are in place.



Assess whether containment of regulated waste is performed properly.



Evaluate and document the availability of handwashing

• facilities. If immediate access to handwashing facilities is not

feasible, ascertain whether skin cleansers are used (e.g., alcohol gels).



Assess the use of appropriate personal protective equipment (e.g., masks, eye protection, face shields, gowns and disposable gloves, including latex-free gloves, where appropriate).



Ensure that a program is in place for immediate and proper clean-up of spills, and disposal of contaminated materials, specifically for spills of blood or other body fluids.



Ensure that the employer has chosen an appropriate EPA- approved disinfectant to clean contaminated work surfaces and that the product is being used in accordance with the manufacturer’s recommendations.



Determine that the employer has made available to all employees with occupational exposure to blood or OPIM the hepatitis B virus (HBV) vaccination series within 10 working days of initial assignment at no cost to the employee and that any declinations are documented.



Ensure that healthcare workers who have contact with patients or blood and are at ongoing risk for percutaneous injuries are offered a test for antibody to the HBV surface antigen in accordance with the U.S. Public Health Service guidelines.



Investigate procedures implemented for post-exposure evaluation and follow-up following an exposure incident



Observe whether appropriate warning labels and signs are present.



Determine whether employees receive training in accordance with the standard.



Evaluate the employer’s sharps injury log. Ensure that all injuries that appear on the sharps injury log are also recorded on the OSHA-300 log.



Ensure that employees’ names are not on the log, but that a case or report number indicates an exposure incident.



Determine whether the employer uses the information on the sharps injury log when reviewing and updating its ECP.



Ensure that the employer has chosen an appropriate EPA- approved disinfectant to clean contaminated work surfaces and that the product is being used in accordance with the manufacturer’s recommendations.



Determine that the employer has made available to all employees with occupational exposure to blood or OPIM the hepatitis B virus (HBV) vaccination series within 10 working days of initial assignment at no cost to the employee and that any declinations are documented.



Ensure that healthcare workers who have contact with patients or blood and are at ongoing risk for percutaneous injuries are offered a test for antibody to the HBV surface antigen in accordance with the U.S. Public Health Service guidelines.

 Evaluate the general work environments (e.g.,

hallways, points of access and egress, waiting areas) and document hazards likely to cause slips, trips, and falls, such as but not limited to:

 Slippery or wet floors, uneven floor surfaces, cluttered or

• bstructed work areas/passageways, poorly maintained

walkways, broken equipment, or inadequate lighting

 Unguarded floor openings and holes  Damaged or inadequate stairs and/or stairways  Elevated work surfaces which do not have standard

guardrails

 Improper use of ladders and/or stepstools

 Note any policies, procedures and/or engineering

controls used to deal with wet surfaces. These would include, but are not limited to, ensuring spills are reported and immediately cleaned up, posting signs/barriers alerting employees to wet floors, keeping passageways/aisles clear of clutter, and using appropriate footgear.

 Where appropriate, evaluate the use of no-skid waxes

• r other types of coated surfaces designed to enhance

surface friction.



Nearly one-third of the world's population is infected with Tuberculosis (TB), nearly 9 million develop the disease, and it kills almost 2 million people per year. In the United States, approximately 13,000 new cases of TB are reported annually, and 650 persons die from TB each year. TB is the leading cause of mortality among persons infected with HIV.

If your clinic / facility is accepting patients with known HIV or known TB, you must comply with the requirements of OSHA and NIOSH to protect healthcare workers from exposure. These include: Administrative Controls

 The first and most important level of TB controls is the

use of administrative measures to reduce the risk for exposure to persons who might have TB disease. Administrative controls consist of the following activities:

 assigning responsibility for TB infection control in the

setting;

 conducting a TB risk assessment of the setting;



developing and instituting a written TB infection-control plan to ensure prompt detection, airborne precautions, and treatment of persons who have suspected or confirmed TB disease



ensuring the timely availability of recommended laboratory processing, testing, and reporting of results to the ordering physician and infection-control team



implementing effective work practices for the management

• f patients with suspected or confirmed TB disease



ensuring proper cleaning and sterilization or disinfection of potentially contaminated equipment (usually endoscopes)



training and educating HCWs regarding TB, with specific focus on prevention, transmission, and symptoms



screening and evaluating HCWs who are at risk for TB disease or who might be exposed to M. tuberculosis (i.e., TB screening program)



applying epidemiologic-based prevention principles, including the use of setting-related infection-control data



using appropriate signage advising respiratory hygiene and cough etiquette



coordinating efforts with the local or state health department

Environmental Controls



The second level of the hierarchy is the use of environmental controls to prevent the spread and reduce the concentration

• f infectious droplet nuclei in ambient air.



Primary environmental controls consist of controlling the source of infection by using local exhaust ventilation (e.g., hoods, tents, or booths) and diluting and removing contaminated air by using general ventilation.



Secondary environmental controls consist of controlling the airflow to prevent contamination of air in areas adjacent to the source (AII rooms) and cleaning the air by using high efficiency particulate air (HEPA) filtration or UVGI.

Respiratory-Protection Controls



The third level of the hierarchy is the use of respiratory protective equipment in situations that pose a high risk for

• exposure. Use of respiratory protection can further reduce

risk for exposure of HCWs to infectious droplet nuclei that have been expelled into the air from a patient with infectious TB disease (see Respiratory Protection). The following measures can be taken to reduce the risk for exposure:

 implementing a respiratory-protection program,  training HCWs on respiratory protection, and  training patients on respiratory hygiene and cough etiquette

procedures.

Ergonomics is the science of fitting the job to the

• worker. When there is a mismatch between the

physical requirements of the job and the physical capacity of the worker, work-related musculoskeletal disorders (MSDs) can result. Ergonomics is the practice of designing equipment and work tasks to conform to the capability of the worker, it provides a means for adjusting the work environment and work practices to prevent injuries before they occur.

Employers are encouraged to perform Job Safety Analysis (JSA)

• n all positions to identify potential areas where employees

may sustain MSD’s. A training program, designed and implemented by qualified persons, should be in place to provide continual education and training about ergonomic hazards and controls to managers, supervisors and all healthcare providers, including "new employee" orientation. Training should be updated and presented to employees as changes occur at the workplace, and be at a level of understanding appropriate for those individuals being trained



Lifting guidelines for health care workers (nurse assistants, licensed practical nurses, registered nurses) which should include:

 Never transfer patients/residents when off balance  Lift loads close to the body  Never lift alone, particularly fallen patients/residents, use team

lifts or use mechanical assistance

 Limit the number of allowed lifts per worker per day  Avoid heavy lifting especially with spine rotated  Training in when and how to use mechanical assistance  Nobody lifts anything in excess of 35#

 Workplace violence (WPV) is a recognized hazard

across all disciplines of healthcare. NIOSH defines workplace violence as violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty

 OSHA has no codified standard for WPV  OSHA Guideline 3148 addresses WPV in healthcare

settings

 Enforced under General Duty Clause

 Your program should include:

 Written WPV plan, including “zero tolerance” statement

and domestic violence guidelines

 Complete worksite analysis /risk assessment for your

• peration

 Review of records / incidents of past acts  Job hazard analysis  Employee surveys / questionnaires  Work practice and engineering controls  Training for all employees  Annual program evaluation

 Required for all employers with 10 or more

employees

 Records to be maintained include:

 OSHA 300 log  OSHA 300- A Summary  OSHA 301 Incident report*

 Records must be maintained if an incident

meets the general recording criteria, which are:

* Alternate form may be used if it contains all required information

An OSHA 300 Log entry must be made if:

 Death of worker as result of incident  Lost work days as result of incident  Restricted work days (light duty) as result of

incident

 Loss of consciousness from incident  Medical treatment greater than first aid

 In addition, you must CALL OSHA and report to

them any of the following:

 Any work related fatality must be called in within 8 hours  Any worker injury that results in in-patient

hospitalization of the injured employee, any amputations,

• r any loss of an eye must be reported within 24 hours of

the incident

 You can report to OSHA by:

 Calling OSHA's free and confidential number at 1-800-

321-OSHA (6742).

 Calling your closest Area Office during

normal business hours.

 A pandemic is a global disease outbreak. An

influenza pandemic occurs when a new influenza virus emerges for which there is little

• r no immunity in the human population,

begins to cause serious illness and then spreads easily person-to-person worldwide

 Recent pandemics include:

 Bird Flu (avian influenza), 1997  SARS (severe acute respiratory syndrome) 2002  West Nile Virus, 1937 & 1994  Mad Cow Disease ( bovine spongiform

encephalopathy) 2007

 H1N1 (Swine flu) 2009  S1 (infectious bronchitis)  Y 2 K, 2000

Employee risks of occupational exposure during a pandemic may vary from very high to high, medium,

• r lower (caution) risk.

The level of risk depends in part on whether or not jobs require close proximity to people potentially infected with the pandemic influenza virus, or whether they are required to have either repeated or extended contact with known or suspected sources of pandemic virus such as coworkers, the general public, outpatients, school children or other such individuals or groups



Very high exposure risk occupations are those with high potential exposure to high concentrations of known or suspected sources of pandemic influenza during specific medical or laboratory procedures.



High exposure risk occupations are those with high potential for exposure to known or suspected sources of pandemic influenza virus.



Medium exposure risk occupations include jobs that require frequent, close contact (within 6 feet) exposures to known or suspected sources of pandemic influenza virus such as coworkers, the general public, outpatients, school children or other such individuals or groups.



Lower exposure risk (caution) occupations are those that do not require contact with people known to be infected with the pandemic virus, nor frequent close contact (within 6 feet) with the

• public. Even at lower risk levels, however, employers should be

cautious and develop preparedness plans to minimize employee infections.

 Occupational Risk Pyramid for Pandemic

Influenza

 Very High Exposure Risk:

 Healthcare employees (for example, doctors, nurses,

dentists) performing aerosol-generating procedures

• n known or suspected pandemic patients (for

example, cough induction procedures, bronchoscopies, some dental procedures, or invasive specimen collection)

 Healthcare or laboratory personnel collecting or

handling specimens from known or suspected pandemic patients (for example, manipulating cultures from known or suspected pandemic influenza patients)

 High Exposure Risk:

 Healthcare delivery and support staff exposed to

known or suspected pandemic patients (for example, doctors, nurses, and other staff that must enter patients' rooms)

 Medical transport of known or suspected pandemic

patients in enclosed vehicles (for example, emergency medical technicians)

 Performing autopsies on known or suspected

pandemic patients (for example, morgue and mortuary employees)

 Medium Exposure Risk:

 Employees with high-frequency contact with the

general population (such as schools, high population density work environments, and some high volume retail).

 Lower Exposure Risk:

 Employees who have minimal occupational contact

with the general public and other coworkers (for example, office employees).

 Work Practice Controls:

 Providing resources and a work environment that

promotes personal hygiene. For example, provide tissues, no-touch trash cans, hand soap, hand sanitizer, disinfectants and disposable towels for employees to clean their work surfaces.

 Encouraging employees to obtain a seasonal influenza

vaccine (this helps to prevent illness from seasonal influenza strains that may continue to circulate).

 Providing employees with up-to-date education and

training on influenza risk factors, protective behaviors, and instruction on proper behaviors (for example, cough etiquette and care of personal protective equipment).

 Developing policies to minimize contacts between

employees and between employees and clients or customers.

 Engineering Controls:

 Installing physical barriers, such as clear plastic sneeze

guards.

 Installing a drive-through window for customer service.  In some limited healthcare settings, for aerosol generating

procedures, specialized negative pressure ventilation may be indicated.

 Personal Protective Equipment

If used correctly, PPE can help prevent some exposures; however, they should not take the place of other prevention interventions, such as engineering controls, cough etiquette, and hand hygiene:

 Selected based upon the hazard to the employee;  Properly fitted and some must be periodically refitted (e.g.,

respirators);

 Conscientiously and properly worn;  Regularly maintained and replaced, as necessary;  Properly removed and disposed of to avoid contamination of

self, others or the environment.

Steve Wilder Sorensen, Wilder & Associates 727 Larry Power Road Bourbonnais, IL 60914 800-568-2931 (toll free) 815-482-2989 (cell) swilder@swa4safety.com www.swa4safety.com @SorensenWilder