ISBN: 978-1-4822-0655-5

9 781482 206555

90000

Healthcare / Health Administration & Policy

Comprehensive in scope, this totally revamped edition of a bestseller is the ideal desk reference for anyone tasked with hazard control and safety management in the healthcare industry. Presented in an easy-to-read format, Healthcare Hazard Control and Safety Management, Third Edition examines hazard control and safety management as proactive functions of an organization.

Like its popular predecessors, the book supplies a complete overview of hazard control, safety management, compliance, standards, and accreditation in the healthcare industry. This edition includes new information on leadership, performance improvement, risk management, organizational culture, behavioral safety, root cause analysis, and recent OSHA and Joint Commission Emergency Management requirements and regulatory changes.

The book illustrates valuable insights and lessons learned by author James T. Tweedy, executive director of the International Board for Certification of Safety Managers. In the text, Mr. Tweedy touches on the key concepts related to safety management that all healthcare leaders need to understand.

• Identifies common factors that are often precursors to accidents in the healthcare industry

•Examines the latest OSHA and Joint Commission Emergency Management Requirements and Standards

•Covers facility safety, patient safety, hazardous substance safety, imaging and radiation safety, infection control and prevention, and fire safety management

• Includes references to helpful information from federal agencies, standards organizations, and voluntary associations

Outlining a proactive hazard control approach based on leadership involvement, the book identifies the organizational factors that support accident prevention. It also examines organizational dynamics and supplies tips for improving organizational knowledge management. Complete with accompanying checklists and sample management plans that readers can immediately put to use, this text is currently the primary study reference for the Certified Healthcare Safety Professional Examination.

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Healthcare H

azard Control

and Safety Managem

entTh

ird Edition James T. Tweedy,

MS, CHSP, CPSO, CHEP, CHCM

Healthcare Hazard Controland Safety Management

Third Edition

Tweedy

K21514

w w w.produc t i v i t yp re s s .com

K21514 cvr mech.indd 1 2/5/14 2:21 PM

Healthcare Hazard Controland Safety Management

Third Edition

Healthcare Hazard Controland Safety Management

Third Edition

James T. Tweedy,MS, CHSP, CPSO, CHEP, CHCM

CRC PressTaylor & Francis Group6000 Broken Sound Parkway NW, Suite 300Boca Raton, FL 33487-2742

© 2014 by Taylor & Francis Group, LLCCRC Press is an imprint of Taylor & Francis Group, an Informa business

No claim to original U.S. Government worksVersion Date: 20140131

International Standard Book Number-13: 978-1-4822-0656-2 (eBook - PDF)

This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to publish reliable data and information, but the author and publisher cannot assume responsibility for the valid-ity of all materials or the consequences of their use. The authors and publishers have attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint.

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Visit the Taylor & Francis Web site athttp://www.taylorandfrancis.com

and the CRC Press Web site athttp://www.crcpress.com

With a father’s heart of love, I dedicate this book to the memory of my precious daughter, Elizabeth Cheryl Tweedy, who in her brief 19

years touched the lives of so many for time and eternity. She taught all who knew her the true meaning of the words love and friendship.

I have come to realize that the completeness of one’s life cannot be measured in length of years but in the way in which we choose to live the time allotted us.

So I PrayBy

Elizabeth Cheryl Tweedy

January 18, 1977–June 26, 1996

In a world where sorry is so commonplaceThat undeniable pain is evident on every faceWe are guided by theoryLed by a blackened lightAnd virtues are just a conceptOf a long forgotten time

Where happiness is misunderstoodAnd confusion reigns supremeI look around and trembleAs I think of what it means

But I know who I am in You …Called out and commissioned by ChristTo go unto all the nationsAnd make the sacrifice

So I pray …

Let me love with your loveLet me shine with your lightLet me care with your compassion, LordIn this world black as nightLet me trust with all my heartLet me speak only the truthLet me teach so they might understandWhat it means to know you

So I pray …

Send me Lord today

vii

ContentsPreface...........................................................................................................................................xxixAcknowledgments .........................................................................................................................xxxiAuthor ........................................................................................................................................ xxxiii

Chapter 1 Healthcare Hazard Control ..........................................................................................1

Introduction ..................................................................................................................1International Board for Certification of Safety Managers ...........................................1Hazard Control .............................................................................................................2Hazard Control Management .......................................................................................3

Program or Function ................................................................................................3Hazard Control Is Good Business ...........................................................................4

Hazard Control Responsibilities...................................................................................4Hazard Control Manager Responsibilities ..............................................................5Supervisor Involvement ...........................................................................................6

Addressing Behaviors ...................................................................................................6Employee Engagement ............................................................................................6Working with Employee Organizations ..................................................................7

Hazard Control Practice ...............................................................................................7Hazard Control Policy Statements...........................................................................7Hazard Control Plan ................................................................................................7Objectives and Goals ...............................................................................................9Reviewing Plans, Policies, and Procedures .............................................................9

Understanding Hazards ................................................................................................9Hazard Identification ............................................................................................. 10Managing Hazards ................................................................................................ 10Preparing for Inspections ...................................................................................... 11Inspection Reports ................................................................................................. 12

Hazard Analysis ......................................................................................................... 12Change Analysis .................................................................................................... 13Creative Hazard Analysis ...................................................................................... 13Risk Analysis ......................................................................................................... 13Phase Hazard Analysis .......................................................................................... 13Process Hazard Analysis ....................................................................................... 13

Job Hazard Analysis ................................................................................................... 14Job Design ............................................................................................................. 14

Hazard Control and Correction .................................................................................. 14Engineering Controls ............................................................................................. 15Administrative Controls ........................................................................................ 16Work Practice Controls.......................................................................................... 16

Personal Protective Equipment .................................................................................. 16Eye and Face Protection ........................................................................................ 17Head Protection ..................................................................................................... 17Foot Protection ...................................................................................................... 17Arm and Hand Protection ..................................................................................... 17Body and Torso Protection .................................................................................... 18

viii Contents

Hazard Control Committees ...................................................................................... 18Hazard Survey Teams ............................................................................................ 18

Hazard Control Evaluation ......................................................................................... 19Areas to Evaluate ................................................................................................... 19Accreditation Standards ........................................................................................20

Hazards .......................................................................................................................20Conducting Hazard Surveys and Environmental Tours ........................................ 21

Facility Hazard Index ................................................................................................. 21Safety Action Teams ..................................................................................................22System Safety .............................................................................................................22

Hazard and Operability .........................................................................................24Failure Mode and Effects Analysis .......................................................................25Fault Tree Analysis ................................................................................................25Hazard Control and Risk Management .................................................................26Instructional Systems Design ................................................................................26

Ergonomics .................................................................................................................26Musculoskeletal Disorders ....................................................................................28Evaluate Ergonomics Efforts .................................................................................28Workstation Evaluations ........................................................................................28Computer Workstation Interventions.....................................................................29Back Pain ...............................................................................................................29

Review Exercises ........................................................................................................30

Chapter 2 Understanding Accidents ........................................................................................... 31

Introduction ................................................................................................................ 31Accident Causation Theories ..................................................................................... 31

Henri Heinrich’s Five-Factor Accident Sequence ................................................. 31Accident Causes .................................................................................................... 31Multiple Causation Theory .................................................................................... 32Biased Liability Theory ......................................................................................... 32Accident Pyramid .................................................................................................. 32Prevention of Fatal Events ..................................................................................... 33

Human Factors ........................................................................................................... 33Error....................................................................................................................... 33Motivating People ..................................................................................................34

Accident Deviation Models ........................................................................................34Accident Reporting .................................................................................................... 35Accident Investigations ..............................................................................................36

Classifying Causal Factors .................................................................................... 37Interviewing Witnesses ......................................................................................... 37

Accident Analysis ....................................................................................................... 37Root Cause Analysis .............................................................................................. 37Accident Reports ................................................................................................... 38

Organizational Functions That Support Accident Prevention ................................... 39Interfacing Support Functions ............................................................................... 39Operational and Support Functions ....................................................................... 39Human Resources .................................................................................................. 39Facility Management ............................................................................................. 39Purchasing/Receiving ............................................................................................ 39

ixContents

Employee Health ...................................................................................................40Shift Workers .........................................................................................................40

Workers’ Compensation ............................................................................................. 41Return-to-Work/Modified Duty Positions ............................................................. 42

Substance Abuse......................................................................................................... 43Orientation, Education, and Training ......................................................................... 43

Providing Adequate Sessions ................................................................................44Training and Hazard Control ................................................................................44Training Methods .................................................................................................. 45Off-the-Job Safety Education ................................................................................ 45Instructional Systems Design ................................................................................46

Promoting Safety and Hazard Control .......................................................................46Review Exercises ........................................................................................................ 47

Chapter 3 Leadership and Management ..................................................................................... 49

Introduction ................................................................................................................ 49Leadership .................................................................................................................. 49

Practical Leadership ..............................................................................................50Management ...............................................................................................................50

Management Theories ........................................................................................... 51Peter Drucker ......................................................................................................... 52Classic Management Theory ................................................................................. 52Motivation–Hygiene Theory ................................................................................. 52Managerial Grid .................................................................................................... 52Management Theory S .......................................................................................... 53Theory Z ................................................................................................................ 53Knowledge Management ....................................................................................... 53

Decision Making ........................................................................................................ 53Management by Exception ....................................................................................54

Functions of Management ..........................................................................................54Planning .................................................................................................................54Directing ................................................................................................................54Organizing ............................................................................................................. 55Controlling ............................................................................................................. 55Coordinating .......................................................................................................... 55

Other Management Concerns ..................................................................................... 55Staffing .................................................................................................................. 55Project Management .............................................................................................. 56Psychological Safety .............................................................................................. 56Crisis Management ................................................................................................ 56

Organizational Dynamics .......................................................................................... 56Traditional Organizational Structure .................................................................... 56Organizational Culture .......................................................................................... 57Covert and Overt Cultures ..................................................................................... 57

Effective Speaking and Writing ................................................................................. 59Communication ..................................................................................................... 59Communication Barriers ....................................................................................... 59Effective Writing ...................................................................................................60Purpose for Writing ...............................................................................................60

x Contents

Persuasive Writing ................................................................................................. 61Editing ................................................................................................................... 61Writing a Report .................................................................................................... 61

Review Exercises ........................................................................................................ 62

Chapter 4 Federal Agencies, Standards Organizations, and Voluntary Associations ................ 63

Federal Law ................................................................................................................ 63Occupational Safety and Health Administration ....................................................... 63

Summary of General Duties ..................................................................................64Priorities ................................................................................................................65Citations .................................................................................................................65State-Approved Plans ............................................................................................66Recordkeeping (29 CFR 1904) ..............................................................................66Recording Work-Related Injuries and Illnesses ....................................................66Medical Treatment .................................................................................................66Restricted Work ..................................................................................................... 67Classifying Injuries ............................................................................................... 67Classifying Illnesses .............................................................................................. 67Posting the Summary ............................................................................................ 67Form 301 Injury and Illness Incident Report ........................................................ 67Access to Employee Exposure and Medical Records (29 CFR1910.1020) ........... 67OSHA Whistle-Blowing Responsibilities .............................................................68OSHA Management Guidelines ............................................................................68Occupational Safety and Health Review Commission ..........................................68

Environmental Protection Agency .............................................................................69Resource Conservation and Recovery Act ............................................................69

Comprehensive Environmental Response, Compensation, and Liability Act ................................................................................................ 70Superfund Amendments and Reauthorization Act of 1986 .............................. 70Clean Air Act .................................................................................................... 71Clean Water Act ................................................................................................ 71Federal Insecticide, Fungicide, and Rodenticide Act ....................................... 71Toxic Substances Control Act ........................................................................... 71

Department of Transportation .................................................................................... 71Federal Motor Carrier Safety Administration ....................................................... 72

Nuclear Regulatory Commission ............................................................................... 72Department of Health and Human Services .............................................................. 72

National Institute for Occupational Safety and Health ......................................... 72Centers for Disease Control and Prevention .......................................................... 73Food and Drug Administration ............................................................................. 73Agency for Healthcare Research and Quality ....................................................... 73National Institutes of Health .................................................................................. 74Agency for Toxic Substances and Disease Registry.............................................. 74Health Resources Services Administration ........................................................... 74Assistant Secretary for Preparedness and Response ............................................. 74Centers for Medicare and Medicaid Services ....................................................... 75

Department of Homeland Security ............................................................................ 75Emergency Preparedness and Response ............................................................... 75Science and Technology ........................................................................................ 75Information Analysis and Infrastructure Protection ............................................. 75

xiContents

Federal Emergency Management Agency ............................................................. 76Fire Administration ............................................................................................... 76US Coast Guard ..................................................................................................... 76

Institute of Medicine .................................................................................................. 76Americans with Disabilities Act ................................................................................77

Title I Employment ................................................................................................77Title II Public Services ..........................................................................................77Title III Public Accommodation and Services Operated by Private Entities ........77Title IV Telecommunications ................................................................................77Title V Miscellaneous............................................................................................ 78

Bureau of Labor Statistics .......................................................................................... 78Accreditation Organizations ...................................................................................... 78

Joint Commission .................................................................................................. 78EOC Management ................................................................................................. 79American Osteopathic Association ....................................................................... 79DNV National Integrated Accreditation for Healthcare Organizations ................80Accreditation Canada ............................................................................................80Commission on Accreditation of Rehabilitation Facilities ................................... 81College of American Pathologists Laboratory Accreditation ............................... 81

Voluntary Standards Organizations ........................................................................... 82American Conference of Governmental Industrial Hygienists ............................. 82American National Standards Institute ................................................................. 82American Society of Heating, Refrigerating, and Air-Conditioning Engineers ........................................................................................................ 82American Society of Mechanical Engineers ......................................................... 82ASTM International .............................................................................................. 83Compressed Gas Association ................................................................................ 83Factory Mutual Research Corporation .................................................................. 83International Electrotechnical Commission .......................................................... 83National Council on Radiation Protection and Measurements .............................84National Fire Protection Association ....................................................................84NSF International ..................................................................................................84Safety Equipment Institute ....................................................................................84Underwriters Laboratories.....................................................................................84

Associations and Other Organizations .......................................................................85AIA Academy of Architecture for Health .............................................................85American Dental Hygienists’ Association ............................................................85American Health Care Association .......................................................................85American Hospital Association .............................................................................85American Society of Healthcare Engineering.......................................................86American Society of Healthcare Risk Management .............................................86American Association of Occupational Health Nurses .........................................86American Association of Safety Councils ............................................................86American Chemistry Council ...............................................................................87American Industrial Hygiene Association®...........................................................87American Public Health Association ....................................................................87ASIS International .................................................................................................87American Society of Safety Engineers .................................................................88American Welding Society ....................................................................................88Association of Healthcare Environment................................................................88Association of Occupational Health Professionals ................................................88

xii Contents

Canadian Centre for Occupational Health and Safety .......................................... 89CHEMTREC .................................................................................................... 89ECRI ................................................................................................................. 89

Facility Guidelines Institute .................................................................................. 89Health Physics Society .......................................................................................... 89Human Factors and Ergonomics Society ..............................................................90Institute of Hazardous Materials Management .....................................................90International Association of Nanotechnology .......................................................90International Organization for Standardization ....................................................90International System Safety Society ...................................................................... 91National Board of Boiler and Pressure Vessel Inspectors ..................................... 91National Restaurant Association ........................................................................... 91National Safety Council ........................................................................................92Society for Chemical Hazard Communication .....................................................92World Health Organization ...................................................................................92

Review Exercises ........................................................................................................92

Chapter 5 Facility Safety ............................................................................................................95

Introduction ................................................................................................................95Facility Guidelines Institute .......................................................................................95Administrative Area Safety ........................................................................................95Slip, Trip, and Fall Prevention ....................................................................................96

Poor Lighting, Stairs, and Handrails .....................................................................96Hazard Identification and Reporting .....................................................................97Static Coefficient of Friction .................................................................................97

Safety Signs, Colors, and Marking Requirements .....................................................97Elevators and Escalators .............................................................................................98Ladder Safety ........................................................................................................... 100Scaffolding (29 CFR 1910.22, 23, 28) ...................................................................... 100Fall Protection .......................................................................................................... 101

ANSI Z359.1: Safety Requirements for Fall Arrest Systems, Subsystems, and Components .................................................................................................. 101ANSI Z359.2: Minimum Requirements for a Comprehensive Managed Fall Protection ..................................................................................................... 101ANSI Z359.3: Safety Requirements for Positioning and Travel Restraint Systems ................................................................................................................ 102ANSI Z359.4: Safety Requirements for Assisted Rescue and Self-Rescue Systems, Subsystems, and Components .............................................................. 102

Tool Safety................................................................................................................ 102Machine Guarding (29 CFR 1910.212) .................................................................... 103

Requirements for Safeguards .............................................................................. 104Abrasive Wheel Grinder Safety (29 CFR 1910.215 and .243) ................................. 104Compressed Air Safety ............................................................................................ 105Electrical Safety (29 CFR Subpart S) ...................................................................... 105

Grounding ............................................................................................................ 106Circuit Protection Devices ................................................................................... 106Work Practices ..................................................................................................... 106Electrical Shock ................................................................................................... 107

Painting Operations (29 CFR 1926.20, 29 CFR 1926.21, 29 CFR 1910.132-138) ........ 108Control of Hazardous Energy (29 CFR 1910.147) .................................................... 108

xiiiContents

Authorized Employees ........................................................................................ 108Affected Employees ............................................................................................ 108Periodic Inspection and Reviews ......................................................................... 109Maintenance ........................................................................................................ 109Tag-Out Devices .................................................................................................. 109Lockout Devices .................................................................................................. 110Training ............................................................................................................... 110

Permit Confined Spaces (29 CFR 1910.146) ............................................................ 110Vaults, Manholes, and Tanks ............................................................................... 111Written Elements ................................................................................................. 111Attendant Duties .................................................................................................. 111Potential Confined Space Hazards ...................................................................... 112

OSHA Hearing Conservation Standard (29 CFR 1910.95) ...................................... 112Measuring Noise Levels ...................................................................................... 113Hearing Protection Evaluation ............................................................................ 114Audiometric Testing ............................................................................................ 114

Heating, Ventilating, and Air-Conditioning Systems............................................... 114Introduction ......................................................................................................... 114Boiler Systems ..................................................................................................... 115Pipe Marking Standards ...................................................................................... 115Label Placement .................................................................................................. 116Ventilation Systems ............................................................................................. 116Exhaust and Ventilation Standards ...................................................................... 117

Assessing IAQ .......................................................................................................... 118Preventing IAQ Problems .................................................................................... 118Workplace Mold .................................................................................................. 119Remediation Actions ........................................................................................... 120

Powered Industrial Trucks (Forklifts, 29 CFR 1910.178) ........................................ 120Landscape and Grounds Maintenance ..................................................................... 120

Blower Safety....................................................................................................... 121Edger Safety ........................................................................................................ 121Chain Saw Safety ................................................................................................ 121Trimmer Safety .................................................................................................... 121Push Mower ......................................................................................................... 122Riding Mower Safety ........................................................................................... 122

Fleet and Vehicle Safety ........................................................................................... 122Safe Practices for Motor Vehicle Operations (ANSI/ASSE Z15.1 Standard) ....... 122

Helicopter Safety (1910.183) ..................................................................................... 123Contractor and Construction Safety .........................................................................124

OSHA Construction Standards (29 CFR 1926) .................................................. 125Healthcare Construction Site Safety Issues ......................................................... 125Healthcare Construction Site Hazardous Waste Issues ....................................... 126

Weather-Related Safety ............................................................................................ 126Hot Weather Safety .............................................................................................. 126Cold Weather Safety ............................................................................................ 126

Review Exercises ...................................................................................................... 127

Chapter 6 Emergency Management .......................................................................................... 129

Introduction .............................................................................................................. 129Joint Commission Requirements .............................................................................. 129

xiv Contents

Emergency Electrical Power Sources ....................................................................... 132Emergency Water Supply Planning .......................................................................... 133

Plan Elements ...................................................................................................... 134Key Emergency Management Concepts .................................................................. 134

Standardization .................................................................................................... 134All-Hazards Planning .......................................................................................... 134Understanding System Thinking ......................................................................... 135Hospital Evacuation Planning ............................................................................. 135Community Involvement ..................................................................................... 135Partnership for Community Safety ...................................................................... 135Hospital Roles in Community Emergencies ........................................................ 136

Legislation ................................................................................................................ 136Disaster Management, Emergency Management, and Business Continuity ............ 137

NIMS Healthcare Implementation ...................................................................... 138Emergency Exercises................................................................................................ 138

Homeland Security Exercise and Evaluation Program ....................................... 139Engaging Stakeholders ........................................................................................ 139

Incident Command System ...................................................................................... 139Incident Commander Responsibilities ................................................................. 139Incident Action Planning and Information Assessment ...................................... 140Multiagency Coordination ................................................................................... 140Managing Complex Incidents .............................................................................. 140Command Function ............................................................................................. 141Operational Functions ......................................................................................... 141

Strategic National Stockpile ..................................................................................... 141Weather Emergencies and Natural Disasters ........................................................... 142

National Oceanic and Atmospheric Administration Weather Radio .................. 142Emergency Alert System ..................................................................................... 142Tropical Analysis and Forecast Branch ............................................................... 143Hurricanes ........................................................................................................... 143Tropical Storm Watch .......................................................................................... 143Tropical Storm Warning ...................................................................................... 144Hurricane Watch .................................................................................................. 144Hurricane Warning .............................................................................................. 144Inland Tropical Storm Watch .............................................................................. 144Inland Tropical Storm Warning .......................................................................... 144Inland Hurricane Watch ...................................................................................... 144Inland Hurricane Warning .................................................................................. 144Thunderstorms ..................................................................................................... 144Floods .................................................................................................................. 145Tornadoes ............................................................................................................ 145Wildfires .............................................................................................................. 145Blizzards .............................................................................................................. 146Earthquakes ......................................................................................................... 146

Other Emergencies ................................................................................................... 146Technology Emergencies ..................................................................................... 146Transportation Accidents ..................................................................................... 147Civil Disturbances ............................................................................................... 147Bomb Threats ...................................................................................................... 147Information and Communication Technology Emergencies ............................... 147

xvContents

Emergency Communications ................................................................................... 147Telecommunications Service Priority ................................................................. 147Government Emergency Telecommunications Service ....................................... 148Wireless Priority Service ..................................................................................... 148Cyber-Attack: Response ...................................................................................... 148

Emergency Egress .................................................................................................... 149Emergency Lighting ............................................................................................ 149

Hazardous Material Response .................................................................................. 150HAZWOPER Emergencies ................................................................................. 150Industrial/Agricultural Chemical Decontamination Guidance ........................... 150

Planning for Terrorism ............................................................................................. 151Biological Agents ................................................................................................ 151Chemical Agents ................................................................................................. 151Blood Agents ....................................................................................................... 152Blister Agents (Vesicants) .................................................................................... 152Choking and Irritating Agents ............................................................................. 152Nerve Agents ....................................................................................................... 152Industrial Chemical Agents ................................................................................. 152Nuclear Devices ................................................................................................... 152Terrorist Dissemination Devices ......................................................................... 153NIOSH Publication Number 2002-139 ................................................................ 153Pandemic Planning .............................................................................................. 153

Healthcare Emergency Coalitions ............................................................................ 153Six-Tier Model ..................................................................................................... 154Developing a Coalition EOP................................................................................ 154Healthcare Coalition Standard Operating Procedures ........................................ 154Coalition Exercises .............................................................................................. 155

2013 National Preparedness Report ......................................................................... 155Opportunities for Improvement ........................................................................... 156Key Factors for Future Progress .......................................................................... 156

Review Exercises ...................................................................................................... 156

Chapter 7 Hazardous Materials ................................................................................................ 159

Introduction .............................................................................................................. 159Hazardous Substance Safety .................................................................................... 159

Hazardous Substance Exposures ......................................................................... 159Hazardous Chemical Determination ................................................................... 160Reproductive Hazards ......................................................................................... 161Threshold Limit Values ....................................................................................... 162Chemical Properties ............................................................................................ 162Flash Points ......................................................................................................... 162Airborne Exposure .............................................................................................. 163OSHA Additive Formula ..................................................................................... 163Emergency Showers and Eyewashes ................................................................... 164Compressed Gas Safety ....................................................................................... 164

OSHA Hazard Communication Standard (29 CFR 1910.1200) ............................... 165Globally Harmonized System ............................................................................. 165Major Hazard Communication Standard Changes .............................................. 165Safety Data Sheet Changes .................................................................................. 166

xvi Contents

Managing and Communicating Changes to the Hazard Communication Standard ............................................................................................................... 167Employee Training .............................................................................................. 167Aspects of Pesticide Regulation That GHS Does Not Affect ............................. 168

DOT Hazardous Material Regulations..................................................................... 168Placards ............................................................................................................... 169Containers ............................................................................................................ 169

Healthcare Hazardous Materials .............................................................................. 169Acetone ................................................................................................................ 169Acryl Amide ........................................................................................................ 169Ammonia ............................................................................................................. 170Asbestos ............................................................................................................... 170

OSHA Asbestos General Industry Standard (29 CFR 1910.1001) ................. 170OSHA Asbestos Construction Standard (29 CFR 1926.1101) ........................ 170EPA Standards ................................................................................................ 170

Benzene (29 CFR 1910.1028) .............................................................................. 171Cadmium (29 CFR 1910.1027) ............................................................................ 171Carbon Monoxide ................................................................................................ 171Chlorine Compounds ........................................................................................... 171Iodine ................................................................................................................... 171Isopropyl Alcohol ................................................................................................ 172Lead (29 CFR 1910.25) ....................................................................................... 172Mercury ............................................................................................................... 172Methyl Methacrylate ........................................................................................... 172Peracetic Acid ...................................................................................................... 172Pesticides ............................................................................................................. 173Phenol Substances ............................................................................................... 173Quaternary Ammonium Compounds .................................................................. 173Solvents ................................................................................................................ 173Ethyl Alcohol ....................................................................................................... 173Glutaraldehyde ..................................................................................................... 174

Ethylene Oxide (29 CFR 1910.1047) ........................................................................ 174Formaldehyde (29 CFR 1910.1048) .......................................................................... 174Hazardous Drugs ...................................................................................................... 175

Hazardous Pharmaceutical Wastes...................................................................... 175Medical Gas Systems ............................................................................................... 175

Anesthetic Gas Hazards ...................................................................................... 176Scavenging ........................................................................................................... 177Nitric Oxide ......................................................................................................... 177Nitrous Oxide ...................................................................................................... 178

Managing Waste ....................................................................................................... 178Medical Waste ..................................................................................................... 179Other Types of Hazardous Waste ........................................................................ 179Universal Waste ................................................................................................... 179Electronic Waste (E-Waste) ................................................................................. 179Proper Hazardous Waste Marking and Labeling ................................................ 180DOT Labels ......................................................................................................... 180

Hazardous Waste Operations and Emergency Response Standard ......................... 180Chemical Protective Clothing ............................................................................. 181HAZWOPER and Hospitals ................................................................................ 181Spill Response Personal Protective Equipment ................................................... 182

xviiContents

Respiratory Protection (29 CFR 1910.134) .............................................................. 183Types of Respirators ............................................................................................ 183

Review Exercises ...................................................................................................... 185

Chapter 8 Infection Control and Prevention ............................................................................. 187

Introduction .............................................................................................................. 187Healthcare Immunizations ....................................................................................... 187

Guidelines of the Advisory Committee for Immunization Practice ................... 188Other Vaccination Considerations ....................................................................... 188

Centers for Disease Control and Prevention ............................................................ 189CDC Guidelines for Hand Hygiene in Healthcare Settings ................................ 189Guidelines for Environmental Infection Control in Healthcare Facilities .......... 189Other CDC Infection Control Guidelines ........................................................... 190CDC Standard Precautions .................................................................................. 190Disease and Infection Transmission Routes ........................................................ 191Airborne Precautions ........................................................................................... 191Droplet Precautions ............................................................................................. 191Contact Precautions ............................................................................................. 191New Infection Risk .............................................................................................. 192

CMS Hospital-Acquired Conditions and Present on Admission Indicators ............ 192Disinfectants, Sterilants, and Antiseptics ................................................................ 193

Germicidal Effectiveness .................................................................................... 193Regulatory Approval of Disinfectants ................................................................. 193EPA’s Registered Sterilizers, TB, and Antimicrobial Products .......................... 194CDC Recommendations ...................................................................................... 194Selecting a Disinfectant ....................................................................................... 194

OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) ................................. 195Exposure Control Plan ......................................................................................... 195OSHA Hand Hygiene Requirements ................................................................... 196Employee Involvement ........................................................................................ 196Recordkeeping ..................................................................................................... 196Engineering Controls ........................................................................................... 197Needleless Systems .............................................................................................. 197Exposure Determination...................................................................................... 197Control Measures................................................................................................. 197Personal Protective Equipment............................................................................ 198Housekeeping, Laundry, and Waste Practices ..................................................... 198Hepatitis B Virus ................................................................................................. 198Hepatitis B Vaccination ....................................................................................... 198Hepatitis C Virus ................................................................................................. 199Human Immunodeficiency Virus ........................................................................200Other Key Topics .................................................................................................200Latex Allergies .................................................................................................... 201Information and Training .................................................................................... 201Training Methods and Interactive Question Opportunities ................................202Trainer Qualifications ..........................................................................................202Medical Recordkeeping .......................................................................................202Training Recordkeeping ......................................................................................202Hazardous Waste Operations and Emergency Response (29 CFR 1910.120) .......203Postexposure Evaluation and Follow-Up .............................................................203

xviii Contents

Tuberculosis ..............................................................................................................203TB Screening Procedures for Settings Classified as Low Risk ..........................204TB Screening Procedures for Settings Classified as Medium Risk ....................204TB Screening Procedures for Settings Classified as Potential Ongoing Transmission ........................................................................................................204OSHA Tuberculosis Exposure Enforcement Guidelines .....................................205OSHA Citations for TB Exposures .....................................................................205OSHA Abatement Methods .................................................................................205OSHA Tuberculosis Respirator Requirements ....................................................206TB Exposure Control Plan ..................................................................................206Administrative Controls ......................................................................................206Environmental Controls ......................................................................................207Respiratory Protection Controls ..........................................................................207Engineering Controls ...........................................................................................207

Healthcare Opportunistic Infections ........................................................................207Bacteria ................................................................................................................207Methicillin-Resistant Staphylococcus aureus .....................................................208Viruses .................................................................................................................208Aspergillus ...........................................................................................................208Anthrax ................................................................................................................209Severe Acute Respiratory Syndrome ...................................................................209Pseudomonas .......................................................................................................209Legionella ............................................................................................................209Infection Control Risk Assessment ..................................................................... 210

Medical Waste .......................................................................................................... 210Sharps Containers ................................................................................................ 210Separating Medical and Hazardous Wastes ........................................................ 211Infectious Wastes ................................................................................................. 211Medical Waste Best Practices ............................................................................. 211Waste Handling for Off-Site Transfer ................................................................. 211Containers ............................................................................................................ 212Medical Waste Disposal ...................................................................................... 212DOT Infectious Shipping Requirements ............................................................. 212

Review Exercises ...................................................................................................... 213

Chapter 9 Fire Safety Management .......................................................................................... 215

Introduction .............................................................................................................. 215Life Safety Code Comparisons............................................................................ 215

Occupancies Defined by NFPA 101 Life Safety Code and NFPA 5000™ Building Code .......................................................................................................... 215

Healthcare ............................................................................................................ 215Ambulatory Healthcare ....................................................................................... 216Hazard Content Description ................................................................................ 216Deficiencies ......................................................................................................... 217

Fire Safety Management .......................................................................................... 217Fire Safety Evaluation System ............................................................................. 217Design Considerations ......................................................................................... 217Fire Prevention .................................................................................................... 218Inspections ........................................................................................................... 218Fire Warning and Safety...................................................................................... 219

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Manual Alarm Stations ....................................................................................... 219Electrically Supervised Systems ......................................................................... 219Special Requirements for Cooking Areas ........................................................... 219Fire System Inspections .......................................................................................220Fire Confinement .................................................................................................220

Emergency Exits .......................................................................................................220Exit Sign Illumination .........................................................................................220Emergency Lighting ............................................................................................ 221OSHA Egress Standards ..................................................................................... 221OSHA Exit Sign Marking Standards .................................................................. 221

Portable Fire Extinguishers ...................................................................................... 221How Fire Extinguishers Work ............................................................................. 222Types of Fire Extinguishers ................................................................................. 222Proper Maintenance ............................................................................................ 223Air-Pressurized Water Extinguishers .................................................................. 223Carbon Dioxide Extinguishers ............................................................................ 223Dry Chemical Extinguishers ............................................................................... 223Marking Extinguishers ........................................................................................224Extinguisher Ratings ...........................................................................................224

Special Fire Safety Considerations ..........................................................................224Electrical Equipment Installations ......................................................................224Flammable and Combustible Materials...............................................................224General Precautions .............................................................................................225Inside Storage Areas ............................................................................................225Fire and Chemical Hazard Symbols ....................................................................225Surgical Fires .......................................................................................................225ASTM Surgical Fire Standard .............................................................................226Fire Blankets ........................................................................................................226Welding Fire Safety (29CFR 1910.252 and NFPA 51B) ..................................... 227Welding Personal Protective Equipment ............................................................. 227

Life Safety Requirements ......................................................................................... 227Interim Life Safety .............................................................................................. 227Compartmentalization .........................................................................................228Integrity of Egress ...............................................................................................228Doors ................................................................................................................... 229Corridors .............................................................................................................. 229Patient Sleeping Rooms ....................................................................................... 229Signs ....................................................................................................................230Protection from Fire and Smoke .........................................................................230Hazardous Areas .................................................................................................230Storage Rooms ..................................................................................................... 231New Buildings and Corridors .............................................................................. 231Openings .............................................................................................................. 232Welding Fire Prevention and Protection.............................................................. 232

NFPA 99-2012 Fire Protection Fundamentals ......................................................... 232Flammable Liquids and Gases ............................................................................ 232Laboratories ......................................................................................................... 232Utilities ................................................................................................................ 233Mechanical Heating, Ventilating, and Air-Conditioning .................................... 233Elevators, Escalators, and Conveyors .................................................................. 233Rubbish Chutes, Incinerators, and Laundry Chutes ............................................ 233

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Fire Detection, Alarm, and Communications Systems ....................................... 233Smoke Alarms .....................................................................................................234Defend In-Place and Notification ........................................................................234Automatic Sprinklers ...........................................................................................234Manual Extinguishing Equipment.......................................................................234

Review Exercises ...................................................................................................... 235

Chapter 10 Environmental Services and Food/Dietary Department Safety .............................. 237

Environmental Services and Laundry Operations ................................................... 237Basic Cleaning Guidelines .................................................................................. 237Contaminated Work Environments ..................................................................... 238Contaminated Equipment .................................................................................... 238Handling Contaminated Laundry ....................................................................... 238Sharps and Containers ......................................................................................... 239Hazardous Materials ............................................................................................ 239Latex Allergy ....................................................................................................... 239Environmental Safety .......................................................................................... 239Using Cleaning Solutions .................................................................................... 239Equipment Carts ..................................................................................................240Cleaning for Safety and Health ........................................................................... 241Critical Instruments and Surfaces ....................................................................... 241Noncritical Instruments and Environmental Surfaces ........................................ 241Sterilants and High-Level Disinfectants ............................................................. 241Intermediate-Level Disinfectants ........................................................................ 241Low-Level Disinfectants ..................................................................................... 241Green Cleaning ....................................................................................................242CDC Guideline for Disinfection and Sterilization in Health-Care Facilities (2008) ................................................................................................... 243System Methods .................................................................................................. 243LEED for Healthcare ...........................................................................................244Microfiber Mopping ............................................................................................244Laundry Operations .............................................................................................244Contaminated Laundry........................................................................................245Personal Protective Equipment............................................................................245Sharps Handling ..................................................................................................245Hazardous Chemicals ..........................................................................................246Other Hazards ......................................................................................................246Loading or Unloading Laundry ...........................................................................246Linen Handling ....................................................................................................246

Dietary and Food Services .......................................................................................246Importance of Sanitation ..................................................................................... 247Health Inspections ...............................................................................................248Food Service Area Layout ...................................................................................249Overview of Kitchen Hazards .............................................................................249Cutting Hazards ...................................................................................................250Kitchen Electrical Safety .....................................................................................250Slip, Trip, and Fall Prevention .............................................................................250Fire Safety and Burn Prevention .........................................................................250Chemical Hazards ............................................................................................... 251OSHA Machine Guarding Requirements (29 CFR 1910.212) ............................ 252

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Ergonomics .......................................................................................................... 252Delivering Meals to Isolation Rooms .................................................................. 252Importance of Hand Washing ............................................................................. 253Basics for Handling Food Safely ......................................................................... 253Storage .................................................................................................................254Preparation ..........................................................................................................254Thawing ...............................................................................................................254Cooking Temps ....................................................................................................254Serving .................................................................................................................254Prepare Foods Separately ....................................................................................254Thermometers ...................................................................................................... 255Regular Equipment Maintenance ........................................................................ 255Safe Ice Handling ................................................................................................ 255Foodborne Illness ................................................................................................ 255Controlling Food Contamination ........................................................................256FDA Bad Bug Book .............................................................................................256Preventing Cross Contamination ......................................................................... 257Hazard Analysis and the Critical Control Point System ..................................... 257Foodborne Illness Primer for Healthcare ............................................................ 257

Review Exercises ...................................................................................................... 258

Chapter 11 Support Department Safety ...................................................................................... 259

Central Sterile Supply .............................................................................................. 259Autoclaves and Sterilizers ................................................................................... 259Ethylene Oxide (ETO) Standard (29 CFR 1910.1047) ........................................ 259Glutaraldehyde .....................................................................................................260Safety Issues ........................................................................................................260Disinfectants ........................................................................................................ 261Drying and Storage of Instruments ..................................................................... 261Surfaces ............................................................................................................... 261International Association of Healthcare Central Service Materiel Management .......................................................................................................261Association for the Advancement of Medical Instrumentation........................... 262

Materials Management ............................................................................................. 262Cost, Quality, and Outcomes ............................................................................... 263Improving Healthcare Delivery ........................................................................... 263Association for Healthcare Resource & Materials Management (AHRMM)...... 263

Medical Equipment Management ............................................................................264Joint Commission Requirements .........................................................................265Maintenance, Testing, and Inspecting .................................................................265Medical Equipment Reporting ............................................................................266SMDA of 1990 .....................................................................................................266SMDA Reportable Events....................................................................................266Other Reporting Requirements ........................................................................... 267Equipment Control and Asset Management ........................................................ 267Work Order Management .................................................................................... 267Data Quality Management .................................................................................. 267Patient Safety .......................................................................................................268Risk Management ................................................................................................268Medical Equipment Inventory Inclusion Crite