OSHA Watch
July / August 2004
Volume 6, No. 4
Precautions for Health-Care Workers
and Allied Professionals” launched
the concept of universal precautions
when glove use became standard
practice to guard against parental
exposure to potentially infective
materials in healthcare settings.
If the
Glove Fits . . .
Part One of Two
Those of us who have worked in the
healthcare field for over twenty years
remember the days when
glove use was
FOCUS nonexistent or at the
Glove
very least, reserved for
Use
special situations:
“Throughout the 1970s, I worked
in a hospital laboratory while
attending graduate school. I
drew at least a dozen blood
samples per day and the thought
of wearing gloves while doing so
never crossed my mind. I also
didn’t see my colleagues wearing
them. In a vain attempt to be
“cool”, I also remember
removing the plastic cap of the
needle with my teeth, but that’s
another story.
Kimberly-Clark Health Care
To prevent workers from
catching the only bloodborne
disease we knew of at the time,
blood samples from patients with
hepatitis B were conspicuously
labeled with bright orange biohazard stickers, just so that we’d
know to be “careful” with them!
For these patients, we didn’t
wear gloves; we just knew not to
pipette their serum by mouth…”
Glove use hit full stride when OSHA’s
Bloodborne Pathogens Standard
became effective in 1992. In fact, the
demand was so great that glove
manufacturers in Malaysia and
Thailand added chemicals to rubber
trees to make them grow faster and
shortened the washing and bleaching
cycles. The result? The protein
content was sky high, causing 1015% of healthcare workers to develop
a latex allergy.
—See If the Glove Fits, page 2
FOCUS
Glove
Use
It wasn’t until the mid-1980s when
the Centers for Disease Control and
Prevention’s landmark “AIDS:
How to Respond
when a Co-Worker
Is Injured
1. Give First Aid
Every year, five million workers are
injured on the job. More than half are
severe enough to cause the worker to
spend some time away from work.
Here’s OSHA’s advice for handling a
job-related injury or illness.
2. “Defib” Cardiac Arrest Victims
Employers who are not within three
to four minutes of a hospital or clinic
must keep adequate first aid supplies
readily available and employ someone
who is trained to render first aid.
OSHA “encourages employers to
consider acquiring” automated
external defibrillators (AEDs) to
Inside . . .
Working Safely with Potentially
Violent Patients . . . . . . . . . . . . . . . . 5
Ask the Expert . . . . . . . . . . . . . . . . . 7
In the News . . . . . . . . . . . . . . . . . . . . 9
Coming Next Issue:
• Latex Allergies
• Working with Toxic Drugs
—See Injured Co-Worker, page 8
Quality America: We Make Compliance Easy! 1-800-946-9956
Page 2
OSHA Watch July / August 2004
If the Glove Fits—from page 1
This is the first of a 2-part series that
looks at when and how to wear latex
and vinyl medical gloves. We’ll also
show you how to store
FOCUS them so that they don’t
Glove
disintegrate and how to
Use
verify that they’re working properly. In the next
issue of OSHA Watch, we’ll explore
latex allergies and discuss the pros
and cons of synthetic gloves for
protecting against both biohazards
and hazardous chemicals, such as
glutaraldehyde and chemotherapy
drugs.
This year, healthcare workers worldwide will use about 30 billion gloves.
Most healthcare facilities now use a
mixture of several types of gloves, but
latex gloves remain the first choice of
many healthcare workers due to their
Now
You
Know!
The ideal latex glove
is powder free and very
low in extractable latex
protein.
dexterity, tactile sensitivity,
durability, comfort and low cost.
But what about latex allergies? Latex
proponents maintain that today,
gloves contain less than 50 micrograms of protein per gram compared
with latex gloves a decade ago, which
had up to 2,000 micrograms of
protein per gram. Fewer people today
are becoming sensitized to latex due
to the lower antigen content.
The Right Glove for the Job
Disposable medical gloves fall into
two categories: surgical gloves and
examination gloves.
• Surgical gloves are fitted, sterile,
have extended cuffs and
packaged by size for left and
right hands.
• Examination (exam) gloves are
usually ambidextrous non-sterile
gloves, usually packaged by size
(S,M,L,XL) as singles in boxes of
100.
The Powder Problem
Most glove powder is composed
primarily of USP absorbable dusting
powder (chemically treated
cornstarch). A powder-laden
environment is a potential source of
respiratory problems and asthma-like
attacks for healthcare workers, but
most importantly, powder carries
latex proteins, which are aerosolized
on donning or removal.
To reduce the risk of staff developing
—See If the Glove Fits, page 3
Latex vs. Vinyl
Glove Material
Disadvantages
Advantages
Natural Rubber
Latex
• Protects against bloodborne pathogens.
• Tactile sensitivity, dexterity good. Highly
elastic.
• Comes in many sizes.
• Low cost.
• Renewable resource.
• Superior durability in situations involving
twisting, torquing and extensive hand
movements.
• Failure rate up to 0-4%.
• No protection against most hazardous
chemicals, such as glutaraldehyde.
• Degraded by oils in hand lotions.
• Oxygen, ozone* and UV light can
degrade.
• 10-16% of healthcare workers are
allergic to latex.
Vinyl (Polyvinyl
Chloride, PVC)
• Some protection against bloodborne
pathogens.
• Protects against many chemicals.
• Best used for low-risk tasks such as
handling emesis basins and urine
specimens.
• Resistant to light, ozone and oil
degradation.
• Can use hand lotions without degradation.
• Failure rates up to 65%.
• Limited sizes available.
• Stiff material; reduced hand and finger
movement.
• Can’t be worn for more than 30 minutes.
• Do not use for handling cytotoxic drugs.
• Will break down with alcohol and
glutaraldehyde.
*Ozone is created by electrical equipment such as generators, UV or florescent light, and x-ray equipment.
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OSHA Watch July / August 2004
If the Glove Fits—from page 2
allergies from repeated latex exposure
over time, several professional
healthcare organizations recommend
to:
• Discontinue unnecessary use of
latex gloves.
• Use low-allergen and powder-free
gloves.
• Anyone with a Type I allergy to
natural rubber latex should use
only synthetic gloves, avoid
contact with all latex containing
items, and work in a powder-free
or synthetic environment.
Latex or Vinyl?
One alternative to latex is vinyl. Vinyl
gloves are less expensive than latex
gloves, but they’re also more permeable (see Latex vs. Vinyl chart).
Consider wearing vinyl gloves only
when the superior barrier protection
of latex is not needed. A very short
procedure with minimal prospect for
blood or body fluid contact might be
one for which a vinyl glove could be
Sales of Surgeons’
Gloves, 2004
Powder-free
Latex
Powdered Latex
Synthetic
(polyisoprene,
neoprene)
considered an acceptable choice. For
example, vinyl gloves are a good
choice for prepping the surgical site
prior to the start of surgery when the
patient’s skin is intact, making body
fluid contact highly unlikely. Like
Page 3
When to Wear Gloves for Biohazard Protection
• Surgery, assisting during surgery,
suturing, shaving patients
• Treating lacerations, abrasions, and
compound fractures; trauma
procedures; microsurgery
• Taking rectal temperatures,
administering rectal medications,
sigmoidoscopy, endoscopy
• Using surgical power tools, lasers,
electrocautery devices and power saws
• Wound dressing changes; cleaning,
packing and irrigation
• Emergency childbirth; pelvic exams;
handling breast milk
• Phlebotomy, fingersticks, heelsticks,
lumbar punctures, giving injections*
• Touching patient’s non-intact skin
• Lab specimen collection and handling;
removing rubber stoppers from blood
tubes
• Digital exam of mucous membranes;
oral/nasal suctioning
• Cleaning blood or OPIM from patient
care areas
• Cleaning/servicing contaminated
equipment
• Handling contaminated laundry
• Collecting filled sharps containers and
biohazardous waste
* OSHA’s 11/5/99 Directive says: “gloves are usually not necessary when administering
intramuscular or subcutaneous injections as long as bleeding that could result in hand contact
with blood or other potentially infectious materials is not anticipated.” (Editor’s Note: OSHA
must think we’re clairvoyant when it comes to injections! Call me crazy, but I recommend wearing gloves, since there’s often a drop of blood that needs to be wiped away after the injection! )
latex gloves, vinyl gloves shouldn’t be
worn continuously for more than 30
minutes.
requirements for leakage, holes,
strength and durability (ASTM D3577-91 standards). The FDA allows a
Other practical issues to consider
when selecting gloves are the degree
and tenacity with which tape, labels,
Tegaderm, EKG leads, and other
adhesives stick to their surfaces.
Exam Glove Sales, 2004
15%
Powdered
Latex
When to Wear Gloves
Don’t wear gloves when performing
routine tasks that do not involve
contact with blood or other
potentially infectious materials, such
as using the telephone or computer,
writing in a chart or taking a
patient’s blood pressure. The
exception is when a worker has
hangnails, chapped hands or other
abrasions on the hands. In this
circumstance, wear gloves in all
patient care activities.
How Well Do Gloves Work?
Neither vinyl nor latex exam gloves
are completely impermeable. All
gloves for sale in the U.S. must meet
Food and Drug Administration
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35%
Powder-free
Latex
50%
Synthetic
(nitrile and
vinyl)
2.5% failure rate per 1,000 sterile
gloves tested for holes, and a 4%
failure rate for exam gloves, but
leakage and tears are much higher in
some circumstances with some glove
varieties.
Change exam gloves every 15 to 30
minutes depending on the task or
procedure, the amount of blood and
—See If the Glove Fits, page 4
Page 4
OSHA Watch July / August 2004
If the Glove Fits–from page 3
fluid exposure and the contact with
needles and other sharp instruments.
Gloves worn longer than 30 minutes
cause fluid to accumulate between
the latex lattices which results in
“wicking,” (fluid passing through to
the hands). After 50 minutes of
hydration, one-third of latex gloves
are permeable to pathogens (HBV,
Kimberly-Clark Health Care
What Glove
Degradation
Looks Like
Hardening, brittleness, cracking
Softening or “creep” (increasing
length of the fingers)
Tackiness
Loss of strength, elasticity or
tear-resistance
Clumping or debris. Halos
around debris are weakened
areas that can fracture during
use.
HCV, HIV). Wicking
also occurs when handling surfactants, such
as soaps, so never wash
or re-wear latex or
vinyl exam gloves.
Don’t Get
an Oil Leak!
Hand creams
made from these
oils weaken latex’s
barrier properties:
their integrity. If staining
occurs during use, it may
be due to chemicals in the
glove reacting with
chemicals secreted by the
wearer. Some gloves react
with lactic and uric acid
from human perspiration
to cause an amber or
brown stain. Nicotine
from the skin of smokers
may turn gloves brown, as
do copper and iron, excreted to varying degrees
through the skin of
healthy individuals. Some
illnesses and taking some
medications may also
result in glove staining.
During surgery, glove
puncture rates can
approach 60%,
Mineral oil
especially during
emergency procedures
Lanolin
(American Journal of
Coconut oil
Surgery 2001; 181:564566). Double-gloving
Palm oil
increases safety, but
Jojoba
many surgeons object
to the loss of sensation
Vaseline® and
and dexterity. Consider
other petroleumsynthetic gloves or cotbased products
Glove Storage
ton liners under latex
gloves for wet work,
Do not store gloves in
and replace gloves as
areas where there are
soon as practical when contaminated, extremes in temperature, near
unless a critical procedure can’t be
sterilizers, heaters or air conditioners
interrupted.
or where they are exposed to
Remove gloves whenever they
become contaminated, punctured or
damaged. Also remove them between
patients and between different tasks
performed on the same patient.
Finally, remove gloves when leaving
the work area and before handling
non-contaminated items such as
telephones.
How to Spot a Defective Glove
Before donning gloves, check to be
sure that they will do their job and
protect you against bloodborne
diseases. Tell-tale signs of glove
degradation include increased
transparency, tackiness, softening,
stiffness or brittleness, white hazing
with cracks, perforations (ozone
attack), or gloves that tear easily.
A discolored glove may or may not be
a symptom of glove degradation.
Certain solutions such as iodine, may
discolor gloves without affecting
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sunlight, ultraviolet light, fluorescent
light or X-ray machines.
Store gloves in their original
packaging, in a cool, dry place. Don’t
put them into large bins for extended
storage; this increases oxygen
exposure and speeds up degradation.
Hands Down in Favor of Latex?
Even though latex gloves still have a
home in most medical facilities
across the nation, will they ever face
extinction? Probably not—as long as
new latex allergies continue to
decline. But technology to develop
new and better synthetic gloves
continues to bring us products that
might soon be able to match latex’s
sensitivity and durability.
Part 2 of this 2-Part Series will look
at advantages and disadvantages of
synthetic gloves for working with
bloodborne pathogens and hazardous
chemicals. Stay tuned!
OSHA Watch July / August 2004
Page 5
Working Safely with…
anxious demeanor in the midst of an
angry interpersonal encounter, may
defuse the situation.
Potentially Violent Patients
Start by Listening
E
ach day more than 9,000
nurses and healthcare workers
are injured or verbally or
physically attacked on the job. OSHA
confirms the rising rate of assaults,
and maintains that the risk of jobrelated violence against healthcare
and social workers is presently higher
than for any other field.
Over the past 10 years of providing
OSHA seminars, I’ve asked thousands
of physician office employees
whether or not they had experienced
“violence” at work. Without fail, it
goes like this:
Dr. Dunn: May I see a show of hands
of those who have had a person come
into the practice with a weapon?
Usually less than 5 hands go up. I
then go on to ask how many have
been physically abused (punching,
kicking, biting, pushing) by a patient
or co-worker? Usually about 30% of
the audience raises their hands.
Finally, I ask how many have been
verbally abused at work, and every
hand in the audience goes up.
Nervous chuckles indicate to me that
healthcare workers feel like verbal
abuse is par for the course in this
business.
In this article, we look briefly at how
an individual healthcare worker can
reduce the possibility of a verbal
assault escalating into a physical
assault. It’s impossible to ensure your
personal safety in every situation, but
you can practice certain behavior to
reduce the possibility that you will be
injured in a violent situation.
Be Prepared for Those Who Are
Likely to Escalate from Cranky
to Downright Mean
Since a history of violence is the best
indicator of future violence, put a
system in place to warn (flagging the
patient chart; incident log) staff that a
potentially aggressive, abusive or
violent patient will be in the facility.
To accomplish this, patient
information must include past history
of violent behavior, incarceration,
probation reports or any other
information, which will assist healthcare staff to assess violence status.
Verbal Abuse Often Paves the
Way for Physical Abuse
When a patient or co-worker is
getting overly defensive or having
verbal outbursts, the situation can deescalate and resolve OR it will escalate into physical violence.
Showing respect for others is a
primary means for de-escalating
hostility and aggression, but this is
easier said than done, especially when
faced with the threat of violence.
Realize that the aggressor is often
feeling threatened, anxious and
fearful, and will respond even more
aggressively if s/he feels more
threatened.
Communicate respect by listening
carefully and demonstrating nonaggressive, non-challenging body
language. The ability to show concern
for the specific, personal needs of
others while maintaining a non-
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Being a good listener is a far more
powerful tool than speaking when
trying to defuse hostility.
Everyone wants to be heard and
understood. People often become
angry or aggressive only after a
lengthy period of not being listened
to or acknowledged both collectively
and individually. By listening effectively, and showing an interest in
resolving the issue or addressing the
person’s needs, you can often defuse
an angry or threatening situation:
Acknowledge the importance of whatever concern they are expressing (“I
see how important this is to you…..”)
Emphasize willingness to be cooperative and address the issue(s) being
raised (“Could you help me understand how…….”,“What is it you want
to see happen in this situation?”
“What are some other possible ways
to resolve this situation?”).
Then, paraphrase what was said to be
sure you have understood the
intended message. This prevents
misunderstandings and allows the
speaker to correct you if they feel you
inaccurately expressed what they were
trying to get across.
Finally, help them maintain their
dignity, attempting to calm them
down by reassuring them that their
concerns are legitimate (“I understand how you must feel….”). Refrain
from openly judging their behavior,
since this could cause any progress
you’ve made take a turn for the
worse.
— See Potentially Violent Patients, page 6
Page 6
OSHA Watch July / August 2004
Potentially Violent Patients
—from page 5
Avoid Accusatory Language
Accusatory language blames, accuses,
threatens, orders, puts down or
makes the other person feel guilty. It
makes them defensive and hostile
rather than cooperative and understanding. Starting a sentence with “I
or We” can lower the level of escalation and tension, whereas a “You”
message usually raises the level of
pressure. In general, be cautious
about starting sentences with “You”
or “You people.” For example, it usually makes people defensive to begin a
sentence with “You didn’t....” or “Your
people always...”.
Keep an Eye on Your Body
Language
About 80% of communication is nonverbal; we exchange meaning through
eye movements, facial expressions,
body posture, gestures, and proximity.
Try to pay extra attention to the nonverbal signals your body is giving
M
r. Jones appears very irritable when he arrives an hour late for
his appointment. When the receptionist indicates that he can’t
see the doctor immediately by saying: ”You were an hour late,
Mr. Jones, so we can’t see you until there’s a break in our schedule.” At
this point, Mr. Jones becomes verbally abusive. How could you re-phrase
the receptionist’s statement to prevent Mr. Jones from flying off the
handle? One option is: “We’ll make our best effort to fit you in as soon as
possible, Mr. Jones. (Editor’s Note: Front office staff can be intolerant of
patients who consistently arrive late, and this attitude can carry over to
all others. Unless Mr. Jones is chronically late, we should assume that
something out of his control occurred—a flat tire, a traffic ticket or he
might have just lost his job!)
when dealing with anger. Are you
frowning or shaking your head while
the other person talks? Are you
receptive to the information being
shared? Make sure your body posture
is open (hands at sides) rather than
closed (hands on hips, arms crossed,
pointing fingers) to communicate
respect and attention.
Be aware of standing eye to eye with a
person. Communication specialists
stress that standing at an angle (sideways) rather than directly across from
Signs that May Predict Violent Behavior
someone helps keep a situation calm
and non-adversarial.
Disengaging from
an Angry Person
If it appears that your best efforts are
failing or that you have become so
angry that the interaction is becoming more threatening, disengage from
the other person, if only to allow a
cooling off period, and/or schedule a
time more conducive to effectively
solve the problem.
If you suspect that emotions are
heading in a destructive direction,
prepare to disengage from the person
by saying something like:
• Has a history of violence (this is the strongest indicator).
• Talks and complains loudly; uses profanity, or makes sexual comments.
• Continually uses excuses and/or blames others. Holds grudges.
• Demands unnecessary services. Threatens others or vows to get even.
• Accuses staff members of being against him or out to get him.
• States that he or she is going to lose control.
• Throws or punches inanimate objects.
• Paces rapidly, excessive sweating or flushed face, twitching face, shallow
breathing, keeping head down, furrowed brows.
Acknowledge: “I can see you’re
furious with me,
Commit involvement: and we
need to talk more about it.
State your needs: Right now
though, I think things are too
intense. I need to consult with
XYZ, but,
• Challenges authority. Tries repeatedly to intimidate others.
• Shows intense interest in discussing or owning weapons.
• Appears tense and angry.
• Appears intoxicated or under the influence of drugs.
• Shows a romantic or other obsession with someone.
• Has had multiple life stressors, such as divorce, death in the family, or
financial problems.
State your intention to return to
the issue: I’ll be back.” or “We
can work through this later.”
Then leave immediately! Hopefully,
you’ve kept yourself between the
patient and the door.
— See Potentially Violent Patients, page 12
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OSHA Watch July / August 2004
Page 7
ASK THE EXPERT
Safety Sharps, Pap Smears, and Blood Tube Holders
More on
Safety Sharps
Q: Please clarify
the OSHA
requirement for
continual
(annual) evaluation of new safety sharp devices.
If the injury rate
has been
reduced or
Dr. Sheila Dunn
stayed the same
and there are no reports of employee
dissatisfaction, what is our obligation
to review/consider a different device?
A:
OSHA doesn’t say exactly what
needs to be done in an annual review,
rather the Agency (OSHA) leaves it up
to employers to determine that
devices in use remain appropriate,
control the hazard and reduce risks to
workers. Your OSHA manual should
state how you are to perform this
annual review. In Quality America’s
OSHA Safety Program Manual, we
provide an annual checklist that
includes this review as well as a recap
(no pun intended) of any sharps
injuries that occurred in the previous
year.
Q: If you have
already implemented
a safety device, do
you have to go back
and start all over and
re-evaluate and select
new devices in every
category?
A: No, but you should have a means
to ascertain whether problems are
occurring with devices that are being
used, such as employee feedback and
sharps injury data. Use this information to determine if any changes in
devices are needed. You need to also
keep abreast of new technology and
allow staff to consider it if the current
product you use has been improved
or if some newer technology offers
better protection.
Q: I manage several employees that
received the hepatitis B vaccine many
years ago, but never had a titer
performed to see if they were
immune. Do we have to go back and
titer them?
A: OSHA follows the most current US
Public Health Guidelines which do
require titering employees after they
receive the HBV vaccine. OSHA
announced in a November 27, 2001
Compliance Directive (CPL 2-2.69Enforcement Procedures for the
Occupational Exposure to Bloodborne
Pathogens) that post-vaccination
testing for antibody to hepatitis B
surface antigen (anti-HBs) response is
required in order to help determine
appropriate post-exposure
prophylaxis.
OSHA’s position on going back and
titering employees who either
worked in your practice before that
time or came to your practice having
received the vaccination but not the
titer is not clear. We recommend
that every OSHA Safety Officer have
one of the following for each
employee that is subject to the
Bloodborne Pathogens Standard:
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• A signed declination form, or
• A titer indicating immunity to
HBV, or
• Evidence that an employee was
given the series of 3 vaccinations
(twice) and did not mount an
immune response.
Then, if an employee is exposed to a
patient with hepatitis B, you’ll know
whether to administer immune
globulin, start the series of
vaccinations or do nothing.
With that said, the US Public Health
Service (CDC) acknowledges that up
to 60% of persons who initially
respond to the HBV vaccination will
lose detectable antibodies over a
period of about 12 years. This means
that you can expect half of the
employees who received the
vaccination years ago to be nonimmune. If this is the case,
administer a booster dose and then
re-titer.
Q: How should the cytobrush and
spatula used to take a pap smear be
disposed of after preparing the slide
or using a thin prep solution?
A: OSHA requires that any
contaminated sharp be placed in a
sharps container, so cytobrushes
must be discarded in a sharps
container and the spatula may be
discarded either in a biohazard bag (if
it’s wooden and won’t puncture the
bag) or also in the sharps container.
Q: We just experienced our first
needlestick in 12 years of practice. We
— See Ask the Expert, page 8
Page 8
OSHA Watch July / August 2004
Ask the Expert—from page 7
Q: I was given a letter dated 1/27/04
followed the directions in your OSHA
Safety Program Manual and took
blood from the source patient and the
employee. One of our employees told
me that we must record this on OSHA
Form 200, and that we must call such
incidents in to OSHA. Why isn’t this
information in your manual?
from LabCorp entitled: “Statement of
Laboratory Corporation of America
Holdings Explaining Why OSHA’s
Interpretation of the Bloodborne
Pathogen Standard to Prohibit Reuse
of Blood Tube Needle Holders is
Erroneous”. It goes on for 12 pages
explaining why OSHA’s requirement
to discard these holders is wrong.
Who should we believe? Do you think
OSHA will change their mind on this?
A: Rest assured, Quality America’s
OSHA Safety Program Manual is
correct. OSHA’s Form 200 and all
other forms needed to report workplace injuries/illnesses were discontinued in 2001 and replaced with other
forms (Form 300, 301 and 301A) that
are not required for physician offices.
After a needlestick, all you need to fill
out is the Accident/Sharps Injury Log
(Form 14). Moreover, NO post-exposure forms ever need to be sent to
OSHA or posted in your facility. Never
“call in info to OSHA”, because doing
this could bring them in for an
inspection, which opens a whole new
can of worms. Often, employees will
tell you what they think is right, but
in this case, the employee is way off
base. When issues such as this arise,
please call us at 800-946-9956.
of the Month
3. Record or Notify OSHA
Doctor’s offices and other ambulatory
medical facilities are NOT required to
maintain OSHA Forms 300, 301,
letter, we spoke to their bloodborne
pathogens coordinator, Dionne
Williams. Ms. Williams said, “It’s
unfortunate that LabCorp is sending
this memo out to people who can be
influenced by it, because it is erroneous. What is LabCorp hoping to
gain by this”? She went on to say that
the one-use requirement for blood
tube holders is an OSHA regulation
and that “LabCorp does not set policy
for the nation.”
We asked her what OSHA plans to do
about LabCorp and she replied that
OSHA is in the midst of a “standing”
inspection of LabCorp. Bottom line, it
doesn’t appear that OSHA is planning
to budge on their position.
QUESTION OF THE MONTH
?
revive victims of sudden cardiac
arrest. Lightweight and portable,
battery-operated AEDs are easy to use
and can quickly restore heart rhythm
to normal.
A: Believe OSHA! After reading the
ANSWER TO LAST MONTH’S
Question
Injured Co-Worker—from page 1
Besides Hepatitis B, what vaccines are
employers required to provide to workers?
Although OSHA does not require employers to provide
them, vaccines suggested by the US Public Health
Service for healthcare workers are:
• Influenza (annually)
• Measles
• Mumps
• Rubella
• Varicella (chicken pox
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301A or post injury or illness summaries, but all workplaces must
record sharps injuries (see Form 14
in Quality America’s OSHA Safety
Program Manual). Only notify OSHA
when a worker is killed on the job or
if three or more workers are hospitalized.
Report these types of catastrophes to
the nearest OSHA area office or call
the agency’s toll-free number 800321-OSHA (6742) within eight hours.
Fatal heart attacks must also be
reported.
(Editor’s Note: This is the first time
we’ve heard OSHA specifically mention heart attacks. Sounds like OSHA
is serious about those AEDs.)
OSHA Watch July / August 2004
Page 9
IN THE NEWS
The latest injury statistics, released
by the Bureau of Labor Statistics
(BLS), U.S. Department of Labor
implicate lifting and moving patients
as the most frequent injury, second
only to truck drivers. Of the 1.4
million injuries in private industry
that require recuperation away from
work beyond the day of the incident,
ten occupations (including healthcare) accounted for one-third of the
cases.
79,000 healthcare workers suffer
sprains and strains annually (usually
to their backs), due to overexertion
related to lifting or moving patients.
Source: BLS website www.bls.gov/news.
release/pdf/osh2.pdf
Keep up SARS Vigilance
Following the April 2004
announcement from the Chinese
Ministry of Health of nine SARS cases
the Centers for Disease Control and
Prevention alerted state health
departments that in turn distributed
the information to local medical
personnel and health facilities. CDC
hopes that when somebody who was
in China eight or nine days ago,
walks in and says, ‘I’ve got a fever and
cough,’ that one of the first things
they’re asked about is travel.
(Editor’s Note: The SARS virus
infected 8,098 people and killed 774
worldwide between Nov. 1, 2002, and
July 31, 2003, according to the World
Health Organization.)
Blue Light Scanners Spot
Workers’ Dirty Hands
New light-scanning technology may
soon help healthcare facilities ensure
that employees’ hands are clean.
eMerge Interactive Inc., a struggling
technology company in Sebastian,
Fla., is planning to tweak light
scanners it already sells to beef plants
to detect germs on human hands.
Currently, a blue-light scanner the
size of an electric hand dryer detects
fecal contamination and pinpoints on
a digital display where on a person’s
hands more scrubbing is needed.
Contamination shows up on a
built-in display as a bright red spot
on a person’s dirty hand.
eMerge’s first clean-hand scanners
could go on sale as early as year’s end
to restaurants, nursing homes,
hospitals and day-care centers. Using
identification cards, the devices can
even record which employees
scrubbed acceptably and which ones
still have dirty hands.
Source: Associated Press. April 3, 2004 To
view a video of the hand-scanner, go to:
http://wid.ap.org/interactives/scanner.html
Patient Safety Goals
The Joint Commission on
Accreditation of Healthcare
Organizations (JCAHO) released its
proposed 2005 National Patient
Safety Goals and Requirements for
public review and comment. Among
the changes JCAHO is proposing are
new goals for reducing the risk of
harm from patient falls and the risk
of surgical fires. JCAHO also is
proposing that hospitals develop
plans for implementing bar-code systems for patient identification and for
matching patients to their
medications or other treatments by
January 1, 2007. To view the potential
www.quality-america.com
eMerge Interactive Inc.
Ouch, My Aching Back:
Moving Patients
goals and complete an online field
review, go to http://www.jcaho.org/
accredited+organizations/05_npsg_fr.
htm and click on “Hospital.”
OSHA Turns up Heat on
Haz Com
OSHA’s new initiative to focus attention on hazardous chemicals in the
workplace is a two-edged sword, consisting of both compliance assistance
and enforcement components.
The Hazard Communication (Haz
Com or “Right to Know”) Standard
has been in effect for 20 years and is
intended to protect employees in
medical workplaces against substances such as glutaraldehyde,
bleach and chemotherapy drugs.
How? Through those indecipherable
documents we love to hate: Material
Safety Data Sheets (MSDS).
One benefit of the new Haz Com
initiative is that OSHA may adopt a
global system of chemical
classification and labeling, which
promises to improve the quality of
MSDS’s and labels.
— See In the News, page 10
Page 10
OSHA Watch July / August 2004
D
I
L
B
E
R
T
•
DILBERT reprinted by permission of United Feature Syndicate, Inc.
In the News—from page 9
(Editor’s Note: Asst. Labor Sec. John
Henshaw must have gotten a gander
at some of the MSDS that companies
try to pawn off on us….. faxed copies
of faxes, written in Greek and barely
legible. Maybe we’ll finally get MSDS
sheets that tell us what we need to
know: how to protect ourselves when
working with these chemicals, how to
recognize when we’ve been harmed
by them, and what to do about it!)
Green Light for Alcohol Rub
Dispensers in Hallways
On April 28, 2004, the National Fire
Protection Association (NFPA)
amended the Life Safety Code (LSC)
to permit alcohol-based hand rub dispensers not only in patient rooms and
suites, but also in corridors where
they were previously prohibited. This
is good news for medical facilities
that are inspected by the Joint
Commission on Accreditation of
Healthcare Organizations (JCAHO)
and the Center for Medicare and
Medicaid Services (CMS), since both
these organizations enforce the LSC.
The new amendment allows alcohol
gel dispensers in corridors provided
the following conditions are met:
www.quality-america.com
The corridor is 6 or more feet
wide and dispensers are
separated at least 4 feet apart.
• The maximum individual fluid
capacity is 1.2 liters for
dispensers in corridors.
• The dispensers are not installed
over or directly adjacent to
electrical outlets and switches.
• Dispensers installed directly over
carpeted surfaces are permitted
only in sprinklered smoke
compartments.
Surgical Tool Causes OR Fire
A hot surgical tool was the likely
OSHA Watch July / August 2004
source of an operating-room fire that
seriously injured a 78-year-old patient
at Wilson Memorial Regional Medical
Center in Johnson City, NY.
The patient was undergoing a biopsy
for temporal arteritis on the side of
her head when she suffered seconddegree burns to her face and neck.
The surgeon was using a cauterizing
tool to close the wound, when a flame
erupted. The cauterizing tool likely
ignited cloth surgical draping in the
presence of oxygen near the patient’s
face. No other medical gases were
used during the operation. An
inspection of the cauterizing tool
revealed no particular problems with
the device and oxygen was not
leaking from the oxygen tube.
Witnesses on the surgical team
described a frantic scene in which the
surgeon initially fought the fire with
his hands. In spite of efforts to
extinguish the fire, flames burned the
patient’s face, the blue drape,
bedding, and even the oxygen tube in
her nose. The surgeon performed an
emergency tracheotomy, and the
patient was discharged after spending
six days in the burn unit, her lawyers
said.
Although the fire was extinguished in
a few seconds, fire officials criticized
the hospital staff for waiting about 90
minutes to call the fire department.
Source: Binghamton, NY, Press &
Sun-Bulletin
Page 11
Baltimore hospital issued thousands
of HIV and hepatitis test results with
out-of-range quality control results
during a 14-month period ending last
August. Similar problems were
uncovered in tests for sexually
transmitted diseases
such as chlamydia
and gonorrhea.
Inspectors also
found that the lab
used reagents for a
variety of routine
tests after they had
passed their expiration date.
State investigations
began after a lab
tech reported that her complaint
about a malfunctioning instrument
went unheeded. The lab tech also said
she became infected with HIV and
hepatitis when the machine known as
a Labotech malfunctioned and
splattered her with infected blood.
(Editor’s note: We’re left to wonder
what type of PPE she was wearing?)
Timothy D. Miller, the president and
CEO, and the medical director of the
laboratory, Dr. Philip Whelan have
resigned. Though Miller insisted he
didn’t know about the problems, the
complainant disclosed that she sent a
letter detailing the problems to Miller
late last year.
MEDLINE Offers Patient
Rx Information
Knowing that informed patients who
Maryland Lab Pays Price for
Ignoring Employee Complaint
State health officials ordered
Maryland General Hospital to take
immediate action to fix a laboratory
“rife with equipment failures” or face
fines of up to $10,000 a day. Despite
passing College of American
Pathologists (CAP) accreditation last
year, the 243-bed, acute care
Question
?
of the Month
take an active role in their health care
are better patients, the nation’s
largest medical library has released a
new consumer-friendly website for
patients to get authoritative, reliable
information about their medication
or condition.
About 80% of adults now use
the Internet to find health information and most believe it helps
them get better health care.
Using free “prescription pads,”
healthcare providers can direct
patients to The National Library
of Medicine’s MedlinePlus to get
more detailed information than
was provided in the office or
clinic.
MedlinePlus (http://www.medlineplus.gov) has information on more
than 650 diseases and conditions.
Under each health topic, patients can
find information on symptoms,
diagnosis and treatment, current
news stories, research studies, clinical
trials, helpful graphics, and
interactive tutorials. MedlinePlus
accepts no advertising and most
information is available in Spanish.
In pilot studies, participating
internists report that MedlinePlus
empowers patients (54 percent),
explains difficult concepts and
procedures (43 percent), and
improves patient-physician
communication (42 percent).
Source: NIH News Release:
http://www.nih.gov/news/pr/apr2004/nlm-22.htm
How long do we need to keep
the Monthly and Annual
Facility Checklists?
Find out in the next edition of
Quality America’s
OSHA Watch.
www.quality-america.com
Page 12
OSHA Watch July / August 2004
Potentially Violent Patients
—from page 6
Keep Records of Abuse
It’s surprising that over 80% of all
assaults in healthcare facilities go
unreported. Report any incidents of
abuse, verbal attacks or aggressive
behavior regardless of whether it
resulted in injury, such as pushing,
shouting, or an act of aggression
requiring action by staff. Also keep
records of assaults resulting in
employee injuries. Use the Accident
Report (Form 14) in Quality
America’s OSHA Safety Program
Manual. Include the circumstances of
the incident and a description of the
environment, location or any contributing factors. Finally, indicate
what corrective measures will be
taken to prevent recurrence.
In a future issue of OSHA Watch,
If you’re looking for an effective
way to teach your staff how to
diffuse potentially violent situations,
consider Quality America’s
Online Training Center.
Go to www.quality-america.com to
take a demo course.
we’ll highlight administrative and
operational steps you can take to
decrease the probability of experiencing workplace violence. In the meantime, make employees aware that
people who are anxious or upset
could become abusive, especially if
not treated in a respectful, concerned
fashion. Consider using actual scenarios of confrontational encounters during staff meetings to teach employees
appropriate responses. The behaviors
they adopt will increase their chances
of surviving a bad encounter
unscathed!
O nline Training C enter
SELF-PACED COURSES FOR OSHA COMPLIANCE
NEW COURSE: “Preventing Workplace Violence”
Quality America’s Online Training Courses Are:
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• OSHA Annual Retraining • Basis OSHA Training
• New Employee • OSHA Orientation
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• Administering Your OSHA Program
• Selecting and Evaluating Safety Sharps
Try our demo course by visiting www.quality-america.com
We Make Compliance Easy!
www.quality-america.com
Coming
Next Issue
Look for the
September/October 2004
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with all your favorite
features, including . . .
Ask the Expert
In the News
Plus . . . .
Latex Allergy
Working with Toxic Drugs
and much more!
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