1. Chapter 11 Safety and Health Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc.

2. 2 Learning Objectives  Understand the purpose of the Occupational Safety and Health Administration (OSHA).  Follow OSHA guidelines as they pertain to a medical practice.  Develop a checklist for a medical practice’s OSHA readiness.

3. 3 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. Learning Objectives (cont’d.)  Understand the priorities of an OSHA inspection.  Identify and define OSHA violations.  Understand and discuss the Clinical Laboratory Improvement Amendments of 1988.

4. 4 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. National Patient Safety Goals Released yearly by the Joint Commission’s Board of Commissioners As of 2008, there are 37 goals.

5. 5 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. Establishment of OSHA  Develop and enforce mandatory job safety and health standards.  Maintain reporting and record keeping of job- related injuries.  Encourage employers and employees to reduce hazards.  Provide for research in occupational safety.  Establish separate but dependent responsibilities and rights.  Provide for state-level occupational safety and health programs.

6. 6 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. Bloodborne Pathogen Standards  Hazard communication plan  Exposure control plan  Medical waste plan  Housekeeping policy  Personal protective measures  General safety precautions  Fire safety plan  Staff development and in-service training program

7. 7 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. Hazardous Materials in a Medical Office  Printer or copier cartridges  Typing correction fluid  Glass and surface cleaners  Antibacterial soaps  Chemicals used for instrument cleaning  Furniture polish

8. 8 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. Exposure Control Plan Components:  Exposure determination  Compliance regulations  HBV vaccination  Postexposure evaluation  Hazards communication to employees  Record-keeping requirements

9. 9 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. Exposure Control Plan (cont’d.)  Procedures and policy manual must cover:  Biohazard labeling  Classification of exposure categories  Engineering controls  Exposure determination  Needlesticks and cuts  Injury on the job  Incidence of exposure to blood/body fluids  HBV immunizations  Protective equipment

10. 10 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. Biohazard Labeling

11. 11 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. Medical Waste Plan The plan should include:  Categories of waste  Disposal of sharps  In-service training  Medical waste containers

12. 12 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. Medical Waste Plan (cont’d.) The plan should include:  Preparation of medical waste for pick up  Weighing, storing, and tracking medical waste

13. 13 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. Engineering Controls

14. 14 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. Personal Protective Measures Staff must be provided with:  Gloves  Eye shields  Resuscitation bags  Splash guards  Protective jump suits  Eye wash stations

15. 15 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. Fire Safety Plan  Exits and signs  Fire drills  Floor plans  Hazardous areas  Evacuation methods  Missing persons  Testing of sprinkler systems  Emergency telephone numbers  Fire prevention Office must have written policies and procedures regarding:

16. 16 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. Fire Safety Plan (cont’d.)  Inspection of heat and air conditioning systems  Testing of fire alarms  Compliance  Missing persons  Testing of sprinkler systems  Emergency telephone numbers  Fire prevention

17. 17 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. Staff Development/In-Service Training Training must include:  Epidemiology and symptoms of HBV and HIV  Modes of transmission of HBV and HIV  Exposure control plan  Standard precautions  HBV vaccine  Procedures to follow should exposure occur  Signs, labels, tags, color coding for biohazards  Compliance

18. 18 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. Management Responsibilities  Provide a safe, healthful workplace.  Be familiar with OSHA standards.  Educate staff.  Inspect the office.  Minimize hazards.  Be sure employees have PPE.  ID hazards.

19. 19 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. Management Responsibilities (cont’d.)  Keep operating procedures.  Provide training.  Report accidents.  Keep good records.  Allow access to OSHA information.  Do not discriminate.  Post citations.

20. 20 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. OSHA Inspections Inspectors will:  check for posting of OSHA safety poster  review OSHA log of injuries for the past three years  inspect for compliance with OSHA standards  comment on and note obvious hazards  inquire about the existence of a basic safety and health program  ask for OSHA manual

21. 21 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. OSHA Inspections (cont’d.) Five priorities of an OSHA inspection: 1.Imminent danger 2.Catastrophes and fatal accidents 3.Employee complaints 4.Programmed inspections 5.Follow-up inspections

22. 22 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. Common Violations of Bloodborne Pathogen Standards  Improper storage containers for non-sharps waste  Inappropriate decontamination of work surfaces  PPE noncompliance  HBV vaccine unavailable  Improper labeling of containers  Hand washing improperly performed  Written schedule for cleaning and decontamination not available

23. 23 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. CLIA  The amendments to the Clinical Laboratory Improvement Act (CLIA) issued performance requirements for laboratories.  These amendments apply to physician office labs (POL) and require inspections by CMS in order to obtain certification.

24. 24 Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier Inc. Disaster Planning  Identify potential risk.  Store computer backup tapes off-site.  Store emergency supplies off-site.  Develop an evacuation plan.  Develop a plan for patient care off-site.  Ensure that insurance policy includes disasters.  Develop a plan for contacting patients, vendors, and employee’s families.