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Safety Issuesfor the

Veterinary HospitalStaff

5th Edition

Philip J. Seibert, Jr., CVT

About The Author

Phil is a Certified Veterinary Technician with over 20 years ofexperience in the profession and now concentrates his efforts as afull-time author and consultant.

Because of his clinical experience and management skills, hebecame the first veterinary technician to evaluate and accreditveterinary hospitals for the American Animal HospitalAssociation (AAHA). The experience of "inspecting" over 1200veterinary hospitals has given him a unique perspective of ourprofession.

Phil’s many articles dealing with veterinary hospital operationshave appeared in national publications such as Journal of the

AVMA, AAHA Trends, Veterinary Forum, DVM Newsmagazine, the Veterinary Technician,Veterinary Practice STAFF and Veterinary Practice News. His books on hospital safety and reg-ulatory compliance are considered the most practical and authoritative in the profession. Phil isalso the founder and Managing Editor of the profession's only safety-specific newsletter, TheVeterinary Safety & Health Digest. Recently, Phil teamed up with long-time friend and fellowconsultant Dr. Tom Catanzaro, to write the best-selling book Veterinary Practice ManagementSecrets which was released by Hanley Belfus publishers in 2000.

Because he has taken the lead in "deciphering" the regulatory agency rules affecting the veteri -nary profession and has been able to provide practical, veterinary-specific advice, Phil has earnedthe reputation of the veterinary profession's OSHA expert.

Recognizing the power of interactive learning, Phil is the founder and Director of The OSHACenter on the Veterinary Information Network (VIN) and Veterinary Support Personnel Network(VSPN). He regularly teaches interactive OSHA and staff training courses on VIN and VSPN.

Phil can be contacted at:

Veterinary Practice Consultants1550 Athens RdCalhoun, TN 37309-3035

Phone: (423) 336-1925FAX: (423) 336-6047E-mail: [email protected] Site: www.v-p-c.com/phil

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3The Objectives of a Safety Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Your Safety Rights. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Your Safety Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4The Leadership’s Rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4The Leadership’s Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Hazards That Affect Everyone In The Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Dressing Appropriately for the Job . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Save Your Back! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Clean-up After Yourself . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Everything In It’s Place . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Beware Break Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Machinery & Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Electrical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Fire & Evacuation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Using A Fire Extinguisher . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Don’t Become A Victim of Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Hazardous Chemicals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Secondary Containers & Labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Material Safety Data Sheets (MSDSs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Special Chemicals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Ethylene Oxide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Formalin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Glutaraldehyde . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Animal & Medical Hazards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Noise is Noise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Bathing, Dipping or Spraying Areas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Zoonotic Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Rabies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Bacterial Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Ringworm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Visceral Larval Migrans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Cutaneous Larval Migrans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Lyme Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Mange . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Toxoplasmosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

A Dirty Mouth? - Precautions for Dentistry Operations. . . . . . . . . . . . . . . . . . . . . . . . 16

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Safety Issues for the Veterinary Hospital Staff

Contents

Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Collimator Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Personal Dosimetry Badges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17The Dark Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Scavenging Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Leak Check Your Machine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Spill Clean-up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Compressed Gasses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Sharps and Medical Waste . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Medical Waste Defined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20One-Handed Needle Recapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Pushing Drugs - The Pharmacy Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Cytotoxic Drugs (CDs). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Self-Assessment Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Internet Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

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Most people who work with animal do so because ofan intense love for animals and desire to help them.We'll bet you're like that also. We're sure you'll findthat there are may rewards for working in the veteri-nary community. Sometimes the rewards are verypersonal and sometimes they're shared with others,but they're the reason we're all here.

With every reward comes responsibility. One ofyour responsibilities is safety: the safety of yourself,your patients, and your co-workers. If you are hurton the job, the injury goes well beyond the physicalpain and disability you suffer. The hospital is affect-ed financially and organizationally because thehealth care delivery team is incomplete and othershave to work harder to cover the shortage. Finally,your patients and clients are affected by less than afull team providing their care.

Regardless of your position in the practice, as a staffmember in a veterinary hospital, you are exposed tohazards in your day-to-day routine and often duringthe non-routine functions that always seem to occur.These hazards can be diseases, exposure to harmfulchemicals or radiation, or simply the obvious physi-cal dangers from the animals we serve. That's thebad news. The good news is that these hazards, whenproperly identified, can be controlled and your risk ofinjury minimized or even eliminated.

By participating in this training, you have taken thefirst step in controlling your risk of an accident or ill-ness: you are becoming aware of potential problems.Some of the issues we'll discuss will seem very obvi-ous to you, while others will seem more obscure.Remember that all the issues discussed in this manu-al are real possibilities for a veterinary health careworker. You may have very limited exposure tosome of these challenges, but awareness of the haz-ards faced by other members of the team will onlystrengthen your understanding and the overall moralewithin your team.

The second step is to integrate the safety procedures

you'll learn into the everyday habits of your job. Ashuman beings, we operate from a set of "habits" formost of life's activities. We develop likes and dis-likes on every level and safety is no different. Onlyyou can improve the risk you face by incorporatingthe proper safety processes in your daily activities.Your safety should not be something you have to stopto think about...it should be automatic. The only wayit becomes automatic is by practice.

Good luck in your chosen profession. I'm sure it willlive up to your expectations!

The Objectives of a Safety Program

Obviously the purpose of any training is to provideinformation or develop skills. That's also the primarypurpose of a comprehensive safety program. By edu-cating you about the hazards in your job and provid-ing you the proper guidance and resources, you cantake the steps to protect yourself. With knowledge,you become empowered!

You're probably already aware of the really obvioushazards of your job, but undoubtedly, there are somethings that will surprise you. By simply increasingyour awareness of the issue, we can significantlydecrease your chances of injury!

Certainly, we can't discount the regulatory require-ments for safety. If you are receiving this trainingfrom your employer, they are fulfilling a vitalrequirement in the safety net of the American work-

Introduction

place. If you are learning this material as a self-studyprogram, you can take pride in the knowledge thatyou are becoming an "self-taught expert" in the filedand your knowledge and initiative are certain to berewarded in your professional career.

Your Safety Rights

Both you and your leaders enjoy the basic rightsafforded every American: the right to choose one'sown course of action and the right to self-protection.This basically means that every American has theright to expect their workplace is reasonably freefrom UNNECESSARY hazards. Remember, one cannever totally avoid every hazard, but we can mini-mize our exposure to them in most cases.

The ability to participate in the safety program atwork is paramount to your rights. It's assumed thatthe leaders of a business are the expert on that busi-ness, but it is you, the worker, that is usually the firstone to become aware of potential problems. Youhave the fundamental right to bring those concerns tothe attention of the leadership without fear ofreprisal. In most instances, the complaint should goto your first-line supervisor or the person designatedby your hospital policies. Not all complaints willresult in changes to the operation. Some complaintsstem from just a lack of knowledge and just provid-ing accurate information is enough. However, if youfeel your complaint was not taken seriously or youbelieve the danger is still present, you have the rightto bring the issue to the attention ofyour regional OSHA office.

When medical evaluations or exposurerecords are collected by the hospital,they must be made available to you forreview. This does not mean that youare entitled to see private or sensitiveinformation about other staff members,but it does mean that you are entitled tothe relevant data that may be compiledas the result of monitoring programs.You are also entitled to know about thenature and types of accidents that have

occurred in your hospital. If your practice employsmore than 10 employees, you have the right to viewthe Summary of Work Related Injuries & Illnesses(OSHA Form 300A) which should be posted on theemployee bulletin board at certain times of the year.

Your Safety Responsibilities

It's your responsibility to learn and follow the safetyrules and working practices for the jobs in the hospital.Even though OSHA will not cite or fine you directlyfor violations of these responsibilities, you are requiredunder the Occupational Safety & Health Act to "com-ply with all occupational safety and health standardsand all rules, regulations, and orders issued under theAct." This not only includes specific OSHA standards,but also applies to the workplace-specific rules estab-lished by the leadership of your hospital.

Although you cannot be disciplined for exercisingyour rights under the Occupational Safety & HealthAct, you can be disciplined for willful violations ofany safety rule or standard. In some cases, this dis-cipline can be a simple as a verbal reprimand, but insevere or chronic situations, it can include termina-tion. In most states, if you are terminated for willfulviolation of safety rules you will likely be deniedunemployment benefits.

In addition to the responsibility to follow the rules,the Act requires you to:

• Read the OSHA poster.• Comply with all applicable stan-dards.• Wear or use prescribed personalprotective equipment while working.• Report hazardous conditions toyour supervisor.• Report any job-related injury orillness to the proper person and seektreatment promptly.

The Leadership's Rights

The owner of the business doeshave rights under the Occupational

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You should find and read theWorkplace Safety Notices in

your practice

Safety & Health Act. Although the Act and OSHA'sStandards place requirements on the leadership of abusiness for maintaining safety, this is not meant torestrict their right to set rules of conduct or operationfor its staff. The leadership has the right to set andenforce the rules for their practice, as long as thoserules comply with the laws.

The leadership must have an opportunity to take careof any safety-related problems. Basically, this meansthat you should bring your complaints or suggestionsto your leader and allow them a reasonable amountof time to investigate and take action before youexercise your rights under OSHA's complaint inspec-tion procedures.

Every American has the right to be present duringany inspection of their personal property without alawful court order. Unless your practice ownerspecifically gives you the authority to act on his orher behalf in such an instance, you are not authorizedto admit an inspector to the practice in their absence.

The Leadership's Responsibilities

It's the practice leadership's responsibility to providea safe and healthful work environment for the staff.This does not mean a facility without any hazards -that's impossible. It does mean that the leadership isexpected to take a reasonable degree of effort to iden-tify the hazards present, correct the ones that can be

eliminated or control the ones that can not be elimi-nated. And of course, the business must comply withthe laws and regulations, including those pertainingto safety and health.

Even though it is has been pointed out that establish-ing the safety procedures for the hospital and theemergency procedures for reacting to accidents is aright of the leadership, it's also a responsibility thatcannot be avoided. And the leadership must enforcethese rules as diligently as they would be expected toenforce any other rule in the practice.

Finally, providing adequate safety training to you isanother fundamental responsibility of the practiceleaders. Even if you have years of experience, thepractice must make sure that you are capable ofdoing your job safely. Sometimes this training is ina formal setting - like staff meetings or continuingeducation settings. But just because you are not in aformal setting, does not mean you are not gettingtraining either. A great deal of learning and trainingtakes place at the everyday level; on-the-job trainingand feedback is definitely an appropriate way to getthe knowledge. In the end, you are the best person toknow if you are competent to do your job safely. Ifyou think you need extra safety training in any area,don't hesitate – tell your supervisor immediately sothat arrangements can be made for the proper instruc-tion.

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Personal Notes:

You should know where theHospital Safety Manual is locatedand take time to become familiarwith it. Memorize the "do's anddon'ts" of the hospital and alwaysfollow the safety rules. No one canprotect you from an injury or illnessbetter than you can protect yourself!

Dressing Appropriately forthe Job

One of the first rules of safety is todress appropriately for the job at hand. In the veteri-nary profession ,that also includes footwear and jew-elry. You can reduce the chances of getting injuredfrom slips and falls by wearing shoes that cover yourwhole foot and have non-slip soles. Be especiallycautious walking on uneven or wet floors. Never runinside the hospital or on uneven footing. Excessivejewelry and very loose-fitting clothing can presenthazards if an animal struggles during restraint, so it'sbest to keep it to a minimum. This is definitely oneof those times when less is more!

Save Your Back!

According to insurance statistics, back injuriesaccount for one in every five workplace injuries toAmerican workers. To minimize your chances ofsuffering one of these very painful injuries, remem-ber the rules for lifting : keep your back straight andlift with your legs. Never bend over to lift an object.That rule applies to patients as well as inanimateobjects such as boxes or supplies. If your practicedoesn't have a motorized lift table, get help when lift-ing patients over 40 pounds. Remember to followsound ergonomic principles when positioning orrestraining patients, especially when working withhorses or food animals.

Because veterinary workers perform such a varietyof jobs in any given hour, it's pretty rare for us toacquire the types of ergonomic injuries common in

other industries. However, it'simportant to note that the bestdefense against almost allergonomic injuries is to changeyour posture and routine frequent-ly.

Clean-up After Yourself!

Some injuries are caused by clut-tered or dirty work areas. We alsoknow that "clutter" contributes tothe severity of accidents that oth-

erwise would be minor. Cleanliness and organizationare good business standards, especially in a health-care facility. Always clean up spills as soon as theyhappen. You should always clean and return equip-ment to the proper storage place immediately afteruse. At least daily, remove all trash from your workarea. Organize drawers, cabinets and counters sothat items can be found easily and "clutter" isreduced.

Everything In Its Place

Always store supplies and equipment properly. Storeheavy supplies or equipment on the lower shelves toprevent unnecessary strains. Never use stairways orexit hallways as storage areas. Don't overloadshelves or cabinets. Store liquids in containers withtight-fitting lids and always replace the lids when fin-ished using the product. When possible, store chem-icals on shelves that are at or below eye level. Thiswill minimize the possibility of accidentally spillingthe chemical on you when getting or replacing a con-tainer. Never climb into or on cabinets, shelves,chairs, buckets or similar items. Use an appropriateladder or step to reach high locations.

Beware Break Time!

The ingestion of pathogenic organisms or harmfulchemicals is definitely present in most veterinary sit-uations. That's why it's important that you only eat

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Hazards That Affect Everyone In The Practice

Remember to keep your backstraight and lift with your legs

or drink in areas free of toxic and biologically harm-ful substances. This also applies to the preparation offoods and beverages: make sure your coffee pot andutensil area is well away from sources of possiblecontamination such as the lab or treatment/bathingtub. Check the cabinets above your drink or food tomake sure it doesn't contain hazardous chemicals orsupplies that could spill onto the area. Always storeyour food, drinks, condiments and snacks in a refrig-erator free from biological or chemical hazards; vac-cines, drugs and laboratory samples are all potentialcontamination sources and should not be in the samearea as your food or drinks.

Machinery & Equipment

Never operate machinery or equipment without allthe proper guards in place. Equipment like fans andcage dryers have moving parts that can severely hurtor even sever a finger. Long hair should be tied backor up to prevent it from getting caught in fans, orother moving parts. Avoid wearing excessively looseclothing or jewelry when working around machinerywith moving parts.

If you must perform minor maintenance or user serv-ice of any electrical device, be sure to unplug it ordisconnect the electrical power so that it can not beaccidently energized until it is safe.

When using equipment like autoclaves, microwaveovens, cautery irons or other heating devices, be sureto understand the proper rules for safe operation.Burns, especially from steam, arepainful and serious, and almostalways can be prevented.Autoclaves also present a dangerfrom the pressure that is used forproper sterilization. When open-ing the autoclave, first release thepressure with the "vent" deviceand keep your hands and faceaway from the steam. Let thesteam rise completely beforeopening the door fully. Be carefulwhen removing the packs because

they are still hot. Always assume cautery devices andbranding irons are hot and use the insulated handlewhenever you handle them. Never place heated ironson any surface where they could overheat and start afire, or where someone may accidentally touch them.

Electrical

Many procedures performed on a daily basis requirethe use of electricity. Although new equipment andbuildings have many safety features built-in, youmust be conscious of avoiding a situation whichcould cause a fire or physical harm to yourself,another person or a patient.

Do not remove light switch or electrical outlet cov-ers. Always keep circuit breaker boxes closed andnever block access by stacking supplies or equipmentin front of them. Only persons trained to performmaintenance duties should repair electrical outlets,switches, fixtures or breakers.

If you must use a portable dryer or other electricalequipment in a wet area, make sure it is properlygrounded and only plugged into a ground-fault cir-cuit interruption (GFCI) type outlet.

Extension cords should only be used for temporaryapplications and should always be of the 3-conduc-tor, grounded type. Never run extension cordsthrough windows or doors which may close anddamage the wires nor across aisles or floors where atripping hazard may be created.

Surge supressors should only beused to protect sensitive electronicequipment and should never beoverladed. Surge supressors arenot designed for things likeheaters, autoclaves, coffee potsand may overheat to cause a fire.

Equipment with grounded plugsmust never be used with adaptersor non-grounded extension cords.Never alter or remove the ground

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Overloaded surge suppressors orextension cords can start a fire!

terminals on plugs. Appliances or equipment withdefective ground terminals or plugs should not beused until repaired.

When changing light bulbs (especially flourescentbulbs), be careful to remove and replace the bulbwithout breaking it. Inoperable bulbs should be dis-posed of directly into the outside dumpster or insideof a container to keep the bulb from breaking.

Fire & Evacuation

The potential for dramatic loss of life (both humanand animal) and the destruction of property make ahospital fire one of the most feared accidents imagi-nable. Fortunately, this danger can be significantlyreduced by a few simple precautions.

Never use power adapters or surge suppressors as asubstitute for permanent wiring. Overloaded orfaulty electrical cords can overheat or short and starta fire, even when the equipment is turned off!

Always store flammable liquids properly; materialslike gasoline, paint thinner and ether should never bestored inside the hospital except in an approved flam-mable storage cabinet. Some components of special-ty dental and large animal acrylic repair kits are alsovery flammable. Very small amounts of these com-ponents are usually not a problem, but always ensurethey are stored and used in an area with good venti-lation and the containers have tight-fitting lids thatare replaced immediately after use.

Flammable items, particularly newspapers, boxes,and cleaning chemicals must always be stored atleast three feet away from an ignition source such asa water heater, furnace or stove. Always use extracare when using portable heaters. Never leave themunattended, and always make sure they are placed nocloser than 3 feet from any wall, furniture or otherflammable material.

Become familiar with the location of the emergencyexits in your facility. Make sure the emergency exitsare always unlocked and free from obstructions when

you are in the building. If you must work in a buildingwhen security warrants the doors be locked, make sureyou have at least two clear exits form the building.

Learn the emergency warning system in your hospi-tal. If the facility is equipped with an electronicalarm system, be sure you know how to activate itmanually. In the absence of an electronic alarm sys-tem, a verbal alarm is very effective. You can use thetelephone intercom feature to alert everyone that thereis a fire in the building or in small buildings, simplyyelling in a loud clear voice will get the message out!

Know your duties in the event of a fire. Remember,your first responsibility is to notify others about the

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Using A Fire Extinguisher

If you must use a portable fire extinguisher,remember the word PASS:

Pull the pin...Some extinguishers requirereleasing a lock latch, pressing a punc-ture lever, or other motion. (Check your

extinguishers to be sure.)

A im low...pointing the extinguisher (orits horn or hose) at the base of the fire.

Squeeze the handle...this releases theextinguishing agent.

Sweep from side to side...at the base of thefire until it appears to be out. Watch thefire area. If a fire breaks out again,

repeat use of the extinguisher.

Most portable extin-guishers work accordingto these directions, butread and follow thedirections on your spe-cific extinguisher.

fire and then to get out of the building safely if anevacuation is ordered. Leave the rescue duties to theprofessionals that are trained and equipped to handlethis very dangerous task. If you do evacuate thebuilding, immediately report to the designatedassembly area for accountability. This is very impor-tant since others will assume you are still in thebuilding if you are not present at the assembly area.

Know where the fire extinguishers are located andhow to use them. Most veterinary hospitals areequipped with dry chemical type fire extinguishers.But, before you decide to use a fire extinguishermake sure the alarm has been sounded, everyone hasleft the building (or is in the process of leaving) andthe fire department has been called.

The National Fire Protection Association recom-mends you NEVER attempt to fight a fire if any ofthese conditions are true:

• if the fire is spreading beyond the immediate areawhere it started, or involves any part of the buildingor structure;

• if the fire could block your escape route;• if you are unsure of the proper operation of the

extinguisher; or• if you are in doubt that the extinguisher you are

holding is designed for the type of fire at hand, or ifit is large enough to suppress the fire.

Don't Become A Victim of Violence

Just as in any occupation, you are at risk of injuryfrom accidents not directly related to your job.Vehicle accidents, personal assault, robbery, andeven natural disasters have resulted in veterinarystaff members being injured while on duty. Althoughno one can prevent every possible scenario, prepara-tion can certainly help and sometimes will minimizethe injury. When outside of the hospital building, beaware of your environment and do your best to avoidplacing yourself in a situation that could go bad. Always keep the "non-client" doors locked from theoutside to prevent anyone from gaining unauthorizedor undetected entry into the building.

If you work in a critical care or 24-hour practice, youshould utilize the "barriers" that are usually avail-able. Things like buzzers to control access from thefront door, and one-way locks on the remainingdoors (to let you out in case of an emergency, butkeep the door locked from the outside) are essentialin these environments, so don't defeat them.

In any business that keeps money or stores valuableitems , there is a potential for robbery. If you everfind yourself in a situation where someone demandsmoney, drugs or other material items while threaten-ing your personal safety - DO NOT WITHHOLDTHE THINGS THEY DEMAND. As soon as safelypossible, let everyone else know of the situation.You should attempt to contact the police if it can besafely done without the person's knowledge, other-wise do it immediately after the person has left.

Cooperate with their demands and give them whatthey want, but do not go with the person. Resistphysical assault or battery to the best of your abilitiesand preferably outside the building so that passers-bycan see what's happening and render assistance orcall the police.

Hazardous Chemicals

You may not think about it, but many products thatyou use every day can be hazardous. Every chemi-cal, even common ones like cleaning supplies havethe potential to cause you harm. Some chemicalscontribute to health problems while others may beflammable and pose a fire threat. The most commonchemicals in use in the veterinary profession are:

• cleaning and disinfecting agents;• insecticides and pesticides;• drugs and medications;• sterilization agents; and• radiology processing fluids.

Planning and training are the keys to safely handlingany chemical. Every business, including your prac-tice must follow the requirements of OSHA's RightTo Know Law. This law requires you to be informed

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of all chemicals you may be exposed to while doingyour job. The Right to Know Law also requires youto wear all safety equipment that is prescribed by themanufacturer when using any product containing ahazardous chemical. The safety equipment must beprovided to you at no cost to you, but it is not option-al - you must wear what is prescribed!

A key component of the Right to Know Law is thehazardous materials plan. This plan will describe thedetails of the practice's MSDS filing system, the sec-ondary container labeling system, and the personresponsible for ensuring all employees have receivedthe necessary safety training. You have a right toreview any of these materials, so ask your supervisorwhere your plan is located.

Part of the planning process includes knowing exactlywhat chemicals are present. There must be an up-to-date list of products containing hazardous chemicalsknown to be in the hospital. It surprises some peopleto learn that the average veterinary hospital has over200 hazardous chemicals present at any one time!

When youreceive a prod-uct from the dis-tributor, everybottle will beidentified with alabel containing

directions and the appropriate warnings. You shouldalways read, understand and follow all the directionsand warnings printed on the label. Whenever possi-ble, you should keep this label intact and readable.Becasue it is sometimes necessary to dilute a productor just transfer it to smaller bottles for ease of use;these smaller bottles are known as secondary con-tainers. Always make sure to label secondary con-tainers with the contents and include any appropriatesafety warnings on the label. Your hospital shouldhave a specified format so that all secondary con-tainer labels are easily recognized; be sure youunderstand that system.

There is a lot of information on a product's label but

that information is generally written for the averageconsumer who will have limited exposure using theproduct. When a product is used in a place like yourveterinary practice, you may be exposed to thatproduct more than the "average consumer" so yourrisk may be greater. The manufacturer of a productthat contains a hazardous chemical will prepare aMaterial Safety Data Sheet (MSDS) for that product.The MSDS will give you additional precautions,instructions and advice for handling that product inthe workplace. Your practice is required to keep anMSDS library for the chemicals that you use. Askyour supervisor where your hospital's MSDS libraryis located. Take the time to review the MSDSs forthe products you use frequently. Although MSDSsmay look com-plicated at firstglance, theinformation thatis important toyou is easy tofind: review thehealth, protec-tive equipmentand disposalsections to gaina better under-standing of therisks and precautions you should know.

Always remember to replace the cap back on the bot-tle when using any chemical product. Working bot-tles of hazardous products should always have tightfitting, screw-on lids. You should endeavor to storechemical bottles in a closed cabinet; this will helpprevent animals from injury if they escape. Ideally,the cabinet or shelf should be at or below eye level.This will minimize the chances of spilling the prod-uct in your face if the cap is not secure. Never storeor use hazardous products near food, beverages orfood preparation areas.

Be very cautious when mixing or diluting any chem-ical product. Try to keep the material from splash-ing on your hands, clothes or face. If it is likely thatthe product will splash on you, wear a pair of protec-

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Example of a secondarycontainer warning label

You should take the time toread the MSDS for the

products you used regularly

tive latex or nitrile gloves and some protective gog-gles or glasses. When making solutions from a con-centrate, you should always start with the correctquantity of water then add the concentrate. Neveradd the water to the concentrate because the chemi-cal may splash or react differently.

When two chemicals are mixed together the result isseldom a simple mixture. It is often a new, some-times very different and very dangerous chemical.Never mix any chemicals unless directed to do so onthe label or MSDS.

Minor spills of most chemicals can be cleaned upwith paper towels or absorbent (like kitty litter) anddisposed of in the trash; however, some very danger-ous chemicals, like formaldehyde or ethylene oxiderequire special procedures. BEFORE you use a newchemical, review the MSDS and learn the proceduresyou must follow for cleaning up a spill. When clean-ing up any spill, remember to wear protective glovesand any other special equipment required on theMSDS. Keep other people and animals away fromthe spill until it is safe. Unless prohibited by theinstructions on the MSDS, wash the spill site and anycontaminated equipment with a detergent soap andwater - NOT a disinfecting soap.

Familiarize yourself with the locations of the eyewash stations in your practice. Test them regularlyand know how to use them before you're in the posi-tion to need them!

Special Chemicals

Ethylene Oxide - Many hospitals use gas steriliza-tion for items that would be damaged by other pro-cedures. Electrical drills, rubber products, andsharps are commonly exposed to ethylene Oxide(EtO) as a sterilization agent in human and veterinarymedicine. This method has distinct advantages, butsince EtO is suspected to be a human carcinogen,special precautions must be maintained:

• Read the MSDS carefully and follow all instruc-tions;

• Store the ampules in a closed cabinet away from

sources of heat;• Only use approved devices for the procedure;• Read, understand and follow all the written pro-

cedures and safety precautions relevant to yourpractice; and

• Know the emergency procedures to be performedin case of an accidental release of EtO.

Formalin - Historically, formalin has been used inthe veterinary profession for tissue preservation,diagnostic tests (knotts), and even sterilization.Since formaldehyde is also a suspected human car-cinogen, OSHA takes it's use very seriously. Thestandards for use of formaldehyde are very similar tothe standards for use of ethylene oxide:

• Read the MSDS carefully and follow all instruc-tions;

• Store supplies safely, include museum jars;• Use only with good ventilation in the room and

avoid breathing vapors;• Wear gloves and goggles to avoid skin & eye

contact;

Whenever possible, you should obtain formalin insmall, pre-measured containers (also called biopsyjars) so that the serious risk is minimized. Often thediagnostic laboratory will supply pre-filled biopsyjars at no charge so be sure to ask!

Glutaraldehyde is a potent chemical used in the vet-erinary practice to sterilize hard instruments withoutthe use of an autoclave. Because it's so effective atkilling germs, it can also be harmful to other livingorganisms – like you! Be sure to follow all the man-ufacturer's safe handling rules when using this "coldsterilization" solution, including washing your handsafter handling instruments exposed to the solution andkeeping the trays covered to minimize evaporation.

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We can't forget that the overriding purpose of a vet-erinary practice is the care and treatment of animals.But sometimes handling our patients can be a hazardin itself! Anyone who has worked with animalsunder stress or pain will relate personal accounts ofinjuries from patients. In fact, insurance statisticsreveal that animal connected accidents are the mostcommon injury of workers in veterinary relatedfields. Unfortunately, this hazard can't be eliminatedso we have to do the next best thing– control it. Yourbest controls for this hazard are your training, knowl-

edge and use of"restraint."

The very first safe-ty rule when work-ing around ani-mals is to stayalert! Animalssometimes react tosituations unex-pectedly. Suddennoises, movementsor even light canbe the stimulusthat would cause

an animal to react, so if you are the person responsi-ble for restraining the animal, keep your attentionfocused on the animal's reactions and not on the pro-cedure. You must learn the proper restraint positionsfor each of the species of animals with which youwork.

Remember that capture/restraint equipment is avail-able if the animal is fractious or not cooperating;sometimes, just a piece of rope to hobble a leg or apiece of gauze for a hasty muzzle will make all thedifference. And don't forget that chemical restraint isoften better for both you and the animal instead ofphysical confrontation, but be sure to ask the veteri-narian for approval before administering any med-ication to a patient.

Large animals like horses and cattle can severely

injure or even kill you just by trying to escape therestraint. Never put your hand, leg or any other partof your body between the animal and the side of theenclosure or chute; use a hook or pole to pass ropesor belts through the chute. If you have to enter astall, paddock or trailer with a large animal, stay onthe side of the animal nearest the door, so that youcan escape if the situation becomes hazardous. Ifyou must capture a fractious animal from a cage orpen, make sure there is another person present thatcould assist you if you get in trouble.

If your job entails handling exotic or non-domesticanimals, remember that they all have their ownunique methods of defense. You should know andunderstand their possible reactions before youattempt to restrain or treat them.

Noise is Noise

Dogs in a cage will inevitably bark, and barking dogscan be a health concern, especially in indoor kennels.Noise levels in dog wards can reach 110 decibels!Although relatively short duration exposure to thesenoise levels, like going into the kennel just to retrievea patient, poses no serious damage to your hearing,chronic, or long-term exposure can contribute tohearing loss. When working in noisy areas forextended periods of time (e.g., cleaning of cages),you must wear personal hearing protectors. It does-n't matter what style or type of hearing protectors youuse (ear plugs or muffs), as long as they are rated tofilter the noise by at least 20 dB (the package willindicate the rating).

Bathing, Dipping or Spraying Areas

There is probably no area of an animal hospital witha greater risk for injury than in the bathing or insec-ticide application areas. Although newer parasitecontrol products significantly reduce our exposure topesticides and insecticides, shampoos and medicaldips are still a big concern.

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Animal And Medical Hazards

The products used for bathing and dipping animalscan be harmful to your health as well as the environ-ment. Even the "all natural" shampoos can cause eyeirritation and you can develop sensitivities to eventhe mildest products if you're exposed often enough.Because it's impossible to prevent splashing andshaking, it's important to ALWAYS wear protectiveglasses or goggles when bathing or dipping animals.In most cases, it's also important to wear gloves anda protective apron to prevent the product from get-ting on your skin or clothing; that minimizes theamount you will probably absorb through your skin!

Bottles of dips, shampoos, and insecticides shouldbe stored in a cabinet at or below eye level. The bot-tle should be properly labeled with the contents andany hazard warning that is appropriate (see details inthe Chemicals section). Always replace the cap or lidon the container when you're finished using it to pre-vent accidental spillage. Plastic containers recycledfrom other areas can be used for diluted shampoosand dips, however, only use the ones that have a"screw-on" type cap or lid.

Always use a ventilation fan to keep the fumes fromshampoos and dips at a safe level. When exhaustfans are too large, they waste heating or air condi-tioning, so you may be hesitant to use them in somesituations. If that's the case, ask your hospital admin-istrator to have a smaller fan installed directly overthe tub or area so that fumes can be exhausted with-out sacrificing the comfort in theroom.

Make sure you know where the eyewash station for this area is located.Learn how to properly use the eyewash device before it is needed. Ifyou ever splash a chemical in youreyes - do not rub your eyes with yourhands! Immediately call out for help;there's usually someone nearby. Witha coworker's assistance, go to the eyewash station and flush BOTH eyes(even if only one eye is affected).Avoid using the spray attachments for

tubs and sinks since the water pressure is unregulat-ed and the streams of water from these devices canbe fine enough to lacerate your cornea.

Zoonotic Diseases

Diseases that are common to both humans and ani-mals are known as zoonotic diseases. Some diseasesare difficult if not impossible to transmit from ani-mals to humans while others are very easily spread.You can be exposed to the organisms that cause dis-ease by several means: inhalation, contact with bro-ken skin, oral, contact with your eyes and eventhrough accidental inoculation by a needle. Thepotential zoonotic diseases which you may beexposed to include:

• Rabies is a very serious, viral disease that canaffect any warm-blooded animal (includinghumans). The virus is spread by contact with aninfected animal's saliva. Usually, the disease ittransmitted through a bite, but the disease hasbeen transmitted by saliva coming in contact withan open wound or the mucous membranes; eventhe residue left on a dog's bowl after eating canharbor the virus.

Although the disease is always present in the wild ani-mal population, in recent years, many states (prima-rily in the eastern part of the country) have con-firmed record high numbers of animal rabies in

domestic species like cats, dogs,horses and cattle. There are record-ed cases animals adopted from petshops and even horses presented touniversity hospitals for treatmentwho were later diagnosed withrabies. Remember, one of thosepets could show up at your hospitalfor an exam and vaccinations orexams! Although rare, there areconfirmed cases of humans con-tracting rabies from animals in theUnited States and in all cases, oncesymptoms appeared, the patientdied.

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Diseases that are common toanimals and humans are known

as zoonotic diseases

The best protection you can have as a veterinaryhealth care worker is an understanding of the reali-ty that rabies is still a threat in the United States.The primary barrier between the wild animal popu-lation and humans is the vaccination of pets anddomestic animals. When you must handle anunvaccinated, wild, or stray animal, always wearprotective (rubber or latex) gloves, and maybe evenprotective gowns and goggles in cases where theprocedure may be "messy." There are two very safeand effective human rabies vaccines that can beadministered to people who work with animals.Ask your hospital administrator about the availabil-ity of this vaccine at your practice.

• Bacterial infections are probably the most likelyzoonotic disease threat in a veterinary environ-ment. Aside from the common bacteria that allanimals harbor naturally, you may be exposed tosome serious pathogens like Pasteurella spp., E.coli, or Pseudomonas spp. Bacteria is most com-monly transferred by direct contact with the ani-mal or it's exudates, especially if you have anycuts or open sores. Some bacteria are easily"aerosolized" or released in the air where theycan be inhaled and absorbed through yourmucous membranes. The best protection fromexposure to bacteria is simply good personalhygiene. Always follow the personal hygienerules discussed later in this chapter.

• Contrary to its name, ringworm is not a parasiteor worm; it is an infection with a fungus know asMicrosporum canis. Ringworm is very easilypassed between animals and humans. Cats andhorses are particularly susceptible to ringworminfestations. Again, the most effective protectionfrom ringworm infestations is to wear gloveswhen handling or treating animals diagnosedwith the condition and to practice good personalhygiene. Be especially careful about preventingcontamination of your clothing when treatingpatients with M. canis because it is believed thatthe fungal spores can be carried to other locations(like your home) and infect other animals orother people.

• When the eggs of common internal parasites likeroundworms infect humans, they usually do notmature into adult parasites, but they do causeother problems. Roundworm larvae can migrateto virtually any organ in the body and developinto a cyst-like growth known as visceral larvalmigrans. These "cysts" are usually not noticeablein everyday life unless they develop in a vitalorgan like the eye, then they do usually causesevere medical problems.

• Another common internal parasite, hookworms,can cause similar problems in humans by a con-dition known as cutaneous larval migrans. Thiscondition particularly affects children who playin areas where pets defecate frequently. Unlikethe visceral "cysts" from roundworms, the cuta-neous migrans are relatively easy to spot.Usually occurring on the lower extremities(legs), small red lines appear near the foot and"migrate" up towards the body.

• Recently, Lyme disease has become a more seri-ous concern for animals and people. When aninfected deer tick bites a host (an animal or per-son) during feeding, the bacteria Borreliaburgdorferi is transferred to the host. Lyme dis-ease in humans is characterized by aches in thejoints, fever, and a host of other "flu-like" symp-toms. The best defense against this disease is tocheck yourself daily for ticks, and remove thempromptly. If you work in a food- or mixed-ani-mal practice, it's also a good idea to use an insectrepellant on you and your clothes when you goout into fields or woods to work.

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Example ofringworm

(Microsporumcanis) on thearm of a staff

member

• Although the common dog mange, Demodexcanis, is rarely contagious to humans, animalswith sarcoptic mange can easily infect people andonly microscopic identification of the mite canpositively determine which form of mange ispresent. When treating patients with mange,always wear gloves and a protective gown andwash your hands thoroughly with disinfectingsoap immediately after the procedure.

• Infestation with a parasite known as Toxoplasmacatti, is called toxoplasmosis. Although it isusually not harmful to healthy humans, it cancause health problems in pregnant women bycausing abnormalities in the developing child.Ideally, if you are a pregnant woman, try to avoidcleaning cat litter pans and practice good person-al hygiene at all times. If that's not possible, wearprotective gloves and clean the pans every daysince the eggs of this parasite need a few days tobecome "infectious".

Because youwill probablycontact someof these dis-eases in yourjob, particularattention top e r s o n a lhygiene andsanitary workpractices isessential. Good personal hygiene includes makingsure your clothes don't become soiled by chemicalsor biological material, and of course, regular handwashing. In general, you should wash your hands:

• after handling medications or lab samples,• treating patients or cleaning cages,• before as well as after you use the restroom, and• before lunch or meal breaks and before you leave

work at the end of your shift.

When treating patients with potentially infectiousdiseases (infectious to people or other animals) weara protective apron, surgical mask, exam gloves, and

if appropriate, eye protection. Thoroughly washyour hands with a disinfecting agent like chlorhexi-dine or povidone-iodine scrub at the completion ofthe treatment. Change your clothes if they havebecome contaminated.

In human medicine, the transfer of HIV (or the AIDSvirus) and hepatitis-B between the patients and theworkers is a real threat. Since all the current researchindicates that our patients do not contract these twoserious diseases, the risk of exposure to animal bloodor other body fluids is less of a concern. Althoughthe term "bloodborne pathogen" is usually reservedfor human infectious agents, the principles of goodclinical hygiene must still be followed. The best wayto minimize this hazard is to take simple precautionslike wearing protective equipment when indicatedand practicing good personal hygiene.

A Dirty Mouth? - Precautions for dentistryoperations

Procedures like high speed or ultrasonic dental scal-ing will often aerosolize the pathogens, so personalprotection is necessary. One of the most commonpathogens in the mouths of animals is Pasteurellamultocida and that organism has been linked to car-diac and pulmonary problems in humans and animalsalike. Whenever you perform dental procedures, besure to wear goggles, gloves and a surgical mask.

Radiology

The ability to "see inside the body" is a great tool inmedicine. In most cases, the method of choice isdiagnostic radiography (x-rays.) Short duration,infrequent exposure to radiation, such as having radi-ographs taken of yourself, is accepted as an insignif-icant variable in your overall health. However, longterm exposure to low doses of radiation has beenlinked to genetic, cutaneous, glandular, and other dis-orders. High dose exposure can cause skin changes,cell damage, and gastrointestinal and bone marrowdisorders that can be fatal. Fortunately, much isknown about the properties of x-rays, and ways toprotect ourselves. By following some very simple

Page 16


Always wear eye protection, amask and gloves when performing

dental prophys

safety precautions, you can utilize radiography inyour practice with complete confidence.

Although modern radiographic machines have manysafeguards integrated in the design, there is still thepossibility of injury if these tools are used incorrect-ly. When you are involved in the use of radiographicequipment, always wear the appropriate protectiveequipment - lead aprons and gloves are essential andrequired. Thyroid collars and lead glasses are rec-ommended if they are available in your practice. Andof course, NEVER place any part of your body in theprimary beam (even gloved hands).

Before you use an x-ray machine, make sure youknow the function of every individual knob or but-ton. Always use the collimator to restrict the primarybeam to a size smaller than the size of the cassette -in other words, "cone down" to the area to be radi-ographed so that scatter radiation is minimized. Aproperly collimated radiograph will have a smallclear border around the entire film once developed.

Always follow the written operational or safety pro-cedures from the hospital or the manufacturer. If youhaven't already done so, make an exposure chart sothat you can replicate the best techniques for variousstudies. By following a proven technique chart andpositioning the patient correctly the first time, you'llhave fewer "retakes" and therefore eliminate unnec-essary exposure.

Portable machines, like those used in large animaland mobile practices, can be particularly dangerousbecause of their multi-purpose abilities. These

machines can be "aimed" in any direction, andbecause of their limited power they must utilizelonger exposure times to produce diagnostic images.When using a portable machine, always make sureno one is in the path of the primary beam (even at adistance). Always utilize a cassette holding pole andNEVER hold a cassette with your hands while theexposure is made – even with gloves. And of course,remember to wear a lead apron and gloves when nearthe machine during exposure.

If you are involved in the exposure portion of radi-ography, you must have and utilize an individualdosimetry badge. This badge is worn on your collaroutside your protective apron during radiographicprocedures, not as protection, but as a measurementof any "incidental" radiation you may receive duringthe procedure. It's important to return the badge tothe designated storage location (outside the x-rayarea) when not in use. Unless you are taking radi-ographs, don’t wear your badge outside becauseexposure to sunlight will result in false readings. Dueto the relatively low numbers of radiographs taken inmost practices, safer machines, and the use of goodprotective equipment, most workers receive very lit-tle, if any, occupational exposure to radiation.

Radiographic processing chemicals (the developer andfixer) can be very corrosive to materials and organictissues, so use protective gloves and goggles whenmixing or pouring the chemicals. For manual pro-cessing tanks, before use, stir the chemicals with carebut avoid splashing them. After handling radiograph-ic developing chemicals, always wash your hands. It'salso important to avoid breathing the fumes of the pro-cessing chemicals, so make sure there is adequate ven-tilation in the dark room; generally an exhaust fan isnecessary, so make sure it is used.

These chemicals can also react dangerously withother chemicals, so NEVER pour other chemicalsinto a sink or drain where developing chemicals areused. Some liquid drain openers, when mixed withdeveloper and fixer, can produce toxic gases and oth-ers will produce an ectothermic (extremely high tem-perature) reaction that could damage pipes.

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NEVERplace your

hands (or anyother part ofyour body) inthe primary

beam....evenwith protective

gloves!

Anesthesia

Anesthesia is as common to veterinary medicine asantiseptic wound care. The National Institute ofOccupational Safety & Health (NIOSH) estimatesthat over 250,000 U.S. workers are at risk from expo-sure to waste gasses which are not metabolized bythe patient. Long term exposure to waste anestheticgases (WAGs) has been linked to congenital abnor-malities in children, spontaneous abortions, and evenliver and kidney damage.

Although recent discoveries in the types of gassesused in veterinary medicine have produced saferagents for the patients and the workers, there is nochemical that is without risk, so we must still takeprecautions to protect ourselves even when usingagents like isoflurane and sevoflurane. Therefore,OSHA has adopted a safe exposure limit for ALLhalogenated anesthetic agents at 2 parts per million(ppm).

Using a proper scavenging system is the single mosteffective means of reducing your exposure to WAGs.There are three general methods of WAG removal forthe veterinary practic: active scavenging, passiveexhaust and absorption. Each has a place, but rarelydoes one method fit all circumstances. Regardless ofthe system your practice uses, make sure it is con-nected to the machine before use. If you use theabsorption canisters, be sure to check them regularly(by weighing with a gram scale) because once theybecome saturated with gas, they are ineffective!

According to some research, as much as 90% of theanesthetic gas levels found in the room during a pro-cedure can be attributed to leaks in the anesthesiamachine, so always perform a leak check of themachine prior to use. Also make sure you use thecorrect size hoses and rebreathing bags for thepatient. When intubated, inflate the tubes cuff beforeconnecting the patient to the machine. Only shouldstart the flow of anesthetic after connecting thepatient to the machine. When the procedure is com-plete, stop the flow of anesthetic agent and use pureoxygen to "flush" the circuit through the scavenging

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Leak Check Your AnesthesiaMachine

1. Assemble all hoses, canisters, valves or tubes accord-ing to the manufacturer'sinstructions.

2. Turn on the oxygen supplyto the machine.

3. Close the pressure reliefvalve (pop-off).

4. Use your thumb or palm toform a tight seal on the y-piece(the part of the hose thatattaches to the patient’s endo-tracheal tube.)

5. Turn on the oxygen untilthe bag is slightly over inflat-ed, (or when the pressure onthe manometer reaches the 20mark) then close the valve.

6. Observe the pressure in thesystem on the manometer andwatch closely for anydecrease. (If your machine isnot equipped with a manome-ter, observe the size of the bagclosely). If the pressureremains constant, the machineis leak-free. If the pressure drops, there is a leak (orleaks) in the system. The faster the pressure drops, thelarger the leak(s).

7. If there is a leak, check the bag, hoses and other rub-ber (plastic) parts for evidence of cracks or deterioration.Replace any parts that are damaged. Check all connec-tions, especially the seals at the top and bottom of thesoda lime canister and on the one-way valves (clear plas-tic domes). Tighten any loose connections you find.

8. After checking all connections and hoses, if there isstill a leak, have the machine serviced by a qualified tech-nician before use.

9. When the machine is leak-free, re-set the pressurerelief valve (pop-off) to the proper position to use themachine normally.


system before disconnecting the patient.

When refilling the anesthetic machine vaporizer,move the machine to a well ventilated area. Use apouring funnel and be careful to avoid overfilling thevaporizer or spilling the anesthetic. If you acciden-tally break a bottle of anesthetic, immediately evacu-ate all non-essential people from the area. Any win-dows in the building should be opened and allexhaust fans turned on. Quickly control the liquidwith a generous amount of kitty litter and place aplastic bag over the spill toreduce evaporation. Pick up theabsorbed liquid and kitty litterwith a dust pan and place itinside a plastic garbage bag.Seal the bag tightly and disposeof it in an outside trash can.Leave the exhaust fans on andthe windows open until you aresure the gas level has beenreduced to a safe level.

Some procedures, like maskingor tank induction, make collec-tion of waste gasses more diffi-cult, but not impossible. Be sureto use an appropriate flow rateand proper reservoir bag for thesize of patient - DO NOT turnup the oxygen flow meter to maximum when mask-ing a patient. Induction chambers should always beconnected to the scavenging system or absorptioncanisters to reduce the levels of escaping gasses.Make sure the ventilation in the room is good and uselocal exhaust fans when available.

Since patients don't metabolize all the anesthetic gasthey inhale during the procedure, some of the gas isreleased into the room air during respiration evenafter recovery. When monitoring patients duringrecovery, you should avoid close contact with theirface and keep the number of recovering patients to anacceptable number for the size of the area and venti-lation system. When practical, allow the patient topartially recover while still connected to the anes-

thetic machine (oxygen only) and scavenging sys-tem.

When changing the soda lime (carbon dioxideabsorbent) in anesthetic machines, wear rubber orlatex gloves. When the soda lime is wet, as is oftenthe case from humidity in the system, it can be verycaustic to tissues and some metals. Dispose of theused soda lime granules in a plastic trash bag as reg-ular trash.

If you are a woman and becomepregnant, discuss the risk with yourphysician as soon as possible andnotify your supervisor immediatelyso that an appropriate work sched-ule can be negotiated.

Compressed Gasses

Every year thousands of workersare injured while working withcompressed gas cylinders, usuallybecause of improper storage orhandling of these cylinders.Regardless of the size of the cylin-der, or whether the cylinder isempty, full, or in use, store them ina dry, cool place, away from poten-tial heat sources such as furnaces,

water heaters, and direct sunlight. Always secure thetanks in an upright position by means of a chain, orstrap (including the small tanks). Cylinders that arestored inside a closet should also be secured sincethey can fall against the door and cause injury whenyou open the door. If the cylinder is equipped with aprotective cap, they must be firmly screwed in placewhen the cylinder is not in use. If you have to movea large cylinder, don't roll or drag it; always us a handtruck or cart and remember to strap the tank in.

Sharps and Medical Waste

The most serious hazard from needles or sharpobjects in a veterinary medical environment is fromthe physical trauma (and possible bacterial infection)

Even small compressed gascylinders must to be

secured properly


Medical Waste DefinedMaterial Medical Waste Normal Trash

Sharps (any device with characteristicsthat make it possible to puncture, lacer-ate or penetrate the skin)

Any used needles and scalpel blades.Glass or hard plastic that is contaminat-ed with a HUMAN disease-causingagent.

Glass or hard plastic that is not contam-inated with HUMAN disease-causingagents can be disposed of as normalwaste.

Medical Devices such as blood tubes,vials, catheters, IV tubes, etc.

Considered biomedical waste only whenthey contain HUMAN pathogens or theyhave been used for chemotherapyDevices which simply contain or are

contaminated with animal blood (exceptfrom primates) are normally not consid-ered biomedical waste.

Animal Blood or Tissues Only dead animals or animal partswhich are infected with diseases that arecommunicable to humans; this includesbut is not limited to rabies, brucellosis,systemic fungal diseases, tuberculosis,atypical mycobacteriosis, etc.

Tissues from routine surgical procedures(castration, ovariohysterectomy, etc)should be considered regular waste.

Laboratory Cultures Microbiological cultures (bacterial, fun-gal or viral) of HUMAN pathogens areconsidered biomedical waste.

In some cases, culture media from nega-tive tests may be considered regulartrash, but it is probably wise to just clas-sify all lab cultures as biomedical wastefor simplicity.

Bandages/Sponges Used absorbent materials such as band-ages, gauze, or sponges, which are satu-rated with blood or body fluids that con-tain HUMAN pathogens that may splashor drip.

Sponges or bandages used on animalsnot infected with a disease transmissibleto humans.

Primate Materials Normally, waste generated from workon primates is considered regular wasteunless it fits in another category

Animal Waste Waste from animals infected with a dis-ease contagious to humans which can betransmitted by means of the waste.

Normally, waste from animals notinfected with human disease-causingagents should be disposed of as regulartrash.

that is caused by a puncture or laceration. To preventthese types of accidents, always keep sharps, nee-dles, scalpel blades and other sharp instrumentscapped or sheathed until ready for use. Do notattempt to recap the needle after use unless the phys-ical danger from sticks or lacerations cannot beavoided by any other means. When it is necessary torecap a needle, you should use the "one-handed"method . Although it takes a little practice to become"second nature," the one-handed method of recap-ping needles is the safest and most practical one formost veterinary situations.

Do not remove the needle from the syringe for dis-posal because this "unnecessary handling" oftenresults in injuries. Whenever possible, the entireneedle/syringe unit should be disposed of in the des-ignated sharps containers immediately after use.Don't ry to over-fill a sharps container....when it'sfull, it's full! When the sharps container is full, sealand handle it according to your hospital's prescribedpolicy and replace it with a fresh one. Never open asharps container that has already been sealed norstick your fingers into one for any reason.

Destroying the needle prior to disposal is not recom-mended because it may aerosolize the contents ofthe needle and increase your exposure. Likewise,you should not collect sharps in a smaller containerand transfer them to a larger container for disposal.Of course, never throw needles or sharps directly intoregular trash containers, regardless of whether or notthey are capped.

The chart on page 20 explains which materials areusually considered hazardous and which are not.Although this chart is "essentially accurate" somestates have special rules for discarding medicalwaste, so be sure to follow the rules prescribed byyour state.

Pushing Drugs - The Pharmacy Operation

Medicines are designed to cure diseases and makepatients better, but it's important to remember that allmedicines are chemicals and chemicals can be dan-

gerous. In the veterinary pharmacy, you can beexposed to all kinds of drugs just by handling them.Liquids can splash in your eyes when you pour themor they can release vapors that you can inhale.Handling, crushing or breaking tablets can leavepowder residue on your hands that will be ingestednext time you put your hands near your mouth ormucous membranes.

Some chemicals like the cytotoxic drugs (CD's) usedto treat patients with cancer are so "potent" evenminute exposures can cause harm. When preparingCD's, always wear powder-free chemotherapy glovesand a disposable gown that is not used for any otherpurpose. If the drugs are not mixed inside of a bio-logical safety cabinet, then you may need to wear arespirator too; just be sure to follow the instructions

Page 21


One-Handed Needle Recapping

Step 1 - place the cap on a flat surface such asthe counter top or even the floor.

Step 2 - Using onlyone hand, hold thesyringe in the tips ofyour fingers with theneedle pointing awayfrom your body.

Step 3 - Place your fin-ger tips on the flat sur-face so that the needleand syringe are paral-lel and in line with thecap.

Step 4 - Move yourhand forward "drag-ging" your finger tipson the flat surface untilthe needle is inside ofthe cap. You may thenuse your other hand to "seat" the cap firmly.


on the MSDS, package insert and your practice’sChemotherapy Safety Plan.

During administration of CDs, it's not unreasonableto expect the unexpected, so it's very important tokeep unnecessary people from the area and to wearprotective equipment such as gloves, disposableaprons, surgical masks and eye glasses. You shouldavoid wearing contact lenses when preparing oradministering CDs.

When handling or cleaning up after patients that havereceived chemotherapeutic treatments, rememberthat some drugs are excreted in bodily fluids so prop-er precautions are necessary. Always wear powder-free chemotherapy gloves and avoid contaminatingyour clothes when cleaning cages or picking upwaste from chemotherapy patients. Make sure youdispose of all soiled materials from these patients asmedical waste and launder non-disposable items sep-arately from general laundry.

No matter what the drug, The biggest rule to remem-ber when handling ANY medication is to practice

good personal hygiene, especially a thorough handwashing!

Summary

We all face dangers in life every day but that doesn'tmean we have to intentionally place ourselves indanger to get our job done. The successful personmakes sure the reward for the action far outweighsthe risk.

In this workbook, we've discussed your rights andresponsibilities in a safty program, the hazards asso-ciated with your job from both a general and medicalperspective and the actions you should take to protectyourself. But let's keep things in perspective: safetyis not a special program or the cause of additionalwork. It's doing the job properly the first time andfollowing the rules. Safety is not a reason to keepyou from doing your job....it should be the reasonyou can continue to practice your career for a longtime!

Have fun, but be safe.


Name ________________________________________ Date ___________________

Department or Position: __________________________________________________

1. Which one of the following is NOT an objective of a safety program:a. Stop people from doing any job which may be hazardousb. Increase awareness of potential hazards so the proper procedures can be observedc. Educate staff members on the hazards present in the workplaced. Comply with governmental regulations.

2. True of False: You have the right to choose which safety rules you will follow and can never be dis-ciplined for safety issues.

3. The safety director of this hospital is _________________________________.

4. ________ are the best person to judge the competency of your abilities to do your job safely. If youfeel you need additional safety training on any aspect of your job, you should ask _________________.

5. Because of the physical danger from moving parts, never operate machinery or equipment unless all____________ are in place. Report unsafe or broken equipment should be reported to _________________.

6. Dressing appropriately for the job also includes wearing shoes with __________________ and keep-ing ____________________ or loose-fitting clothes to a minimum.

7. Back injuries account for one in every _______ workplace injuries to American workers. Thereforeit's important to lift animals and material safely: always keep your back _____________________ and liftwith your ________________________.

8. There is ample evidence to show that excessive ______________ or dirty work areas contribute tothe frequency or severity of accidents.

9. Eating or drinking in our hospital is only allowed _________________________________________(be specific) because of the potential for disease transmission and chemical contamination.

10. If you must use an electrical appliance in a wet area, make sure it is _________________ and onlyplugged into a _____________________________ type outlet.

11. True or False: It is acceptable to use an extension cord when the location of a piece of equipment isnot near an outlet as long as it does not present a tripping hazard.

12. In the event of a fire, my first duty is to _______________________________.

13. The nearest fire extinguisher to my regular duty area is ___________________________.


14. Which of the following items should never be plugged into a surge suppressor?a. A computerb. Electronic lab equipmentc. A space heaterd. IV pump

15. The fire alarm system in my hospital is activated in the following manner: _____________________.

16. The designated assembly area in the event of an emergency evacuation is______________________.

17. True or False: Portable fire extinguishers should never be used on fires involving part of the buildingor structure.

18. When using a portable fire extinguisher, remember the word PASS, which stands for_____________________, ___________________, ____________________ and ____________________.

19. If you are ever approached by a person who claims to have a weapon, which of the following actionsshould you NOT take?

a. Cooperate with the personb. Resist to the best of your abilities if you think you can "subdue your attackerc. Give the person what they demand - money, drugs, etc.d. Do your best to remember details of the episode and call police as soon as it's safe

20. Every chemical, even common ones like __________________ have the potential to cause you harm.

21. Working bottles of hazardous liquids should always have labels and _______________________.

22. Containers of liquid chemicals should be stored in a closed cabinet, ideally at or below ___________.

23. True or False: Minor spills of most chemicals can be cleaned up with paper towels or absorbent anddisposed of in the regular trash or washed down the sanitary sewer.

24. The Right To Know Law requires you to wear _______________________that is prescribed by themanufacturer when using a product containing a hazardous chemical.

25. The Hazardous Materials Plan for my practice is located __________________________.

26. MSDS is short for ________________ __________________ _______________ _______________.

27. Never mix chemicals together unless instructed to do so ___________________________________.

28. The eye wash station(s) in my hospital is (are) located _____________________________________.

29. When making solutions from a concentrate, you should always mix the components in the properorder, adding the _________________to the correct amount of __________________.


30. Personal hygiene is the most important preventive measure that can be taken by a veterinary healthcare worker; the single most important personal hygiene measure you can take is _____________________.

31. True or False: It is acceptable to perform gas sterilization procedures using ethylene oxide in anyclosed plastic container as long as there is adequate ventilation in the room.

32. Since formalin is a suspected human carcinogen, whenever possible, you should obtain formalin insmall, ___________________ so that your risk of exposure is minimized.

33. True or False: Animal-connected injuries are the most common injury of workers in the veterinaryrelated professions.

34. The first rule of safety when working with animals is to __________________________.

35. The best controls for the hazard of fractious animals is your _______________, ________________and the use of proper restraint.

36. When working with large animals like horses and cattle, never put your _______________________between the animal and the side of the enclosure or chute.

37. When working in noisy areas like the kennels for an extended time, you must wear ______________.

38. Because it's impossible to prevent splashing and shaking, it's important to ALWAYS wear__________________________ when bathing or dipping animals.

39. A zoonotic disease is one that is ____________________________________.

40. True of False: If you are bitten or scratched by an animal and your skin is broken, you are requiredto report the incident to your supervisor regardless of how minor the injury.

41. When treating patients with potentially infectious diseases, wear __________________________________________. And always wash ________________ ____________________ after treatment.

42. Which one of the following is not considered a zoonotic disease:a. Rabiesb. Visceral larval migransc. Lyme Diseased. Feline Leukemia

43. One of the most common pathogens in the mouths of domestic dogs and cats is_________________________ and that organism has been linked to pulmonary and cardiac problems inhumans. Therefore, it is essential that ______________________________ be worn when performing den-tal prophys.

44. Long-term exposure to low doses of radiation has been linked to ___________, _____________,__________________ and other disorders.


45. Never place any part of your body in the ____________________________ when radiographingpatients, even if protected by gloves or an apron.

46. Always use the ______________________ to restrict the primary beam. A properly collimated radi-ograph will have a ____________ _____________ around the outside of the developed film.

47. Always wear the appropriate protective equipment when you're involved in taking radiographs. At aminimum, this includes _______________ and _____________.

48. Your individual dosimetry badge should be worn _________________ whenever taking radiographs.

49. Long-term exposure to _____________________________________ has been linked to congenitalabnormalities in children, spontaneous abortions, and even liver and kidney damage. OSHA has set the max-imum permissible exposure limit for all _____________________________________ at 2 parts per million.

50. As much as 90% of the waste anesthetic gas that escapes into the room air during a procedure can beattributed to ______________________________, so always perform a _____________________________on the machine prior to use.

51. Using a proper _______________________________ is the single most effective means of reducingyour exposure to WAGs.

52. When soda lime is wet it can be very _______________ to human tissue.

53. Compressed gas cylinders should always be secured in an ____________ position by means of__________________________________.

54. The most serious hazard from needles or sharp objects in a veterinary hospital is from___________________________________ and possible ___________________________________.

55. True or False: Animal blood is generally considered non-hazardous unless you know or suspect theanimal to have a zoonotic disease.

56. Do not attempt to remove needles from syringes for disposal. Whenever possible, the entire nee-dle/syringe unit should be disposed of in the designated ________________________ immediately after use.

57. When it is necessary to recap a needle, always use the ____________________________.

58. Needles should never be destroyed prior to disposal because it may ________________________and increase your exposure.

59. Handling, crushing or breaking medication in tablet form can leave _________________ on yourhands that may be ingested or absorbed unless good personal hygiene is practiced.

60. True or False: Chemotherapy patients can expel cytotoxic drug residues in their body fluids, so spe-cial precautions must be used when handling these animals.


Veterinary Practice Consultants: http://www.v-p-c.com/phil

OSHA: http://www.osha.gov

Canadian OSHA: http://www.canoshweb.org

National Institute of Occupational Safety & Health (NIOSH): http://www.cdc.gov/niosh

Centers for Disease Prevention & Control: http://www.cdc.gov

Canadian Centre for Occupational Health & Safety: http://www.ccohs.ca

The Veterinary Information Network (VIN): http://www.vin.com

The Veterinary Support Personnel Network (VSPN): http://www.vspn.org

Infection Control Today: http://www.infectioncontroltoday.com

The Virtual Anesthesia Machine: http://www.anest.ufl.edu/~eduweb/vam

Lab Safety Supply: http://www.labsafety.com

Environmental Protection Agency: http://www.epa.gov

Department of Labor http://www.dol.gov

Internet Safety Resources


Personal Notes:

Veterinary Practice Consultants1550 Athens Rd

Calhoun, TN 37309-3035

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