basic safety and infection control

CHAPTER

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6Basic Safety and Infection Control

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Learning Outcomes

6.1 Describe the components of a medical office safety plan.

6.2 Identify OSHA’s role in protecting healthcare workers.

6.3 Describe basic safety precautions you should take to reduce electrical hazards.

6.4 Illustrate the necessary steps in a comprehensive fire safety plan.

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Learning Outcomes (cont.)

6.5 Summarize proper methods for handling and storing chemicals used in a medical office.

6.6 Explain the principles of good ergonomic practice and physical safety in the medical office.

6.7 Illustrate the cycle of infection and how to break it.

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6.8 Summarize the Bloodborne Pathogens Standard and Universal Precautions as described in the rules and regulations of the Occupational Safety and Health Administration (OSHA).

6.9 Describe methods of infection control including those preventing healthcare-associated infections.

6.10 Describe Centers for Disease Control and Prevention (CDC) requirements for reporting cases of infectious disease.

Learning Outcomes

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Introduction

• Accidents can occur in healthcare settings

• Remove or correct hazards– Physical– Chemical– Biohazardous

• Removal or correction of hazards is integral to risk management

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Medical Office Safety Plan

• Minimize risk

• Establish a safety plan

• Education about potential dangers facilitates the removal or correction of these hazards

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Medical Office Safety Plan (cont.)

• Comprehensive written safety plan

• Easily accessible

• Updated annually

• Know and follow the plan’s policies and procedures

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Apply Your Knowledge

Why is it important to have a safety plan in a medical office and what should the plan cover?

ANSWER: It is important to have a safety plan to help minimize risk and make everyone aware of potential hazards. A safety plan should contain:•OSHA Hazard Communication•Electrical and fire safety•Emergency action plan•Chemical safety•Blood borne pathogen exposure•Personal protective equipment•Needlestick prevention

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Occupational Safety and Health Administration

• Employee safety

• Specific standard vs. General Duty Clause

• Enforces guidelines established by the Centers for Disease Control and Prevention (CDC)

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OSHA Hazard Communication

• Biohazard labels

• Warning signs

• Material Safety Data Sheets (MSDSs)

• Hazard labels

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OSHA

• Final rule

– Standardize

• Labeling

• Safety information

– Right to understand

– Changes

• Hazard

classification

• Labels

• MSDSs

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ANSWER: So employees can take measures to protect themselves against harm.

Why is it important for hazardous materials be correctly labeled?

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Electrical Safety

• Know location of power shutoffs

• Avoid using extension cords

• Observe for frayed electrical wires

• Dry hands before working with electrical devices

• Do not position electrical devices near sources of water

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ANSWER: •Avoid using extension cords. Tape extension cords to the floor to avoid tripping. •Repair or replace equipment that has a broken or frayed cord. •Dry your hands before working with electrical devices. •Do not position electrical devices near sinks, faucets, or other sources of water.

List three electrical safeguards to practice in the healthcare setting?

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Fire Safety

• Many potential hazards in a medical office

• Fire Prevention – Hazards in the exam

room– Office laboratory ~

open flame

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In Case of Fire (cont.)

• Using safety equipment

– Fire extinguisher – “PASS” system

– Fire blanket

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Emergency Action Plans and Drills

• Responsibility– Reporting fire– Overseeing

evacuation

• Building evacuation routes– Current location– Nearest exit

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Emergency Action Plans and Drills (cont.)

• Evacuation Procedure

– Ensure patients and staff are evacuated

– Check that everyone has left

– Take MSDS book

– Assembly area

– Emergency action plan drills

– Local emergency contacts

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Once at the assembly area after an evacuation how would you account for employees and patients?

ANSWER: Conduct a roll call of all employees. You can use the check-in roster to account for patients.

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• Proper handling and storage

• MSDS

• General precautions

• Eye wash station

Chemical Safety

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Chemical Safety (cont.)

• Do not hold under nose

• Use fume hood or personal ventilation device

• Only combine chemicals as required

• No mouth pipetting

• Add acid to other substances

• Clean up spills properly

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What are the precautions you should take when working with hazardous substances?

ANSWER: •Store below eye level•Wear protective gear•Carry with both hands•Properly ventilated

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Ergonomics and Physical Safety

• Ergonomics

• Maintain a healthy and safe posture

• Do not over reach

• Lift properly

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Ergonomics

• Transferring a patient– Lift with knees– Ask for assistance– Use transfer device

• Adjust seat

• Take frequent breaks from the computer

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Physical Safety

• Walk, do not run, in the office.

• Wipe up spills immediately

• Clear the floor of dropped objects

• Be sure there are no snags or tears in the carpet

• Destroy and dispose of medications that are dropped on the floor

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Physical Safety (cont.)

• Be careful when carrying objects

• Close cabinets, doors, and drawers

• Inspect furniture for rough edges

• Tape down cords and equipment cables

• Never use damaged equipment or supplies

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• Safeguards for the laboratory environment

– Wear protective gear

– Follow manufacturer’s guidelines

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• Special safety precautions– Children

– Patients with physical disabilities• Safe flooring • Handrails

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ANSWER: The employer

Whose responsibility is it to ensure a safe work environment?

Whose responsibility is it to follow safe work practices?

ANSWER: The employee

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Infection Control

• Medical assistant – Help to create and maintain a safe and

healthy environment

– Understand how infections• Occur• Are transmitted in the population

– Practice infection control precautions

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Cycle of Infection

Back

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Cycle of Infection (cont.)

• Reservoir Host – body capable of sustaining pathogen growth

– Carrier

– Endogenous infection

– Exogenous infection

• Means of Exit - how the pathogen leaves the host

Click for Cycle of Infections

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• Means of transmission – how the pathogen spreads to a host

– Airborne

– Bloodborne

– During pregnancy or birth

Click for Cycle of Infection

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• How the pathogen spreads to a host

– Foodborne

– Vector-borne

– Touching• Direct – contact with an infected persons mucous

membranes

• Indirect – fomites


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• Means of Entrance

– Any cavity lined with mucous membrane

– Breaks in the skin

• Susceptible Host – An individual with little

or no immunity– Factors influencing

susceptibility


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• Environmental factors

– Dense populations

– Animals and insects

– Economic and political factors

– Availability of transportation

– Urbanization and population growth rates

– Sexual behavior

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Breaking the Cycle

• Asepsis

– Maintain strict housekeeping standards

– Adhere to government guidelines

– Educate patients

• Hygiene

• Health promotion

• Disease prevention

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What is your role as a medical assistant in breaking the cycle of infection in the medical office?ANSWER: To apply these measures: •Maintain strict housekeeping standards to reduce the number of pathogens present•Adhere to government guidelines to protect against diseases caused by pathogens•Educate patients in hygiene, health promotion, and disease prevention..

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OSHA Bloodborne Pathogens Standard and Universal Precautions

• Disposal of infectious or potentially infectious waste

• Laws protect healthcare workers and patients

– Training personnel

– Record keeping

– Housekeeping

– Wearing protective gear

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OSHA Bloodborne Pathogens Standard

• Employers must

– Develop an OSHA Exposure Control Plan

– Provide training to all employees

• Documentation

• PPE, Universal Precautions, engineering controls

• What to do if exposure occurs

– Provide the hepatitis B vaccine

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Universal Precautions (cont.)

• Universal Precautions apply to all blood and body fluids

• Standard Precautions

– Used in healthcare facilities for the care of all patients

– Prevents the transmission of disease

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Universal Precautions (cont.)• Risk categories

I. Tasks that require specific protective measures

II. Tasks that require precautions in certain situations

III. Tasks requiring no special protection

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Written Exposure Plan

• Determination of exposure

• Implementation of control methods

• Post-exposure evaluation and follow-up

• Communication and training

• Recordkeeping

• Evaluation of exposure incidents

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Exposure Incidents• Notify the physician or employer

immediately

• Refer the employee to a licensed healthcare provider

– Counsel the employee

– Draw blood and prescribe treatment

– Written report

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Other OSHA Requirements

• HBV vaccine

• Needlestick Safety and Prevention Act

– Engineered safety devices

– Employer recommendations

• Engineering controls

• Needlestick safety programs

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Other OSHA Requirements (cont.)

• Employee recommendations

– Avoid using needles

– Help choose devices

– Use devices provided

– Do not recap needles

– Dispose of sharps correctly

– Report injuries and hazards

– Participate in training

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ANSWER: There are three categories of risk:

Category 1: Expose a worker to blood, body fluids, or tissues and require specific protective measures

Category 2: Usually do not involve risk of exposure, but precautions are required in certain situations

Category 3: No risk of exposure, so no special protection is required

OSHA divides medical tasks by level of risk. What are these risk categories?

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Infection Control Methods

• Knowledge of

– Medical asepsis • Based on cleanliness• As few microorganisms as possible

– Surgical asepsis• Sterile environment• No microorganisms

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Infection Control Methods (cont.)

• Keep office clean

• Prevent cross-contamination

– Follow guidelines

– Use protective gear

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Hand Hygiene

• Handwashing

• Alcohol-based hand disinfectants (AHD)

• Fingernail length

• Nail polish and artificial nails

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Other Aseptic Precautions• Avoid leaning against sinks, etc.

• Avoid touching your face and mouth

• Use tissues for coughing or sneezing; wash hands afterward

• Avoid working with patients if you have a cold; wear gloves and mask

• Stay home if you have a fever

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Personal Protective Equipment

• Gloves• Masks and protective eyewear or face shields• Protective clothing• Use of multiple types of PPE

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Transmission from Healthcare Workers

• Healthcare-associated infections (HAI)

• Adhere to OSHA Standards

• High risk procedures

• HIV, HBV status of healthcare workers

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Describe the difference between medical and surgical asepsis.

ANSWER: Medical asepsis is based on cleanliness and reducing the number of microorganisms as much as possible. Surgical asepsis is maintaining a sterile environment by eliminating all microorganisms.

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Reporting Guidelines for Infectious Diseases

• State or county health department

• Information is forwarded to the CDC

• National Notifiable Disease Surveillance System

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Reporting Guidelines (cont.)

• Reporting – correct form

– Disease identification

– Patient identification

– Infection history

– Reporting institution name

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How is the information on reportable diseases used by the CDC?

ANSWER: The CDC uses the information reported to them to help control the spread of infection.

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In Summary

6.1 The medical office safety plan should include OSHA’s Hazard Communication; electrical, fire, and chemical safety; emergency action plans; bloodborne pathogen exposure plans; PPE; and needlestick prevention plans.

6.2 The U.S. Department of Labor created OSHA to protect the employees’ safety in the workplace.

Through the creation and enforcement of standards such

as the Bloodborne Pathogens Standard, Hazard Communication, and the Needlestick Safety and Prevention Act, OSHA serves to protect healthcare workers from hazards.

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In Summary (cont.)

6.3 To reduce electrical hazards in the medical office, you should avoid using extension cords, repair or replace damaged cords, avoid overloading circuits, ensure that

all plugs are grounded, dry your hands before using electrical devices, and keep electrical devices away from sinks or other sources of water.

6.4 A comprehensive fire safety plan must include fire prevention strategies, actions to take in the event of a fire, building evacuation routes and plans, fire drills, and local emergency contacts.

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In Summary (cont.)

6.5 When using chemicals in the medical office, you should always wear protective gear, carry the container with both hands, work in a well-ventilated area, never combine chemicals unless it is specifically required in the test procedures, and properly clean up spills immediately.

6.6 In order to protect yourself from work-related musculoskeletal disorders at work, you must follow the principles of good body mechanics.

Your physical safety at work depends on understanding and applying appropriate workplace safeguards.

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In Summary (cont.)

6.7 In order for an infection to occur, these five elements must be in place: a reservoir host, a means of exit, a means of transmission, a means of entrance, and a susceptible host.

The most effective means of breaking the cycle of Infection is by using aseptic techniques.

6.8 Laws set forth in the OSHA Bloodborne Pathogens Standard of 1991 dictate how you must handle infectious or potentially infectious waste generated during medical or surgical procedures.

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In Summary (cont.)

6.9 The two basic methods of infection control are medical asepsis and surgical asepsis.

OSHA recommends that healthcare workers who work

with high-risk patients know their HIV and HBV status, participate in a HBV vaccination program, and avoid direct patient contact if they have a skin condition characterized by sores that secrete fluid.

6.10 The CDC requires reporting of certain diseases to the state or county department of health, who then reports the information to the National Notifiable Disease Surveillance System of the CDC.

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End of Chapter 6

Soap and education are not as sudden as a massacre, but they are more deadly in the long run.

~ Mark Twain

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