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CHAPTER 21
Safety
Objectives:
As a result of successfully completing this
chapter, students will be able to:
 Discuss common safety hazards applicable
to Central Service functions and work areas,
and explain how employee injuries can be
prevented
 Describe special safety precautions for
handling Ethylene Oxide
 Review procedures to report employee
accidents and injuries
Objectives: (continued)
 Explain the importance of ergonomics
and health awareness for Central Service
Technicians
 Discuss procedures to prevent patient
accidents and injuries and to report them if
they occur
 Explain basic procedures which address
three occupational hazards: fire, hazardous
substances, and bloodborne pathogens
 Discuss the basics of internal and
external disaster plans for a healthcare
facility
“Safe”
Freedom from danger, risk or injury
Central Service Technicians are responsible
for working safely after they have been ,made
aware of workplace hazards
Accidents and Injury:
Are not funny
Can happen to anyone
“It will never happen to
me.” is a dangerous
attitude
HAZARDS
Common Central
Service Workplace
Soiled Receiving and
Decontamination Areas
Biohazard
 Prevent Biohazard
exposures (Blood Borne
Pathogens) and exposures
to chemicals, by wearing
appropriate Personal
Protective Equipment (PPE)
 If you are exposed to body
fluids or chemicals notify
your supervisor
immediately
Safety Tips for Working in Soiled Receiving
and Decontamination Areas:
 Never put your hands into a basin
or container holding contaminated
objects that you cannot see
 Never put your hands into a trash
container; instead remove the
inner bag and pour its contents
onto a surface, or use an
instruments to sort through the
contents
 Pour out any solution that
prohibits visual examination of
basin or container contents
 Place all disposable sharps
(needles, blades, etc.) in an
appropriate sharps container
CUTTING INSTRUMENTS
INCLUDING KNIVES, SCALPELS,
BLADES, NEEDLES AND SCISSORS
OF ALL TYPES
Sharps
Safety Tips for Working in Soiled
Receiving and Decontamination Areas:
 Use extreme caution when
disarming scalpel blades. Never use
your hands. Use needle holder or
other tool and wear eye protection
 When reprocessing reusable sharps,
separate them from other
instruments and position them in a
way that will avoid injury to others
 Follow manufacturers’
recommendations for safe use of
chemicals
 Always wear PPE to protect yourself
from chemical exposures
Safety Tips for Working in Soiled
Receiving and Decontamination Areas:
 Follow manufacturers’
recommendations for safe operation
of cleaning and testing equipment
 Use caution when walking in areas
with wet floors
 Utilize mats or nonskid footwear
when appropriate
 Use care when loading or unloading
carts from dumbwaiters and
elevators
 Sinks and work surfaces should be at
appropriate levels to reduce back
and arm strain
Safety Tips for Working in Soiled
Receiving and Decontamination Areas:
 When scrubbing instruments in a sink,
always scrub below the surface of the
water to prevent aerosols
 Use the concentration of detergents
and water recommended by the
manufacturer
 Use thermal insulated gloves when
handling washer baskets, sterilizer
carts and other hot objects
 Move sterilizer carts to low or no
traffic areas to reduce the chance
passersby will come in contact with
the hot cart and be burned
Safety Tips for Working in Preparation
and Sterilization Areas:
 Inspect all equipment for
frayed electrical cords
 Use caution when using
heat sealers
 Use caution when using a
cutting edge
 When lifting instrument
sets, size up the load and lift
with the larger muscles in
your legs and arms
 Hold the item as close to
your body as possible
Safety Tips for Working in Preparation
and Sterilization Areas:
 Follow all procedures for the
handling and disposal of biological
tests
 Continuously check sterilizers for
obvious damage to doors
 Only authorized service personnel
should access control panels and
inner parts of sterilization equipment
for repairs and adjustments
 Only those people who have been
trained to operate sterilizer should
do so
 Unauthorized hospital personnel,
visitors, or visitors should not enter
an area that contains sterilizers
Safety Tips for Working in Preparation
and Sterilization Areas:
 Ensure that proper signs
are warning labels are
posted to warn of hot
surfaces and other hazards
 Use only secure and sturdy
shelving
 Use safety ladders and
stools to reach high items.
Do not climb on shelves
Safety Tips for Working in Supply
Receiving, Breakout, and Storage Areas:
 Use appropriate containers for waste
 Use specialized containers for
storage and disposal of hazardous
materials
 MSDS Sheets should be available for
reference
 Use caution when removing items
from storage units or shelves
 Insure there is time and space to
safely retrieve items
 Use care when using box-cutting
tools
 Scalpel blades should NEVER be
used to open boxes or containers
MSDS
Safety Tips for Working in Supply
Receiving, Breakout, and Storage Areas:
 Handle paper products with care to avoid skin lacerations
 Do not handle broken glass
 Avoid twisting and jerking movements when moving objects
 Inspect work areas for objects left in pathways. Aisles and
doorways must be kept clear at all times
 When working in small areas be aware of traffic patterns
 To avoid injury perform appropriate stretching exercises before
lifting, pushing or pulling
 When transporting patients, supply carts, or equipment be sure
the path in front and on each side of the cart is clear
 Ensure clearance on each side of objects you are carrying to avoid
injury to arms and hands
Safety Tips for Working in Equipment
Distribution and Central Transport Areas:
 Inspect floors for uneven surfaces to
ensure equipment being rolled is not
thrown off balance
 Use caution when approaching automatic
doors
 Use caution when approaching corners or
intersections; use safety mirrors when
available
 Use caution when pushing objects up or
down inclines
 Do not ride or step on supply carts or
other vehicles
 Consider the acquisition and use of
powered carts for moving heavy or
awkward loads
Safety Tips for Working in Equipment
Distribution and Central Transport Areas:
 Consider the acquisition and use of
powered carts for moving heavy or
awkward loads
 Assembly work should be performed
at levels that will least fatigue and
strain employees
 Floors in work areas where employees
must stand should have fatigue mats
to relieve leg strain
 Appropriate chairs should be used at
computer, clerical, and instrument
work stations to properly support
employees backs
 Computer screens should be used to
reduce eyestrain
Safety Tips for Working in Clerical and
other Work Stations:
 Items used frequently to
perform routine tasks should
be stored within easy reach
 Caution should be used when
working with filing cabinets.
Open upper drawers increase
the risk of the cabinet tipping
and open lower drawers
increase the risk of someone
tripping
Handling Compressed Gas Cylinders
 Central Service Technicians
must understand and follow
basic safety precautions
when handling,
transporting, and storing
compressed gas cylinders
Compressed Gas Cylinder
Safety Precautions
 Do not dispense gas cylinders that are not labeled
 Make sure that gas cylinders are secured at all times to prevent
tipping
 Handle carefully when transporting. Do not roll, drag, or drop.
 Use a cover cap during transport
 Cylinder regulators are not interchangeable. Be sure to use the
correct regulator for the gas you are handling
 Inspect all fittings for damage before connecting
 Cylinders should be clearly labeled as ; Full, In Use, or Empty
 Empty cylinders should not be store with full cylinders
 Gas regulator stem valves require a key. That key should be kept
with the regulator at all times
SAFETY
Ethylene Oxide
Dangers of EtO
EtO is a Toxic Gas
100% EtO is Flammable
100% EtO is Explosive
Carcinogenic
 Shown to facilitate cancer in
laboratory tests
 Follow manufacturer’s
handling instructions
Teratogen
 A chemical substance that
may cause harm to an
unborn fetus
 Pregnant women should be
aware of teratogens
Common EtO Terminology
…reading
the fine print
Parts Per Million
Parts Per Million (PPM) is the
term used to measure the
volume of gas in a vapor
Time Weighted Average
Time Weighted Average
(TWA) refers to the exposure
level broken down over the
entire length of the employee’s
shift
Short Term Exposure Limit
Short Term Exposure Limit (STEL)
refers to the concentration limit
over a short time
Permissible Exposure Limit
Permissible Exposure Limit
(PEL) is the maximum
concentration limit allowed by
OSHA over the length of the
shift.
EtO exposure may be possible:
 In the front of the sterilizer by
the door
 In the rear of the sterilizer by
the drains
 Near emission control devices
 In the tank changing area
 When cylinders or
connections leak
EtO Safety Precautions:
 When transferring sterilized items to aeration cabinets, wear gloves
made of neoprene or other appropriate protective material
 Do not hold sterilized items that have not been aerated close to your
body
 When transporting a from the sterilizer to the aerator, pull it instead
of pushing to avoid inhaling EtO fumes
 Avoid working in areas immediately adjacent to the EtO sterilizer
during its cycle. When possible, EtO sterilizer should be located in a
separate room
 Facilities must have a dedicated ventilation system to remove fumes
exhausted during the cycle
 Audible and visual alarms should be installed to alert workers to the
presence of EtO in the work area
EtO Safety Precautions:
Facilities must comply with federal,
state, and local requirements for:
Air Quality
Worker Safety
Discharge
Air Monitoring
Recordkeeping
EtO Safety Precautions:
 With some sterilizers the door of the sterilizer must be opened 6
inches after the cycle is complete and the load must sit in the
chamber for 15 minutes before transfer to the aerator. (Check
manufacturer’s instructions for specific guidelines)
 Once items have been placed in an aeration cabinet, the cycle
should not be interrupted and the door of the aerator should not
be opened
 No items should be removed from the aerator until the aeration
cycle is complete
 Do not mix loads in the aerator. Do not add newly sterilized
items to an aerator that has other items in it
 Report EtO exposures immediately
 Observe out of order and electrical lock out signage
Employee Accident and Injury
Reports
 All employee accidents and
injuries must be reported
 Page 409 in the text
provides an example of an
employee injury report
THE PROCESS OF CHANGING
WORK, OR WORKING CONDITIONS
TO REDUCE EMPLOYEE STRESS.
Ergonomics
AN INJURY TO, OR DISORDER OF THE
MUSCULOSKELETAL SYSTEM WHERE
EXPOSURE TO WORKPLACE RISK FACTORS
MAY HAVE CONTRIBUTED TO THE
DISORDER’S DEVELOPMENT OR
AGGRAVATED A PRE-EXISTING CONDITION
Work-related Musculoskeletal
Disorder
(WMSD)
Ergonomic Stressors:
Force - Such as heavy lifting or manipulating equipment
or tools
Repetition – Using the same motion continually or
frequently
Awkward Positions – Assuming positions that place
stress on the body
Vibration – Rapid oscillation of the body or a body part
Contact Stress – Pressing the body or a body part
against a hard or sharp edge
Reducing WMSDs
Management and Staff must commit to
implementing and following work procedure
and equipment changes that reduce the risk of
WMSDs
All employees must be trained properly
An evaluation of the training programs must
be assessed
Reducing the Risk of Injury
 Central Service employees
should also maintain their
physical health in a manner
consistent with the physical
demands of their work
Preventing Patient Injuries
 Central Service Technicians
help keep patients safe from
injuries, accidents, and
infections
Preventing Patient Injury
Patient Care Equipment
 Test and document all patient care equipment according to manufacturer’s
guidelines
 Ensure that all equipment has been properly decontaminated
 Ensure that all equipment is free from visible defects, such as bent parts,
frayed electrical cords, etc.
 Track and control equipment, document its use
 Ensure that regularly scheduled preventive maintenance is performed and
documented
 Ensure that the facility’s Biomedical Engineering Department is involved in
equipment testing as required
 Assure that safety guards are placed over items as required
 Always cover contaminated equipment being transported to Central Service to
prevent cross-contamination
Preventing Patient Injury
Contaminated Supplies and Reusable Medical Devices
Ensure that all items are thoroughly disassembled, cleaned,
inspected, prepared, packaged, and sterilized according to
protocol
Test processing equipment
Ensure that everyone is properly trained on the equipment
they use
Insure that all instruments are complete and functional
before use
Monitor all sterilization equipment
Preventing Patient Injury
Chemical Residues
Ensure that all items sterilized with EtO are thoroughly
aerated before dispensing them for patient use
Ensure that all items placed in the EtO sterilizer are dry
before they are sterilized
Thoroughly rinse items soaked in glutaraldehyde or other
chemicals
Preventing Patient Injury
Supply and Equipment Transport
Use caution when approaching doors, hallway
intersections, elevators and high traffic areas
Do not use a transport vehicle to prop open or
push open automatic doors
Do not block hallways with carts and equipment
Do not block doors with carts and equipment
Reporting Patient Accidents, Injuries, and
Incidents
ALL accidents, injuries or incidents involving
patients must be reported and investigated
All healthcare workers should report unsafe
practices or hazards that could pose a threat
to patients
Sterilization Process Malfunctions:
 If a sterilization process
malfunctions, all items in
any loads that are thought
to be unsterile must be
recalled
 All Central Service
Technicians must be aware
of their department’s recall
policy
Basic Steps in the Load Recall Process:
Obtain a list of all supplies known to be in the load
Verify the sterilization controls
Notify the Central Service Supervisor, Manager, or
Director
Notify areas (user units) where unsterile items may be
located
Retrieve as many items as possible
Notify Infection Control, the Operating Room, and the
administration according to policy
Basic Steps in the Load Recall Process:
Notify physicians if unsterile items were used in any
procedures they preformed
Document all steps taken
Notify Risk Management Department
Ensure that qualified service personnel inspect the
malfunctioning equipment and that a comprehensive
report is developed
Consult ANSI/AAMI ST79 for specific information
regarding testing before the sterilizer is placed back
into service
Central Service Occupational Hazards
Physical
ChemicalBiological
Fire and Explosions
 All healthcare employees
must take precautions to
minimize the risk of fire and
explosions in the healthcare
facility
THE WEIGHT OF COMBUSTIBLE
MATERIALS PER SQUARE FOOT OF AREA
IN WHICH THOSE MATERIALS ARE
LOCATED
Combustible Loading
Healthcare Fire Safety Programs Must
Include:
Minimization of the Combustible Load
Fire Response Plans
Early Detection
Removal of Persons in Danger
Containment of Fire and Combustible
Products
Extinguishment
Evacuation
Fire Triangle
Combustible/Flammable Substance
Source of OxygenSource of Ignition
Many Facilities Use the RACE Plan
Remove persons in
danger
Alarm Call 911 or
activate alarms
Contain the fire. Close
doors in the area
Extinguish the fire if
safe or Evacuate the area
Hazardous Substances
 Healthcare facilities must
develop a plan to safely
handling chemicals and
other hazardous substances
 Original and secondary
containers of chemicals
must be clearly labeled
MSDS Sheets
 The chemicals used in
Central Service are very
different from the ones
you use at home.
 MSDS Sheets help us
understand how to use
them safely and what to do
in an emergency.
 Understanding our
Chemicals is in your own
best interest.
MSDS Sheets
Contain Important Information
 Product Identification
 List of Hazardous Ingredients
 Physical Data
 Fire and Explosion Information
 Reactivity Data
 Health Hazard Data
 Storage Recommendations
 Emergency and First Aid Procedures
 Spill or Leak Procedures
 Protection Information and Control
Measures
 Special Precautions
Healthcare Facilities must:
 Make MSDS sheets
available to employees.
 Provide training to
employees
 Central Service Technicians
are responsible to handle
hazardous substances
according to procedures
Hazardous Substances
 Pages 421 and 422 in the
text provide lists of common
hazardous materials by
hospital department and a
list of regulated chemicals
and their exposure limits
Disaster Plans and Preparedness
…BEING READY FOR
THE UNEXPECTED…
Disaster
Preparedness...
Types of Disasters
Internal Disaster
 Any situation with the
potential to cause harm to
Central Service employees
or where the loss of utilities
may drastically impact
department operations (i.e.
fire, the loss of water, etc.)
External Disaster
 A situation in which
activities external to the
facility affects departmental
or facility operations (i.e. a
natural disaster, a terrorist
attack, etc.)
Elements of a
Central Service Disaster Plan:
 An emergency call list
outlining lines of
authority and key
individuals to be
notified in specific
types of disasters
Elements of a
Central Service Disaster Plan:
 Protocols for inventory
replenishment and delivery
of emergency supplies
 Posted evacuation plans and
practices drills to ensure
that employees know
alternative ways to leave the
department if their safety is
at risk
Elements of a
Central Service Disaster Plan:
 A well-known and
understood organizational
structure that presents lines
of authority
 Responsibility lists to
identify employees
responsible for certain tasks
during disaster situations
Elements of a
Central Service Disaster Plan:
 Directions for alternative
communications and
transportation if existing
systems (i.e. telephones,
elevators, etc.) cannot be
used
Elements of a
Central Service Disaster Plan:
 Directions for locations for
utility and power shut off
points
 Plans for prioritizing sterile
processing and supply
distribution based on failing
utilities or internal damage
Elements of a
Central Service Disaster Plan:
 A facility risk assessment
that assesses the facility’s
current level of
preparedness to help
guide planning efforts
 A description of how the
institution's disaster
planning and response
efforts are integrated with
other community
response organizations
Elements of a
Central Service Disaster Plan:
The Threat of
Bioterrorism
 Planning for suspected or
confined terrorism events
must be well-organized and
rehearsed
The Threat of
Bioterrorism
Factors that Should alert Healthcare Providers to the
Possibility of a Bioterrorism Attack:
A rapidly increasing disease incidence in a
normally healthy population
An epidemic curve that rises and falls in a
short period of time
An unusual increase in the number of people
with respiratory and gastrointestinal
complaints
An endemic disease rapidly emerging at an
uncharacteristic time or in an unusual pattern
Lower attack rates among people who have
been indoors, especially areas with filtered air
or closed ventilation systems
A cluster of patients arriving from a single
locale
Large numbers of rapidly fatal cases
Any patient presenting a disease that is
relatively uncommon and has bioterrorism
potential (i.e. tularemia, pulmonary anthrax,
etc.)
Factors that Should alert Healthcare Providers to the
Possibility of a Bioterrorism Attack (cnt’d):
Endemic Disease
 A disease that occurs
more or less
continuously
throughout a
community
Checklist for Disaster Readiness
Page 427 in the text
provides a
checklist for
Disaster
Readiness
In All Activities, Central Service
Technicians Must:
 Protect the Patient
 Protect Fellow Healthcare
Workers
 Protect Themselves

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Chapter 21 safety

  • 2. Objectives: As a result of successfully completing this chapter, students will be able to:  Discuss common safety hazards applicable to Central Service functions and work areas, and explain how employee injuries can be prevented  Describe special safety precautions for handling Ethylene Oxide  Review procedures to report employee accidents and injuries
  • 3. Objectives: (continued)  Explain the importance of ergonomics and health awareness for Central Service Technicians  Discuss procedures to prevent patient accidents and injuries and to report them if they occur  Explain basic procedures which address three occupational hazards: fire, hazardous substances, and bloodborne pathogens  Discuss the basics of internal and external disaster plans for a healthcare facility
  • 4. “Safe” Freedom from danger, risk or injury Central Service Technicians are responsible for working safely after they have been ,made aware of workplace hazards
  • 5. Accidents and Injury: Are not funny Can happen to anyone “It will never happen to me.” is a dangerous attitude
  • 8. Biohazard  Prevent Biohazard exposures (Blood Borne Pathogens) and exposures to chemicals, by wearing appropriate Personal Protective Equipment (PPE)  If you are exposed to body fluids or chemicals notify your supervisor immediately
  • 9. Safety Tips for Working in Soiled Receiving and Decontamination Areas:  Never put your hands into a basin or container holding contaminated objects that you cannot see  Never put your hands into a trash container; instead remove the inner bag and pour its contents onto a surface, or use an instruments to sort through the contents  Pour out any solution that prohibits visual examination of basin or container contents  Place all disposable sharps (needles, blades, etc.) in an appropriate sharps container
  • 10. CUTTING INSTRUMENTS INCLUDING KNIVES, SCALPELS, BLADES, NEEDLES AND SCISSORS OF ALL TYPES Sharps
  • 11. Safety Tips for Working in Soiled Receiving and Decontamination Areas:  Use extreme caution when disarming scalpel blades. Never use your hands. Use needle holder or other tool and wear eye protection  When reprocessing reusable sharps, separate them from other instruments and position them in a way that will avoid injury to others  Follow manufacturers’ recommendations for safe use of chemicals  Always wear PPE to protect yourself from chemical exposures
  • 12. Safety Tips for Working in Soiled Receiving and Decontamination Areas:  Follow manufacturers’ recommendations for safe operation of cleaning and testing equipment  Use caution when walking in areas with wet floors  Utilize mats or nonskid footwear when appropriate  Use care when loading or unloading carts from dumbwaiters and elevators  Sinks and work surfaces should be at appropriate levels to reduce back and arm strain
  • 13. Safety Tips for Working in Soiled Receiving and Decontamination Areas:  When scrubbing instruments in a sink, always scrub below the surface of the water to prevent aerosols  Use the concentration of detergents and water recommended by the manufacturer  Use thermal insulated gloves when handling washer baskets, sterilizer carts and other hot objects  Move sterilizer carts to low or no traffic areas to reduce the chance passersby will come in contact with the hot cart and be burned
  • 14. Safety Tips for Working in Preparation and Sterilization Areas:  Inspect all equipment for frayed electrical cords  Use caution when using heat sealers  Use caution when using a cutting edge  When lifting instrument sets, size up the load and lift with the larger muscles in your legs and arms  Hold the item as close to your body as possible
  • 15. Safety Tips for Working in Preparation and Sterilization Areas:  Follow all procedures for the handling and disposal of biological tests  Continuously check sterilizers for obvious damage to doors  Only authorized service personnel should access control panels and inner parts of sterilization equipment for repairs and adjustments  Only those people who have been trained to operate sterilizer should do so  Unauthorized hospital personnel, visitors, or visitors should not enter an area that contains sterilizers
  • 16. Safety Tips for Working in Preparation and Sterilization Areas:  Ensure that proper signs are warning labels are posted to warn of hot surfaces and other hazards  Use only secure and sturdy shelving  Use safety ladders and stools to reach high items. Do not climb on shelves
  • 17. Safety Tips for Working in Supply Receiving, Breakout, and Storage Areas:  Use appropriate containers for waste  Use specialized containers for storage and disposal of hazardous materials  MSDS Sheets should be available for reference  Use caution when removing items from storage units or shelves  Insure there is time and space to safely retrieve items  Use care when using box-cutting tools  Scalpel blades should NEVER be used to open boxes or containers MSDS
  • 18. Safety Tips for Working in Supply Receiving, Breakout, and Storage Areas:  Handle paper products with care to avoid skin lacerations  Do not handle broken glass  Avoid twisting and jerking movements when moving objects  Inspect work areas for objects left in pathways. Aisles and doorways must be kept clear at all times  When working in small areas be aware of traffic patterns  To avoid injury perform appropriate stretching exercises before lifting, pushing or pulling  When transporting patients, supply carts, or equipment be sure the path in front and on each side of the cart is clear  Ensure clearance on each side of objects you are carrying to avoid injury to arms and hands
  • 19. Safety Tips for Working in Equipment Distribution and Central Transport Areas:  Inspect floors for uneven surfaces to ensure equipment being rolled is not thrown off balance  Use caution when approaching automatic doors  Use caution when approaching corners or intersections; use safety mirrors when available  Use caution when pushing objects up or down inclines  Do not ride or step on supply carts or other vehicles  Consider the acquisition and use of powered carts for moving heavy or awkward loads
  • 20. Safety Tips for Working in Equipment Distribution and Central Transport Areas:  Consider the acquisition and use of powered carts for moving heavy or awkward loads  Assembly work should be performed at levels that will least fatigue and strain employees  Floors in work areas where employees must stand should have fatigue mats to relieve leg strain  Appropriate chairs should be used at computer, clerical, and instrument work stations to properly support employees backs  Computer screens should be used to reduce eyestrain
  • 21. Safety Tips for Working in Clerical and other Work Stations:  Items used frequently to perform routine tasks should be stored within easy reach  Caution should be used when working with filing cabinets. Open upper drawers increase the risk of the cabinet tipping and open lower drawers increase the risk of someone tripping
  • 22. Handling Compressed Gas Cylinders  Central Service Technicians must understand and follow basic safety precautions when handling, transporting, and storing compressed gas cylinders
  • 23. Compressed Gas Cylinder Safety Precautions  Do not dispense gas cylinders that are not labeled  Make sure that gas cylinders are secured at all times to prevent tipping  Handle carefully when transporting. Do not roll, drag, or drop.  Use a cover cap during transport  Cylinder regulators are not interchangeable. Be sure to use the correct regulator for the gas you are handling  Inspect all fittings for damage before connecting  Cylinders should be clearly labeled as ; Full, In Use, or Empty  Empty cylinders should not be store with full cylinders  Gas regulator stem valves require a key. That key should be kept with the regulator at all times
  • 25. Dangers of EtO EtO is a Toxic Gas 100% EtO is Flammable 100% EtO is Explosive
  • 26. Carcinogenic  Shown to facilitate cancer in laboratory tests  Follow manufacturer’s handling instructions
  • 27. Teratogen  A chemical substance that may cause harm to an unborn fetus  Pregnant women should be aware of teratogens
  • 29. Parts Per Million Parts Per Million (PPM) is the term used to measure the volume of gas in a vapor
  • 30. Time Weighted Average Time Weighted Average (TWA) refers to the exposure level broken down over the entire length of the employee’s shift
  • 31. Short Term Exposure Limit Short Term Exposure Limit (STEL) refers to the concentration limit over a short time
  • 32. Permissible Exposure Limit Permissible Exposure Limit (PEL) is the maximum concentration limit allowed by OSHA over the length of the shift.
  • 33. EtO exposure may be possible:  In the front of the sterilizer by the door  In the rear of the sterilizer by the drains  Near emission control devices  In the tank changing area  When cylinders or connections leak
  • 34. EtO Safety Precautions:  When transferring sterilized items to aeration cabinets, wear gloves made of neoprene or other appropriate protective material  Do not hold sterilized items that have not been aerated close to your body  When transporting a from the sterilizer to the aerator, pull it instead of pushing to avoid inhaling EtO fumes  Avoid working in areas immediately adjacent to the EtO sterilizer during its cycle. When possible, EtO sterilizer should be located in a separate room  Facilities must have a dedicated ventilation system to remove fumes exhausted during the cycle  Audible and visual alarms should be installed to alert workers to the presence of EtO in the work area
  • 35. EtO Safety Precautions: Facilities must comply with federal, state, and local requirements for: Air Quality Worker Safety Discharge Air Monitoring Recordkeeping
  • 36. EtO Safety Precautions:  With some sterilizers the door of the sterilizer must be opened 6 inches after the cycle is complete and the load must sit in the chamber for 15 minutes before transfer to the aerator. (Check manufacturer’s instructions for specific guidelines)  Once items have been placed in an aeration cabinet, the cycle should not be interrupted and the door of the aerator should not be opened  No items should be removed from the aerator until the aeration cycle is complete  Do not mix loads in the aerator. Do not add newly sterilized items to an aerator that has other items in it  Report EtO exposures immediately  Observe out of order and electrical lock out signage
  • 37. Employee Accident and Injury Reports  All employee accidents and injuries must be reported  Page 409 in the text provides an example of an employee injury report
  • 38. THE PROCESS OF CHANGING WORK, OR WORKING CONDITIONS TO REDUCE EMPLOYEE STRESS. Ergonomics
  • 39. AN INJURY TO, OR DISORDER OF THE MUSCULOSKELETAL SYSTEM WHERE EXPOSURE TO WORKPLACE RISK FACTORS MAY HAVE CONTRIBUTED TO THE DISORDER’S DEVELOPMENT OR AGGRAVATED A PRE-EXISTING CONDITION Work-related Musculoskeletal Disorder (WMSD)
  • 40. Ergonomic Stressors: Force - Such as heavy lifting or manipulating equipment or tools Repetition – Using the same motion continually or frequently Awkward Positions – Assuming positions that place stress on the body Vibration – Rapid oscillation of the body or a body part Contact Stress – Pressing the body or a body part against a hard or sharp edge
  • 41. Reducing WMSDs Management and Staff must commit to implementing and following work procedure and equipment changes that reduce the risk of WMSDs All employees must be trained properly An evaluation of the training programs must be assessed
  • 42. Reducing the Risk of Injury  Central Service employees should also maintain their physical health in a manner consistent with the physical demands of their work
  • 43. Preventing Patient Injuries  Central Service Technicians help keep patients safe from injuries, accidents, and infections
  • 44. Preventing Patient Injury Patient Care Equipment  Test and document all patient care equipment according to manufacturer’s guidelines  Ensure that all equipment has been properly decontaminated  Ensure that all equipment is free from visible defects, such as bent parts, frayed electrical cords, etc.  Track and control equipment, document its use  Ensure that regularly scheduled preventive maintenance is performed and documented  Ensure that the facility’s Biomedical Engineering Department is involved in equipment testing as required  Assure that safety guards are placed over items as required  Always cover contaminated equipment being transported to Central Service to prevent cross-contamination
  • 45. Preventing Patient Injury Contaminated Supplies and Reusable Medical Devices Ensure that all items are thoroughly disassembled, cleaned, inspected, prepared, packaged, and sterilized according to protocol Test processing equipment Ensure that everyone is properly trained on the equipment they use Insure that all instruments are complete and functional before use Monitor all sterilization equipment
  • 46. Preventing Patient Injury Chemical Residues Ensure that all items sterilized with EtO are thoroughly aerated before dispensing them for patient use Ensure that all items placed in the EtO sterilizer are dry before they are sterilized Thoroughly rinse items soaked in glutaraldehyde or other chemicals
  • 47. Preventing Patient Injury Supply and Equipment Transport Use caution when approaching doors, hallway intersections, elevators and high traffic areas Do not use a transport vehicle to prop open or push open automatic doors Do not block hallways with carts and equipment Do not block doors with carts and equipment
  • 48. Reporting Patient Accidents, Injuries, and Incidents ALL accidents, injuries or incidents involving patients must be reported and investigated All healthcare workers should report unsafe practices or hazards that could pose a threat to patients
  • 49. Sterilization Process Malfunctions:  If a sterilization process malfunctions, all items in any loads that are thought to be unsterile must be recalled  All Central Service Technicians must be aware of their department’s recall policy
  • 50. Basic Steps in the Load Recall Process: Obtain a list of all supplies known to be in the load Verify the sterilization controls Notify the Central Service Supervisor, Manager, or Director Notify areas (user units) where unsterile items may be located Retrieve as many items as possible Notify Infection Control, the Operating Room, and the administration according to policy
  • 51. Basic Steps in the Load Recall Process: Notify physicians if unsterile items were used in any procedures they preformed Document all steps taken Notify Risk Management Department Ensure that qualified service personnel inspect the malfunctioning equipment and that a comprehensive report is developed Consult ANSI/AAMI ST79 for specific information regarding testing before the sterilizer is placed back into service
  • 52. Central Service Occupational Hazards Physical ChemicalBiological
  • 53. Fire and Explosions  All healthcare employees must take precautions to minimize the risk of fire and explosions in the healthcare facility
  • 54. THE WEIGHT OF COMBUSTIBLE MATERIALS PER SQUARE FOOT OF AREA IN WHICH THOSE MATERIALS ARE LOCATED Combustible Loading
  • 55. Healthcare Fire Safety Programs Must Include: Minimization of the Combustible Load Fire Response Plans Early Detection Removal of Persons in Danger Containment of Fire and Combustible Products Extinguishment Evacuation
  • 57. Many Facilities Use the RACE Plan Remove persons in danger Alarm Call 911 or activate alarms Contain the fire. Close doors in the area Extinguish the fire if safe or Evacuate the area
  • 58. Hazardous Substances  Healthcare facilities must develop a plan to safely handling chemicals and other hazardous substances  Original and secondary containers of chemicals must be clearly labeled
  • 59. MSDS Sheets  The chemicals used in Central Service are very different from the ones you use at home.  MSDS Sheets help us understand how to use them safely and what to do in an emergency.  Understanding our Chemicals is in your own best interest.
  • 60. MSDS Sheets Contain Important Information  Product Identification  List of Hazardous Ingredients  Physical Data  Fire and Explosion Information  Reactivity Data  Health Hazard Data  Storage Recommendations  Emergency and First Aid Procedures  Spill or Leak Procedures  Protection Information and Control Measures  Special Precautions
  • 61. Healthcare Facilities must:  Make MSDS sheets available to employees.  Provide training to employees  Central Service Technicians are responsible to handle hazardous substances according to procedures
  • 62. Hazardous Substances  Pages 421 and 422 in the text provide lists of common hazardous materials by hospital department and a list of regulated chemicals and their exposure limits
  • 63. Disaster Plans and Preparedness
  • 64. …BEING READY FOR THE UNEXPECTED… Disaster Preparedness...
  • 66. Internal Disaster  Any situation with the potential to cause harm to Central Service employees or where the loss of utilities may drastically impact department operations (i.e. fire, the loss of water, etc.)
  • 67. External Disaster  A situation in which activities external to the facility affects departmental or facility operations (i.e. a natural disaster, a terrorist attack, etc.)
  • 68. Elements of a Central Service Disaster Plan:  An emergency call list outlining lines of authority and key individuals to be notified in specific types of disasters
  • 69. Elements of a Central Service Disaster Plan:  Protocols for inventory replenishment and delivery of emergency supplies
  • 70.  Posted evacuation plans and practices drills to ensure that employees know alternative ways to leave the department if their safety is at risk Elements of a Central Service Disaster Plan:
  • 71.  A well-known and understood organizational structure that presents lines of authority  Responsibility lists to identify employees responsible for certain tasks during disaster situations Elements of a Central Service Disaster Plan:
  • 72.  Directions for alternative communications and transportation if existing systems (i.e. telephones, elevators, etc.) cannot be used Elements of a Central Service Disaster Plan:
  • 73.  Directions for locations for utility and power shut off points  Plans for prioritizing sterile processing and supply distribution based on failing utilities or internal damage Elements of a Central Service Disaster Plan:
  • 74.  A facility risk assessment that assesses the facility’s current level of preparedness to help guide planning efforts  A description of how the institution's disaster planning and response efforts are integrated with other community response organizations Elements of a Central Service Disaster Plan:
  • 76.  Planning for suspected or confined terrorism events must be well-organized and rehearsed The Threat of Bioterrorism
  • 77. Factors that Should alert Healthcare Providers to the Possibility of a Bioterrorism Attack: A rapidly increasing disease incidence in a normally healthy population An epidemic curve that rises and falls in a short period of time An unusual increase in the number of people with respiratory and gastrointestinal complaints An endemic disease rapidly emerging at an uncharacteristic time or in an unusual pattern
  • 78. Lower attack rates among people who have been indoors, especially areas with filtered air or closed ventilation systems A cluster of patients arriving from a single locale Large numbers of rapidly fatal cases Any patient presenting a disease that is relatively uncommon and has bioterrorism potential (i.e. tularemia, pulmonary anthrax, etc.) Factors that Should alert Healthcare Providers to the Possibility of a Bioterrorism Attack (cnt’d):
  • 79. Endemic Disease  A disease that occurs more or less continuously throughout a community
  • 80. Checklist for Disaster Readiness Page 427 in the text provides a checklist for Disaster Readiness
  • 81. In All Activities, Central Service Technicians Must:  Protect the Patient  Protect Fellow Healthcare Workers  Protect Themselves