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Bethesda Healthcare System 1 Life Work Safety Rev. 6/2018

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Page 1: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 1

Life Work Safety

Rev 62018

Bethesda Healthcare System 2

Introduction

Physical Danger Codes

Red Pink Orange Yellow Strong Gamma

MRI Safety

Medical Codes

Blue BEE Team Grey HIT

Incident Reporting

Hazardous Materials

Biomedical Waste

Chemical

Radioactive

Biological

TB

HIVAIDS

Flu Season

MENU

Bethesda Healthcare System 3

Introduction

As soon as a patient enters the hospital we are responsible for their

safety It is a vital part of our business

This CBL will cover basic safety issues that come from potential

sources within the hospital such as fire electrical hazards hazardous

materials etc

The Disaster CBL covers basic safety issues that arise from sources

outside the hospital such as hurricanes major storms biological

attacks and chemical spills

Bethesda Healthcare System 4

General Safety Tips

bull The following general safety tips are reminders to be aware of safety wherever you are

ndash Parking lots

bull watch for cars backing out of parking spots

bull always lock your car

bull do not leave valuables in plain sight in your car

bull have your keys ready when approaching your car and check the back seat before getting in

bull if you feel uncomfortable walking to your car at night call security at BHE ext 84199 or at BHW ext 70160 to escort you

bull In the parking garage DO NOT

ndash walk on the ramp

ndash make a left turn on the ramps

ndash Offices

bull secure valuables out of sight

bull use proper body mechanics when lifting heavy objects

bull open only one file drawer at a time in the same file cabinet

Bethesda Healthcare System 5

General Safety Tips continued

bull Hallways

ndash wipe up small watercoffee spills

ndash pick up trash

ndash be careful rounding corners watch for others

ndash open ldquoblindrdquo doors gently donrsquot crash through

bull Yourself

ndash get enough sleep

ndash concentrate on work while at work

ndash never use illegal or inappropriate drugs

ndash always think of yourself as working within a team

Bethesda Healthcare System 6

CODE RED

bull Code Red is the code for fire If you discover a fire or smoke you must carry out the following steps in their exact order

bull Rescue

bull Activate Alarm

bull Contain Fire

bull Extinguish fire (if safe to do so) or Evacuate

bull If you hear ldquoCode Redrdquo over the hospital paging system you must pause to listen for the location of the fire Then follow your department fire plan

bull If you work at Health City Service Center or the Plaza Click Here for fire procedures

Bethesda Healthcare System 7

1 Rescue

Rescue patientspersons in immediate danger In this initial step

remove the person from the room the fire is in

This is a temporary safety measure It is critical that you get to

the next step (Activate Alarm) as quickly as possible

If you need to progress to the Evacuate step then you must

remove all people in the endangered smoke compartment to the

next smoke compartment on the same floor This is called

horizontal evacuation Removing the patient from a patient room

does not remove the patient from the smoke compartment

Bethesda Healthcare System 8

2 Alarm ndash Pull it Then Call it

bull Pull the nearest alarm To activate the alarm ndash In Bethesda EAST push the handle in and pull it down In Bethesda WEST just pull the handle down Do this as quickly as possible The alarm not only alerts the fire department it also shuts down the air handlers that may be helping to spread the fire

bull Then call the operator at 855 at the East hospital or 755 at the West hospital and report the fire and its location

bull The operator will announce the Code Red then call 911

ndash After office hours (nights weekend and holidays) the operator will also contact the Director of Engineering Asst Director of Engineering and the Administrator on-call

bull When the fire is out the operator will announce ldquoCode Red all clearrdquo three times

bull The Operator will only accept an all clear from a member of the fire response team

Bethesda Healthcare System 9

3 Contain

Contain the firesmoke by closing windows and doors after all

persons are out (remember to check bathrooms)

All other staff in the vicinity of the fire (not involved in the initial

discoveryresponse) are to report to the nursersquos station to

receive assignments closing all doors and windows along

the way and removing all obstacles from the hallways

All staff throughout the hospital will respond by closing all doors

and remaining on the alert for further instructions They

should not enter the fire location unless they are members of

the fire response team

Bethesda Healthcare System 10

4 Extinguish (If safe to do so)

We have many types of fire extinguishers

ABC ndash Marked with an ABC and can be used on all types of fires

Carbon Dioxide ndash used mainly for electrical fires around large pieces of

equipment

Halon Suppression Systems used on sensitive electronic equipment

K Extinguishers ndash Used on grease fires

Water Mist Extinguisher ndash Found in ORLampD best choice for protection

of hospital environments books documents and clean room facilities

To use a fire Extinguisher

P ndash pull the safety pin

A ndash aim the fire extinguisher

S ndash squeeze the handle

S ndash sweep the base of the fire with the spray

Bethesda Healthcare System 11

5 Evacuate

bull Evacuate all persons you are responsible for plus yourself to the next adjacent smoke compartment on the same floor (horizontal evacuation)

bull The charge nurse or designee will prioritize each patientrsquos evacuationcategory

bull Charge nurse or designee ensures that bag valve mask is at bedside of all ventilator dependent patients and oxygen for oxygen dependent patients

bull Staff will be assigned to conduct a methodical room-by-room search accounting for all visitors and leading all patients and visitors to safety A rubber glove will be placed on the doorknobs of all vacated rooms

bull All Emergency equipment is to be plugged into red outlets

bull Station someone at the elevator to prohibit elevator use

bull In some cases relocating patients to another floor may become necessary This is called Vertical Evacuation

Bethesda Healthcare System 12

Fire Drills

bull All staff members will actively participate in hospital-wide fire

drills The Fire Response Team is made up of specific people

throughout the hospital They have additional duties during

each fire drill and fire event

bull Each department has a fire plan Each staff member is

responsible to know that plan

bull Staff will stay alert to the fire situation until the end of the drill

when ldquoCode Red All Clearrdquo is announced three times

Bethesda Healthcare System 13

Oxygen

bull Oxygen is one of the primary ingredients of fire Special care

must be taken during a fire concerning oxygen being delivered

to patients

ndash ZONE OXYGEN valves shall only be turned off by

engineering after consultation with nursing or the nursing

supervisor (new policy 2013)

ndash Bedside oxygen may be turned off by trained employees

bull The hospital is divided into smoke compartments When the fire

alarm sounds the doors of the smoke compartments will

automatically close Do not block these doors which are the

heavy doors in the hallways Patient room doors are not smoke

compartment doors

bull Another source of free air flow in a fire is the elevator shaft

DO NOT USE ELEVATORS DURING A FIRE or FIRE ALARM

Bethesda Healthcare System 14

Electricity

bull In the event of a power outage an emergency power system will

activate within 10 seconds The emergency system will only

power emergency outlets (red outlets) switches and certain

emergency lighting (on all the time with no onoff switches)

bull Use the red outlets (emergency outlets) for ALL life sustaining

equipment

Bethesda Healthcare System 15

Electrical Hazards

bull Electricity is such a common part of our everyday lives that we

sometimes forget the hazards of using this form of energy Signs of

potential electrical hazard are

ndash frayed or damaged cords

ndash loose connections

ndash cords or connections in or near liquids

ndash electrical tools that spark shock or smoke due to damage or defect

ndash loss or lack of grounding electrical equipment

bull Extension cords are to be used only on a temporary basis and must

be approved by Engineering

bull Any appliances brought from home MUST by approved by Biomedical

Maintenance

Bethesda Healthcare System 16

Electrical Hazards

Make it common practice

bull When unplugging electrical cords from the wall outlet

bull DO NOT TO PULL or YANK on the cord when

removing ELECTRICAL CORDS FROM OUTLETS This may result in damage to the wiring and has been known to

cause a spark or a shock to the user

bull Bend (at the knees)

bull Grab the electrical cord by the plug ONLY

bull Carefully pull and ease it out from the outlet

Bethesda Healthcare System 17

Lock outTag Out

bull If you discover a problem with an electrical devise contact Biomedical Maintenance and remove the item from service Always submit a work order Try to be as detailed and specific as possible about how the equipment is malfunctioning You will find the form on the Intranet page under Links called EngBio Work orders

bull When an appliance or devise has been taken out of service (lock out or tag out) you may not use it again until it has been approved by Biomedical Maintenance

bull These rules were made for your safety Do not endanger yourself or your patient by using faulty equipment

Bethesda Healthcare System 18

Downtime Status Codes for eCOS amp SCM Systems

The following codes pertain to eCOS and SCM and will be

utilized when these systems are down These codes are

announced overhead

ldquoStatus 1rdquo = System will be unavailable for up to 1 hour

ldquoStatus 2rdquo = System will be unavailable for up to 2 hours

ldquoStatus 3rdquo = System will be unavailable for more than 2 hours

ldquoSystem is now availablerdquo = System is back up and running

Bethesda Healthcare System 19

Your Environment

bull As with any home or office place occasionally there will be a

broken or poorly functioning plumbing appliance damage to

walls floors or ceiling broken furniture or other damage to the

hospital

bull Report any damage you find to the Engineering Department In

a real crisis situation call Engineering to initially report the

problem In all situations submit an engineering work order

You will find the form on the Intranet page under Links called

EngBio Work orders Fill out the form and submit it

bull Any broken furniture should be labeled with the problem

ldquoBrokenrdquo is not especially helpful for the people trying to fix the

problem

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 2: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 2

Introduction

Physical Danger Codes

Red Pink Orange Yellow Strong Gamma

MRI Safety

Medical Codes

Blue BEE Team Grey HIT

Incident Reporting

Hazardous Materials

Biomedical Waste

Chemical

Radioactive

Biological

TB

HIVAIDS

Flu Season

MENU

Bethesda Healthcare System 3

Introduction

As soon as a patient enters the hospital we are responsible for their

safety It is a vital part of our business

This CBL will cover basic safety issues that come from potential

sources within the hospital such as fire electrical hazards hazardous

materials etc

The Disaster CBL covers basic safety issues that arise from sources

outside the hospital such as hurricanes major storms biological

attacks and chemical spills

Bethesda Healthcare System 4

General Safety Tips

bull The following general safety tips are reminders to be aware of safety wherever you are

ndash Parking lots

bull watch for cars backing out of parking spots

bull always lock your car

bull do not leave valuables in plain sight in your car

bull have your keys ready when approaching your car and check the back seat before getting in

bull if you feel uncomfortable walking to your car at night call security at BHE ext 84199 or at BHW ext 70160 to escort you

bull In the parking garage DO NOT

ndash walk on the ramp

ndash make a left turn on the ramps

ndash Offices

bull secure valuables out of sight

bull use proper body mechanics when lifting heavy objects

bull open only one file drawer at a time in the same file cabinet

Bethesda Healthcare System 5

General Safety Tips continued

bull Hallways

ndash wipe up small watercoffee spills

ndash pick up trash

ndash be careful rounding corners watch for others

ndash open ldquoblindrdquo doors gently donrsquot crash through

bull Yourself

ndash get enough sleep

ndash concentrate on work while at work

ndash never use illegal or inappropriate drugs

ndash always think of yourself as working within a team

Bethesda Healthcare System 6

CODE RED

bull Code Red is the code for fire If you discover a fire or smoke you must carry out the following steps in their exact order

bull Rescue

bull Activate Alarm

bull Contain Fire

bull Extinguish fire (if safe to do so) or Evacuate

bull If you hear ldquoCode Redrdquo over the hospital paging system you must pause to listen for the location of the fire Then follow your department fire plan

bull If you work at Health City Service Center or the Plaza Click Here for fire procedures

Bethesda Healthcare System 7

1 Rescue

Rescue patientspersons in immediate danger In this initial step

remove the person from the room the fire is in

This is a temporary safety measure It is critical that you get to

the next step (Activate Alarm) as quickly as possible

If you need to progress to the Evacuate step then you must

remove all people in the endangered smoke compartment to the

next smoke compartment on the same floor This is called

horizontal evacuation Removing the patient from a patient room

does not remove the patient from the smoke compartment

Bethesda Healthcare System 8

2 Alarm ndash Pull it Then Call it

bull Pull the nearest alarm To activate the alarm ndash In Bethesda EAST push the handle in and pull it down In Bethesda WEST just pull the handle down Do this as quickly as possible The alarm not only alerts the fire department it also shuts down the air handlers that may be helping to spread the fire

bull Then call the operator at 855 at the East hospital or 755 at the West hospital and report the fire and its location

bull The operator will announce the Code Red then call 911

ndash After office hours (nights weekend and holidays) the operator will also contact the Director of Engineering Asst Director of Engineering and the Administrator on-call

bull When the fire is out the operator will announce ldquoCode Red all clearrdquo three times

bull The Operator will only accept an all clear from a member of the fire response team

Bethesda Healthcare System 9

3 Contain

Contain the firesmoke by closing windows and doors after all

persons are out (remember to check bathrooms)

All other staff in the vicinity of the fire (not involved in the initial

discoveryresponse) are to report to the nursersquos station to

receive assignments closing all doors and windows along

the way and removing all obstacles from the hallways

All staff throughout the hospital will respond by closing all doors

and remaining on the alert for further instructions They

should not enter the fire location unless they are members of

the fire response team

Bethesda Healthcare System 10

4 Extinguish (If safe to do so)

We have many types of fire extinguishers

ABC ndash Marked with an ABC and can be used on all types of fires

Carbon Dioxide ndash used mainly for electrical fires around large pieces of

equipment

Halon Suppression Systems used on sensitive electronic equipment

K Extinguishers ndash Used on grease fires

Water Mist Extinguisher ndash Found in ORLampD best choice for protection

of hospital environments books documents and clean room facilities

To use a fire Extinguisher

P ndash pull the safety pin

A ndash aim the fire extinguisher

S ndash squeeze the handle

S ndash sweep the base of the fire with the spray

Bethesda Healthcare System 11

5 Evacuate

bull Evacuate all persons you are responsible for plus yourself to the next adjacent smoke compartment on the same floor (horizontal evacuation)

bull The charge nurse or designee will prioritize each patientrsquos evacuationcategory

bull Charge nurse or designee ensures that bag valve mask is at bedside of all ventilator dependent patients and oxygen for oxygen dependent patients

bull Staff will be assigned to conduct a methodical room-by-room search accounting for all visitors and leading all patients and visitors to safety A rubber glove will be placed on the doorknobs of all vacated rooms

bull All Emergency equipment is to be plugged into red outlets

bull Station someone at the elevator to prohibit elevator use

bull In some cases relocating patients to another floor may become necessary This is called Vertical Evacuation

Bethesda Healthcare System 12

Fire Drills

bull All staff members will actively participate in hospital-wide fire

drills The Fire Response Team is made up of specific people

throughout the hospital They have additional duties during

each fire drill and fire event

bull Each department has a fire plan Each staff member is

responsible to know that plan

bull Staff will stay alert to the fire situation until the end of the drill

when ldquoCode Red All Clearrdquo is announced three times

Bethesda Healthcare System 13

Oxygen

bull Oxygen is one of the primary ingredients of fire Special care

must be taken during a fire concerning oxygen being delivered

to patients

ndash ZONE OXYGEN valves shall only be turned off by

engineering after consultation with nursing or the nursing

supervisor (new policy 2013)

ndash Bedside oxygen may be turned off by trained employees

bull The hospital is divided into smoke compartments When the fire

alarm sounds the doors of the smoke compartments will

automatically close Do not block these doors which are the

heavy doors in the hallways Patient room doors are not smoke

compartment doors

bull Another source of free air flow in a fire is the elevator shaft

DO NOT USE ELEVATORS DURING A FIRE or FIRE ALARM

Bethesda Healthcare System 14

Electricity

bull In the event of a power outage an emergency power system will

activate within 10 seconds The emergency system will only

power emergency outlets (red outlets) switches and certain

emergency lighting (on all the time with no onoff switches)

bull Use the red outlets (emergency outlets) for ALL life sustaining

equipment

Bethesda Healthcare System 15

Electrical Hazards

bull Electricity is such a common part of our everyday lives that we

sometimes forget the hazards of using this form of energy Signs of

potential electrical hazard are

ndash frayed or damaged cords

ndash loose connections

ndash cords or connections in or near liquids

ndash electrical tools that spark shock or smoke due to damage or defect

ndash loss or lack of grounding electrical equipment

bull Extension cords are to be used only on a temporary basis and must

be approved by Engineering

bull Any appliances brought from home MUST by approved by Biomedical

Maintenance

Bethesda Healthcare System 16

Electrical Hazards

Make it common practice

bull When unplugging electrical cords from the wall outlet

bull DO NOT TO PULL or YANK on the cord when

removing ELECTRICAL CORDS FROM OUTLETS This may result in damage to the wiring and has been known to

cause a spark or a shock to the user

bull Bend (at the knees)

bull Grab the electrical cord by the plug ONLY

bull Carefully pull and ease it out from the outlet

Bethesda Healthcare System 17

Lock outTag Out

bull If you discover a problem with an electrical devise contact Biomedical Maintenance and remove the item from service Always submit a work order Try to be as detailed and specific as possible about how the equipment is malfunctioning You will find the form on the Intranet page under Links called EngBio Work orders

bull When an appliance or devise has been taken out of service (lock out or tag out) you may not use it again until it has been approved by Biomedical Maintenance

bull These rules were made for your safety Do not endanger yourself or your patient by using faulty equipment

Bethesda Healthcare System 18

Downtime Status Codes for eCOS amp SCM Systems

The following codes pertain to eCOS and SCM and will be

utilized when these systems are down These codes are

announced overhead

ldquoStatus 1rdquo = System will be unavailable for up to 1 hour

ldquoStatus 2rdquo = System will be unavailable for up to 2 hours

ldquoStatus 3rdquo = System will be unavailable for more than 2 hours

ldquoSystem is now availablerdquo = System is back up and running

Bethesda Healthcare System 19

Your Environment

bull As with any home or office place occasionally there will be a

broken or poorly functioning plumbing appliance damage to

walls floors or ceiling broken furniture or other damage to the

hospital

bull Report any damage you find to the Engineering Department In

a real crisis situation call Engineering to initially report the

problem In all situations submit an engineering work order

You will find the form on the Intranet page under Links called

EngBio Work orders Fill out the form and submit it

bull Any broken furniture should be labeled with the problem

ldquoBrokenrdquo is not especially helpful for the people trying to fix the

problem

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 3: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 3

Introduction

As soon as a patient enters the hospital we are responsible for their

safety It is a vital part of our business

This CBL will cover basic safety issues that come from potential

sources within the hospital such as fire electrical hazards hazardous

materials etc

The Disaster CBL covers basic safety issues that arise from sources

outside the hospital such as hurricanes major storms biological

attacks and chemical spills

Bethesda Healthcare System 4

General Safety Tips

bull The following general safety tips are reminders to be aware of safety wherever you are

ndash Parking lots

bull watch for cars backing out of parking spots

bull always lock your car

bull do not leave valuables in plain sight in your car

bull have your keys ready when approaching your car and check the back seat before getting in

bull if you feel uncomfortable walking to your car at night call security at BHE ext 84199 or at BHW ext 70160 to escort you

bull In the parking garage DO NOT

ndash walk on the ramp

ndash make a left turn on the ramps

ndash Offices

bull secure valuables out of sight

bull use proper body mechanics when lifting heavy objects

bull open only one file drawer at a time in the same file cabinet

Bethesda Healthcare System 5

General Safety Tips continued

bull Hallways

ndash wipe up small watercoffee spills

ndash pick up trash

ndash be careful rounding corners watch for others

ndash open ldquoblindrdquo doors gently donrsquot crash through

bull Yourself

ndash get enough sleep

ndash concentrate on work while at work

ndash never use illegal or inappropriate drugs

ndash always think of yourself as working within a team

Bethesda Healthcare System 6

CODE RED

bull Code Red is the code for fire If you discover a fire or smoke you must carry out the following steps in their exact order

bull Rescue

bull Activate Alarm

bull Contain Fire

bull Extinguish fire (if safe to do so) or Evacuate

bull If you hear ldquoCode Redrdquo over the hospital paging system you must pause to listen for the location of the fire Then follow your department fire plan

bull If you work at Health City Service Center or the Plaza Click Here for fire procedures

Bethesda Healthcare System 7

1 Rescue

Rescue patientspersons in immediate danger In this initial step

remove the person from the room the fire is in

This is a temporary safety measure It is critical that you get to

the next step (Activate Alarm) as quickly as possible

If you need to progress to the Evacuate step then you must

remove all people in the endangered smoke compartment to the

next smoke compartment on the same floor This is called

horizontal evacuation Removing the patient from a patient room

does not remove the patient from the smoke compartment

Bethesda Healthcare System 8

2 Alarm ndash Pull it Then Call it

bull Pull the nearest alarm To activate the alarm ndash In Bethesda EAST push the handle in and pull it down In Bethesda WEST just pull the handle down Do this as quickly as possible The alarm not only alerts the fire department it also shuts down the air handlers that may be helping to spread the fire

bull Then call the operator at 855 at the East hospital or 755 at the West hospital and report the fire and its location

bull The operator will announce the Code Red then call 911

ndash After office hours (nights weekend and holidays) the operator will also contact the Director of Engineering Asst Director of Engineering and the Administrator on-call

bull When the fire is out the operator will announce ldquoCode Red all clearrdquo three times

bull The Operator will only accept an all clear from a member of the fire response team

Bethesda Healthcare System 9

3 Contain

Contain the firesmoke by closing windows and doors after all

persons are out (remember to check bathrooms)

All other staff in the vicinity of the fire (not involved in the initial

discoveryresponse) are to report to the nursersquos station to

receive assignments closing all doors and windows along

the way and removing all obstacles from the hallways

All staff throughout the hospital will respond by closing all doors

and remaining on the alert for further instructions They

should not enter the fire location unless they are members of

the fire response team

Bethesda Healthcare System 10

4 Extinguish (If safe to do so)

We have many types of fire extinguishers

ABC ndash Marked with an ABC and can be used on all types of fires

Carbon Dioxide ndash used mainly for electrical fires around large pieces of

equipment

Halon Suppression Systems used on sensitive electronic equipment

K Extinguishers ndash Used on grease fires

Water Mist Extinguisher ndash Found in ORLampD best choice for protection

of hospital environments books documents and clean room facilities

To use a fire Extinguisher

P ndash pull the safety pin

A ndash aim the fire extinguisher

S ndash squeeze the handle

S ndash sweep the base of the fire with the spray

Bethesda Healthcare System 11

5 Evacuate

bull Evacuate all persons you are responsible for plus yourself to the next adjacent smoke compartment on the same floor (horizontal evacuation)

bull The charge nurse or designee will prioritize each patientrsquos evacuationcategory

bull Charge nurse or designee ensures that bag valve mask is at bedside of all ventilator dependent patients and oxygen for oxygen dependent patients

bull Staff will be assigned to conduct a methodical room-by-room search accounting for all visitors and leading all patients and visitors to safety A rubber glove will be placed on the doorknobs of all vacated rooms

bull All Emergency equipment is to be plugged into red outlets

bull Station someone at the elevator to prohibit elevator use

bull In some cases relocating patients to another floor may become necessary This is called Vertical Evacuation

Bethesda Healthcare System 12

Fire Drills

bull All staff members will actively participate in hospital-wide fire

drills The Fire Response Team is made up of specific people

throughout the hospital They have additional duties during

each fire drill and fire event

bull Each department has a fire plan Each staff member is

responsible to know that plan

bull Staff will stay alert to the fire situation until the end of the drill

when ldquoCode Red All Clearrdquo is announced three times

Bethesda Healthcare System 13

Oxygen

bull Oxygen is one of the primary ingredients of fire Special care

must be taken during a fire concerning oxygen being delivered

to patients

ndash ZONE OXYGEN valves shall only be turned off by

engineering after consultation with nursing or the nursing

supervisor (new policy 2013)

ndash Bedside oxygen may be turned off by trained employees

bull The hospital is divided into smoke compartments When the fire

alarm sounds the doors of the smoke compartments will

automatically close Do not block these doors which are the

heavy doors in the hallways Patient room doors are not smoke

compartment doors

bull Another source of free air flow in a fire is the elevator shaft

DO NOT USE ELEVATORS DURING A FIRE or FIRE ALARM

Bethesda Healthcare System 14

Electricity

bull In the event of a power outage an emergency power system will

activate within 10 seconds The emergency system will only

power emergency outlets (red outlets) switches and certain

emergency lighting (on all the time with no onoff switches)

bull Use the red outlets (emergency outlets) for ALL life sustaining

equipment

Bethesda Healthcare System 15

Electrical Hazards

bull Electricity is such a common part of our everyday lives that we

sometimes forget the hazards of using this form of energy Signs of

potential electrical hazard are

ndash frayed or damaged cords

ndash loose connections

ndash cords or connections in or near liquids

ndash electrical tools that spark shock or smoke due to damage or defect

ndash loss or lack of grounding electrical equipment

bull Extension cords are to be used only on a temporary basis and must

be approved by Engineering

bull Any appliances brought from home MUST by approved by Biomedical

Maintenance

Bethesda Healthcare System 16

Electrical Hazards

Make it common practice

bull When unplugging electrical cords from the wall outlet

bull DO NOT TO PULL or YANK on the cord when

removing ELECTRICAL CORDS FROM OUTLETS This may result in damage to the wiring and has been known to

cause a spark or a shock to the user

bull Bend (at the knees)

bull Grab the electrical cord by the plug ONLY

bull Carefully pull and ease it out from the outlet

Bethesda Healthcare System 17

Lock outTag Out

bull If you discover a problem with an electrical devise contact Biomedical Maintenance and remove the item from service Always submit a work order Try to be as detailed and specific as possible about how the equipment is malfunctioning You will find the form on the Intranet page under Links called EngBio Work orders

bull When an appliance or devise has been taken out of service (lock out or tag out) you may not use it again until it has been approved by Biomedical Maintenance

bull These rules were made for your safety Do not endanger yourself or your patient by using faulty equipment

Bethesda Healthcare System 18

Downtime Status Codes for eCOS amp SCM Systems

The following codes pertain to eCOS and SCM and will be

utilized when these systems are down These codes are

announced overhead

ldquoStatus 1rdquo = System will be unavailable for up to 1 hour

ldquoStatus 2rdquo = System will be unavailable for up to 2 hours

ldquoStatus 3rdquo = System will be unavailable for more than 2 hours

ldquoSystem is now availablerdquo = System is back up and running

Bethesda Healthcare System 19

Your Environment

bull As with any home or office place occasionally there will be a

broken or poorly functioning plumbing appliance damage to

walls floors or ceiling broken furniture or other damage to the

hospital

bull Report any damage you find to the Engineering Department In

a real crisis situation call Engineering to initially report the

problem In all situations submit an engineering work order

You will find the form on the Intranet page under Links called

EngBio Work orders Fill out the form and submit it

bull Any broken furniture should be labeled with the problem

ldquoBrokenrdquo is not especially helpful for the people trying to fix the

problem

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 4: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 4

General Safety Tips

bull The following general safety tips are reminders to be aware of safety wherever you are

ndash Parking lots

bull watch for cars backing out of parking spots

bull always lock your car

bull do not leave valuables in plain sight in your car

bull have your keys ready when approaching your car and check the back seat before getting in

bull if you feel uncomfortable walking to your car at night call security at BHE ext 84199 or at BHW ext 70160 to escort you

bull In the parking garage DO NOT

ndash walk on the ramp

ndash make a left turn on the ramps

ndash Offices

bull secure valuables out of sight

bull use proper body mechanics when lifting heavy objects

bull open only one file drawer at a time in the same file cabinet

Bethesda Healthcare System 5

General Safety Tips continued

bull Hallways

ndash wipe up small watercoffee spills

ndash pick up trash

ndash be careful rounding corners watch for others

ndash open ldquoblindrdquo doors gently donrsquot crash through

bull Yourself

ndash get enough sleep

ndash concentrate on work while at work

ndash never use illegal or inappropriate drugs

ndash always think of yourself as working within a team

Bethesda Healthcare System 6

CODE RED

bull Code Red is the code for fire If you discover a fire or smoke you must carry out the following steps in their exact order

bull Rescue

bull Activate Alarm

bull Contain Fire

bull Extinguish fire (if safe to do so) or Evacuate

bull If you hear ldquoCode Redrdquo over the hospital paging system you must pause to listen for the location of the fire Then follow your department fire plan

bull If you work at Health City Service Center or the Plaza Click Here for fire procedures

Bethesda Healthcare System 7

1 Rescue

Rescue patientspersons in immediate danger In this initial step

remove the person from the room the fire is in

This is a temporary safety measure It is critical that you get to

the next step (Activate Alarm) as quickly as possible

If you need to progress to the Evacuate step then you must

remove all people in the endangered smoke compartment to the

next smoke compartment on the same floor This is called

horizontal evacuation Removing the patient from a patient room

does not remove the patient from the smoke compartment

Bethesda Healthcare System 8

2 Alarm ndash Pull it Then Call it

bull Pull the nearest alarm To activate the alarm ndash In Bethesda EAST push the handle in and pull it down In Bethesda WEST just pull the handle down Do this as quickly as possible The alarm not only alerts the fire department it also shuts down the air handlers that may be helping to spread the fire

bull Then call the operator at 855 at the East hospital or 755 at the West hospital and report the fire and its location

bull The operator will announce the Code Red then call 911

ndash After office hours (nights weekend and holidays) the operator will also contact the Director of Engineering Asst Director of Engineering and the Administrator on-call

bull When the fire is out the operator will announce ldquoCode Red all clearrdquo three times

bull The Operator will only accept an all clear from a member of the fire response team

Bethesda Healthcare System 9

3 Contain

Contain the firesmoke by closing windows and doors after all

persons are out (remember to check bathrooms)

All other staff in the vicinity of the fire (not involved in the initial

discoveryresponse) are to report to the nursersquos station to

receive assignments closing all doors and windows along

the way and removing all obstacles from the hallways

All staff throughout the hospital will respond by closing all doors

and remaining on the alert for further instructions They

should not enter the fire location unless they are members of

the fire response team

Bethesda Healthcare System 10

4 Extinguish (If safe to do so)

We have many types of fire extinguishers

ABC ndash Marked with an ABC and can be used on all types of fires

Carbon Dioxide ndash used mainly for electrical fires around large pieces of

equipment

Halon Suppression Systems used on sensitive electronic equipment

K Extinguishers ndash Used on grease fires

Water Mist Extinguisher ndash Found in ORLampD best choice for protection

of hospital environments books documents and clean room facilities

To use a fire Extinguisher

P ndash pull the safety pin

A ndash aim the fire extinguisher

S ndash squeeze the handle

S ndash sweep the base of the fire with the spray

Bethesda Healthcare System 11

5 Evacuate

bull Evacuate all persons you are responsible for plus yourself to the next adjacent smoke compartment on the same floor (horizontal evacuation)

bull The charge nurse or designee will prioritize each patientrsquos evacuationcategory

bull Charge nurse or designee ensures that bag valve mask is at bedside of all ventilator dependent patients and oxygen for oxygen dependent patients

bull Staff will be assigned to conduct a methodical room-by-room search accounting for all visitors and leading all patients and visitors to safety A rubber glove will be placed on the doorknobs of all vacated rooms

bull All Emergency equipment is to be plugged into red outlets

bull Station someone at the elevator to prohibit elevator use

bull In some cases relocating patients to another floor may become necessary This is called Vertical Evacuation

Bethesda Healthcare System 12

Fire Drills

bull All staff members will actively participate in hospital-wide fire

drills The Fire Response Team is made up of specific people

throughout the hospital They have additional duties during

each fire drill and fire event

bull Each department has a fire plan Each staff member is

responsible to know that plan

bull Staff will stay alert to the fire situation until the end of the drill

when ldquoCode Red All Clearrdquo is announced three times

Bethesda Healthcare System 13

Oxygen

bull Oxygen is one of the primary ingredients of fire Special care

must be taken during a fire concerning oxygen being delivered

to patients

ndash ZONE OXYGEN valves shall only be turned off by

engineering after consultation with nursing or the nursing

supervisor (new policy 2013)

ndash Bedside oxygen may be turned off by trained employees

bull The hospital is divided into smoke compartments When the fire

alarm sounds the doors of the smoke compartments will

automatically close Do not block these doors which are the

heavy doors in the hallways Patient room doors are not smoke

compartment doors

bull Another source of free air flow in a fire is the elevator shaft

DO NOT USE ELEVATORS DURING A FIRE or FIRE ALARM

Bethesda Healthcare System 14

Electricity

bull In the event of a power outage an emergency power system will

activate within 10 seconds The emergency system will only

power emergency outlets (red outlets) switches and certain

emergency lighting (on all the time with no onoff switches)

bull Use the red outlets (emergency outlets) for ALL life sustaining

equipment

Bethesda Healthcare System 15

Electrical Hazards

bull Electricity is such a common part of our everyday lives that we

sometimes forget the hazards of using this form of energy Signs of

potential electrical hazard are

ndash frayed or damaged cords

ndash loose connections

ndash cords or connections in or near liquids

ndash electrical tools that spark shock or smoke due to damage or defect

ndash loss or lack of grounding electrical equipment

bull Extension cords are to be used only on a temporary basis and must

be approved by Engineering

bull Any appliances brought from home MUST by approved by Biomedical

Maintenance

Bethesda Healthcare System 16

Electrical Hazards

Make it common practice

bull When unplugging electrical cords from the wall outlet

bull DO NOT TO PULL or YANK on the cord when

removing ELECTRICAL CORDS FROM OUTLETS This may result in damage to the wiring and has been known to

cause a spark or a shock to the user

bull Bend (at the knees)

bull Grab the electrical cord by the plug ONLY

bull Carefully pull and ease it out from the outlet

Bethesda Healthcare System 17

Lock outTag Out

bull If you discover a problem with an electrical devise contact Biomedical Maintenance and remove the item from service Always submit a work order Try to be as detailed and specific as possible about how the equipment is malfunctioning You will find the form on the Intranet page under Links called EngBio Work orders

bull When an appliance or devise has been taken out of service (lock out or tag out) you may not use it again until it has been approved by Biomedical Maintenance

bull These rules were made for your safety Do not endanger yourself or your patient by using faulty equipment

Bethesda Healthcare System 18

Downtime Status Codes for eCOS amp SCM Systems

The following codes pertain to eCOS and SCM and will be

utilized when these systems are down These codes are

announced overhead

ldquoStatus 1rdquo = System will be unavailable for up to 1 hour

ldquoStatus 2rdquo = System will be unavailable for up to 2 hours

ldquoStatus 3rdquo = System will be unavailable for more than 2 hours

ldquoSystem is now availablerdquo = System is back up and running

Bethesda Healthcare System 19

Your Environment

bull As with any home or office place occasionally there will be a

broken or poorly functioning plumbing appliance damage to

walls floors or ceiling broken furniture or other damage to the

hospital

bull Report any damage you find to the Engineering Department In

a real crisis situation call Engineering to initially report the

problem In all situations submit an engineering work order

You will find the form on the Intranet page under Links called

EngBio Work orders Fill out the form and submit it

bull Any broken furniture should be labeled with the problem

ldquoBrokenrdquo is not especially helpful for the people trying to fix the

problem

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 5: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 5

General Safety Tips continued

bull Hallways

ndash wipe up small watercoffee spills

ndash pick up trash

ndash be careful rounding corners watch for others

ndash open ldquoblindrdquo doors gently donrsquot crash through

bull Yourself

ndash get enough sleep

ndash concentrate on work while at work

ndash never use illegal or inappropriate drugs

ndash always think of yourself as working within a team

Bethesda Healthcare System 6

CODE RED

bull Code Red is the code for fire If you discover a fire or smoke you must carry out the following steps in their exact order

bull Rescue

bull Activate Alarm

bull Contain Fire

bull Extinguish fire (if safe to do so) or Evacuate

bull If you hear ldquoCode Redrdquo over the hospital paging system you must pause to listen for the location of the fire Then follow your department fire plan

bull If you work at Health City Service Center or the Plaza Click Here for fire procedures

Bethesda Healthcare System 7

1 Rescue

Rescue patientspersons in immediate danger In this initial step

remove the person from the room the fire is in

This is a temporary safety measure It is critical that you get to

the next step (Activate Alarm) as quickly as possible

If you need to progress to the Evacuate step then you must

remove all people in the endangered smoke compartment to the

next smoke compartment on the same floor This is called

horizontal evacuation Removing the patient from a patient room

does not remove the patient from the smoke compartment

Bethesda Healthcare System 8

2 Alarm ndash Pull it Then Call it

bull Pull the nearest alarm To activate the alarm ndash In Bethesda EAST push the handle in and pull it down In Bethesda WEST just pull the handle down Do this as quickly as possible The alarm not only alerts the fire department it also shuts down the air handlers that may be helping to spread the fire

bull Then call the operator at 855 at the East hospital or 755 at the West hospital and report the fire and its location

bull The operator will announce the Code Red then call 911

ndash After office hours (nights weekend and holidays) the operator will also contact the Director of Engineering Asst Director of Engineering and the Administrator on-call

bull When the fire is out the operator will announce ldquoCode Red all clearrdquo three times

bull The Operator will only accept an all clear from a member of the fire response team

Bethesda Healthcare System 9

3 Contain

Contain the firesmoke by closing windows and doors after all

persons are out (remember to check bathrooms)

All other staff in the vicinity of the fire (not involved in the initial

discoveryresponse) are to report to the nursersquos station to

receive assignments closing all doors and windows along

the way and removing all obstacles from the hallways

All staff throughout the hospital will respond by closing all doors

and remaining on the alert for further instructions They

should not enter the fire location unless they are members of

the fire response team

Bethesda Healthcare System 10

4 Extinguish (If safe to do so)

We have many types of fire extinguishers

ABC ndash Marked with an ABC and can be used on all types of fires

Carbon Dioxide ndash used mainly for electrical fires around large pieces of

equipment

Halon Suppression Systems used on sensitive electronic equipment

K Extinguishers ndash Used on grease fires

Water Mist Extinguisher ndash Found in ORLampD best choice for protection

of hospital environments books documents and clean room facilities

To use a fire Extinguisher

P ndash pull the safety pin

A ndash aim the fire extinguisher

S ndash squeeze the handle

S ndash sweep the base of the fire with the spray

Bethesda Healthcare System 11

5 Evacuate

bull Evacuate all persons you are responsible for plus yourself to the next adjacent smoke compartment on the same floor (horizontal evacuation)

bull The charge nurse or designee will prioritize each patientrsquos evacuationcategory

bull Charge nurse or designee ensures that bag valve mask is at bedside of all ventilator dependent patients and oxygen for oxygen dependent patients

bull Staff will be assigned to conduct a methodical room-by-room search accounting for all visitors and leading all patients and visitors to safety A rubber glove will be placed on the doorknobs of all vacated rooms

bull All Emergency equipment is to be plugged into red outlets

bull Station someone at the elevator to prohibit elevator use

bull In some cases relocating patients to another floor may become necessary This is called Vertical Evacuation

Bethesda Healthcare System 12

Fire Drills

bull All staff members will actively participate in hospital-wide fire

drills The Fire Response Team is made up of specific people

throughout the hospital They have additional duties during

each fire drill and fire event

bull Each department has a fire plan Each staff member is

responsible to know that plan

bull Staff will stay alert to the fire situation until the end of the drill

when ldquoCode Red All Clearrdquo is announced three times

Bethesda Healthcare System 13

Oxygen

bull Oxygen is one of the primary ingredients of fire Special care

must be taken during a fire concerning oxygen being delivered

to patients

ndash ZONE OXYGEN valves shall only be turned off by

engineering after consultation with nursing or the nursing

supervisor (new policy 2013)

ndash Bedside oxygen may be turned off by trained employees

bull The hospital is divided into smoke compartments When the fire

alarm sounds the doors of the smoke compartments will

automatically close Do not block these doors which are the

heavy doors in the hallways Patient room doors are not smoke

compartment doors

bull Another source of free air flow in a fire is the elevator shaft

DO NOT USE ELEVATORS DURING A FIRE or FIRE ALARM

Bethesda Healthcare System 14

Electricity

bull In the event of a power outage an emergency power system will

activate within 10 seconds The emergency system will only

power emergency outlets (red outlets) switches and certain

emergency lighting (on all the time with no onoff switches)

bull Use the red outlets (emergency outlets) for ALL life sustaining

equipment

Bethesda Healthcare System 15

Electrical Hazards

bull Electricity is such a common part of our everyday lives that we

sometimes forget the hazards of using this form of energy Signs of

potential electrical hazard are

ndash frayed or damaged cords

ndash loose connections

ndash cords or connections in or near liquids

ndash electrical tools that spark shock or smoke due to damage or defect

ndash loss or lack of grounding electrical equipment

bull Extension cords are to be used only on a temporary basis and must

be approved by Engineering

bull Any appliances brought from home MUST by approved by Biomedical

Maintenance

Bethesda Healthcare System 16

Electrical Hazards

Make it common practice

bull When unplugging electrical cords from the wall outlet

bull DO NOT TO PULL or YANK on the cord when

removing ELECTRICAL CORDS FROM OUTLETS This may result in damage to the wiring and has been known to

cause a spark or a shock to the user

bull Bend (at the knees)

bull Grab the electrical cord by the plug ONLY

bull Carefully pull and ease it out from the outlet

Bethesda Healthcare System 17

Lock outTag Out

bull If you discover a problem with an electrical devise contact Biomedical Maintenance and remove the item from service Always submit a work order Try to be as detailed and specific as possible about how the equipment is malfunctioning You will find the form on the Intranet page under Links called EngBio Work orders

bull When an appliance or devise has been taken out of service (lock out or tag out) you may not use it again until it has been approved by Biomedical Maintenance

bull These rules were made for your safety Do not endanger yourself or your patient by using faulty equipment

Bethesda Healthcare System 18

Downtime Status Codes for eCOS amp SCM Systems

The following codes pertain to eCOS and SCM and will be

utilized when these systems are down These codes are

announced overhead

ldquoStatus 1rdquo = System will be unavailable for up to 1 hour

ldquoStatus 2rdquo = System will be unavailable for up to 2 hours

ldquoStatus 3rdquo = System will be unavailable for more than 2 hours

ldquoSystem is now availablerdquo = System is back up and running

Bethesda Healthcare System 19

Your Environment

bull As with any home or office place occasionally there will be a

broken or poorly functioning plumbing appliance damage to

walls floors or ceiling broken furniture or other damage to the

hospital

bull Report any damage you find to the Engineering Department In

a real crisis situation call Engineering to initially report the

problem In all situations submit an engineering work order

You will find the form on the Intranet page under Links called

EngBio Work orders Fill out the form and submit it

bull Any broken furniture should be labeled with the problem

ldquoBrokenrdquo is not especially helpful for the people trying to fix the

problem

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 6: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 6

CODE RED

bull Code Red is the code for fire If you discover a fire or smoke you must carry out the following steps in their exact order

bull Rescue

bull Activate Alarm

bull Contain Fire

bull Extinguish fire (if safe to do so) or Evacuate

bull If you hear ldquoCode Redrdquo over the hospital paging system you must pause to listen for the location of the fire Then follow your department fire plan

bull If you work at Health City Service Center or the Plaza Click Here for fire procedures

Bethesda Healthcare System 7

1 Rescue

Rescue patientspersons in immediate danger In this initial step

remove the person from the room the fire is in

This is a temporary safety measure It is critical that you get to

the next step (Activate Alarm) as quickly as possible

If you need to progress to the Evacuate step then you must

remove all people in the endangered smoke compartment to the

next smoke compartment on the same floor This is called

horizontal evacuation Removing the patient from a patient room

does not remove the patient from the smoke compartment

Bethesda Healthcare System 8

2 Alarm ndash Pull it Then Call it

bull Pull the nearest alarm To activate the alarm ndash In Bethesda EAST push the handle in and pull it down In Bethesda WEST just pull the handle down Do this as quickly as possible The alarm not only alerts the fire department it also shuts down the air handlers that may be helping to spread the fire

bull Then call the operator at 855 at the East hospital or 755 at the West hospital and report the fire and its location

bull The operator will announce the Code Red then call 911

ndash After office hours (nights weekend and holidays) the operator will also contact the Director of Engineering Asst Director of Engineering and the Administrator on-call

bull When the fire is out the operator will announce ldquoCode Red all clearrdquo three times

bull The Operator will only accept an all clear from a member of the fire response team

Bethesda Healthcare System 9

3 Contain

Contain the firesmoke by closing windows and doors after all

persons are out (remember to check bathrooms)

All other staff in the vicinity of the fire (not involved in the initial

discoveryresponse) are to report to the nursersquos station to

receive assignments closing all doors and windows along

the way and removing all obstacles from the hallways

All staff throughout the hospital will respond by closing all doors

and remaining on the alert for further instructions They

should not enter the fire location unless they are members of

the fire response team

Bethesda Healthcare System 10

4 Extinguish (If safe to do so)

We have many types of fire extinguishers

ABC ndash Marked with an ABC and can be used on all types of fires

Carbon Dioxide ndash used mainly for electrical fires around large pieces of

equipment

Halon Suppression Systems used on sensitive electronic equipment

K Extinguishers ndash Used on grease fires

Water Mist Extinguisher ndash Found in ORLampD best choice for protection

of hospital environments books documents and clean room facilities

To use a fire Extinguisher

P ndash pull the safety pin

A ndash aim the fire extinguisher

S ndash squeeze the handle

S ndash sweep the base of the fire with the spray

Bethesda Healthcare System 11

5 Evacuate

bull Evacuate all persons you are responsible for plus yourself to the next adjacent smoke compartment on the same floor (horizontal evacuation)

bull The charge nurse or designee will prioritize each patientrsquos evacuationcategory

bull Charge nurse or designee ensures that bag valve mask is at bedside of all ventilator dependent patients and oxygen for oxygen dependent patients

bull Staff will be assigned to conduct a methodical room-by-room search accounting for all visitors and leading all patients and visitors to safety A rubber glove will be placed on the doorknobs of all vacated rooms

bull All Emergency equipment is to be plugged into red outlets

bull Station someone at the elevator to prohibit elevator use

bull In some cases relocating patients to another floor may become necessary This is called Vertical Evacuation

Bethesda Healthcare System 12

Fire Drills

bull All staff members will actively participate in hospital-wide fire

drills The Fire Response Team is made up of specific people

throughout the hospital They have additional duties during

each fire drill and fire event

bull Each department has a fire plan Each staff member is

responsible to know that plan

bull Staff will stay alert to the fire situation until the end of the drill

when ldquoCode Red All Clearrdquo is announced three times

Bethesda Healthcare System 13

Oxygen

bull Oxygen is one of the primary ingredients of fire Special care

must be taken during a fire concerning oxygen being delivered

to patients

ndash ZONE OXYGEN valves shall only be turned off by

engineering after consultation with nursing or the nursing

supervisor (new policy 2013)

ndash Bedside oxygen may be turned off by trained employees

bull The hospital is divided into smoke compartments When the fire

alarm sounds the doors of the smoke compartments will

automatically close Do not block these doors which are the

heavy doors in the hallways Patient room doors are not smoke

compartment doors

bull Another source of free air flow in a fire is the elevator shaft

DO NOT USE ELEVATORS DURING A FIRE or FIRE ALARM

Bethesda Healthcare System 14

Electricity

bull In the event of a power outage an emergency power system will

activate within 10 seconds The emergency system will only

power emergency outlets (red outlets) switches and certain

emergency lighting (on all the time with no onoff switches)

bull Use the red outlets (emergency outlets) for ALL life sustaining

equipment

Bethesda Healthcare System 15

Electrical Hazards

bull Electricity is such a common part of our everyday lives that we

sometimes forget the hazards of using this form of energy Signs of

potential electrical hazard are

ndash frayed or damaged cords

ndash loose connections

ndash cords or connections in or near liquids

ndash electrical tools that spark shock or smoke due to damage or defect

ndash loss or lack of grounding electrical equipment

bull Extension cords are to be used only on a temporary basis and must

be approved by Engineering

bull Any appliances brought from home MUST by approved by Biomedical

Maintenance

Bethesda Healthcare System 16

Electrical Hazards

Make it common practice

bull When unplugging electrical cords from the wall outlet

bull DO NOT TO PULL or YANK on the cord when

removing ELECTRICAL CORDS FROM OUTLETS This may result in damage to the wiring and has been known to

cause a spark or a shock to the user

bull Bend (at the knees)

bull Grab the electrical cord by the plug ONLY

bull Carefully pull and ease it out from the outlet

Bethesda Healthcare System 17

Lock outTag Out

bull If you discover a problem with an electrical devise contact Biomedical Maintenance and remove the item from service Always submit a work order Try to be as detailed and specific as possible about how the equipment is malfunctioning You will find the form on the Intranet page under Links called EngBio Work orders

bull When an appliance or devise has been taken out of service (lock out or tag out) you may not use it again until it has been approved by Biomedical Maintenance

bull These rules were made for your safety Do not endanger yourself or your patient by using faulty equipment

Bethesda Healthcare System 18

Downtime Status Codes for eCOS amp SCM Systems

The following codes pertain to eCOS and SCM and will be

utilized when these systems are down These codes are

announced overhead

ldquoStatus 1rdquo = System will be unavailable for up to 1 hour

ldquoStatus 2rdquo = System will be unavailable for up to 2 hours

ldquoStatus 3rdquo = System will be unavailable for more than 2 hours

ldquoSystem is now availablerdquo = System is back up and running

Bethesda Healthcare System 19

Your Environment

bull As with any home or office place occasionally there will be a

broken or poorly functioning plumbing appliance damage to

walls floors or ceiling broken furniture or other damage to the

hospital

bull Report any damage you find to the Engineering Department In

a real crisis situation call Engineering to initially report the

problem In all situations submit an engineering work order

You will find the form on the Intranet page under Links called

EngBio Work orders Fill out the form and submit it

bull Any broken furniture should be labeled with the problem

ldquoBrokenrdquo is not especially helpful for the people trying to fix the

problem

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 7: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 7

1 Rescue

Rescue patientspersons in immediate danger In this initial step

remove the person from the room the fire is in

This is a temporary safety measure It is critical that you get to

the next step (Activate Alarm) as quickly as possible

If you need to progress to the Evacuate step then you must

remove all people in the endangered smoke compartment to the

next smoke compartment on the same floor This is called

horizontal evacuation Removing the patient from a patient room

does not remove the patient from the smoke compartment

Bethesda Healthcare System 8

2 Alarm ndash Pull it Then Call it

bull Pull the nearest alarm To activate the alarm ndash In Bethesda EAST push the handle in and pull it down In Bethesda WEST just pull the handle down Do this as quickly as possible The alarm not only alerts the fire department it also shuts down the air handlers that may be helping to spread the fire

bull Then call the operator at 855 at the East hospital or 755 at the West hospital and report the fire and its location

bull The operator will announce the Code Red then call 911

ndash After office hours (nights weekend and holidays) the operator will also contact the Director of Engineering Asst Director of Engineering and the Administrator on-call

bull When the fire is out the operator will announce ldquoCode Red all clearrdquo three times

bull The Operator will only accept an all clear from a member of the fire response team

Bethesda Healthcare System 9

3 Contain

Contain the firesmoke by closing windows and doors after all

persons are out (remember to check bathrooms)

All other staff in the vicinity of the fire (not involved in the initial

discoveryresponse) are to report to the nursersquos station to

receive assignments closing all doors and windows along

the way and removing all obstacles from the hallways

All staff throughout the hospital will respond by closing all doors

and remaining on the alert for further instructions They

should not enter the fire location unless they are members of

the fire response team

Bethesda Healthcare System 10

4 Extinguish (If safe to do so)

We have many types of fire extinguishers

ABC ndash Marked with an ABC and can be used on all types of fires

Carbon Dioxide ndash used mainly for electrical fires around large pieces of

equipment

Halon Suppression Systems used on sensitive electronic equipment

K Extinguishers ndash Used on grease fires

Water Mist Extinguisher ndash Found in ORLampD best choice for protection

of hospital environments books documents and clean room facilities

To use a fire Extinguisher

P ndash pull the safety pin

A ndash aim the fire extinguisher

S ndash squeeze the handle

S ndash sweep the base of the fire with the spray

Bethesda Healthcare System 11

5 Evacuate

bull Evacuate all persons you are responsible for plus yourself to the next adjacent smoke compartment on the same floor (horizontal evacuation)

bull The charge nurse or designee will prioritize each patientrsquos evacuationcategory

bull Charge nurse or designee ensures that bag valve mask is at bedside of all ventilator dependent patients and oxygen for oxygen dependent patients

bull Staff will be assigned to conduct a methodical room-by-room search accounting for all visitors and leading all patients and visitors to safety A rubber glove will be placed on the doorknobs of all vacated rooms

bull All Emergency equipment is to be plugged into red outlets

bull Station someone at the elevator to prohibit elevator use

bull In some cases relocating patients to another floor may become necessary This is called Vertical Evacuation

Bethesda Healthcare System 12

Fire Drills

bull All staff members will actively participate in hospital-wide fire

drills The Fire Response Team is made up of specific people

throughout the hospital They have additional duties during

each fire drill and fire event

bull Each department has a fire plan Each staff member is

responsible to know that plan

bull Staff will stay alert to the fire situation until the end of the drill

when ldquoCode Red All Clearrdquo is announced three times

Bethesda Healthcare System 13

Oxygen

bull Oxygen is one of the primary ingredients of fire Special care

must be taken during a fire concerning oxygen being delivered

to patients

ndash ZONE OXYGEN valves shall only be turned off by

engineering after consultation with nursing or the nursing

supervisor (new policy 2013)

ndash Bedside oxygen may be turned off by trained employees

bull The hospital is divided into smoke compartments When the fire

alarm sounds the doors of the smoke compartments will

automatically close Do not block these doors which are the

heavy doors in the hallways Patient room doors are not smoke

compartment doors

bull Another source of free air flow in a fire is the elevator shaft

DO NOT USE ELEVATORS DURING A FIRE or FIRE ALARM

Bethesda Healthcare System 14

Electricity

bull In the event of a power outage an emergency power system will

activate within 10 seconds The emergency system will only

power emergency outlets (red outlets) switches and certain

emergency lighting (on all the time with no onoff switches)

bull Use the red outlets (emergency outlets) for ALL life sustaining

equipment

Bethesda Healthcare System 15

Electrical Hazards

bull Electricity is such a common part of our everyday lives that we

sometimes forget the hazards of using this form of energy Signs of

potential electrical hazard are

ndash frayed or damaged cords

ndash loose connections

ndash cords or connections in or near liquids

ndash electrical tools that spark shock or smoke due to damage or defect

ndash loss or lack of grounding electrical equipment

bull Extension cords are to be used only on a temporary basis and must

be approved by Engineering

bull Any appliances brought from home MUST by approved by Biomedical

Maintenance

Bethesda Healthcare System 16

Electrical Hazards

Make it common practice

bull When unplugging electrical cords from the wall outlet

bull DO NOT TO PULL or YANK on the cord when

removing ELECTRICAL CORDS FROM OUTLETS This may result in damage to the wiring and has been known to

cause a spark or a shock to the user

bull Bend (at the knees)

bull Grab the electrical cord by the plug ONLY

bull Carefully pull and ease it out from the outlet

Bethesda Healthcare System 17

Lock outTag Out

bull If you discover a problem with an electrical devise contact Biomedical Maintenance and remove the item from service Always submit a work order Try to be as detailed and specific as possible about how the equipment is malfunctioning You will find the form on the Intranet page under Links called EngBio Work orders

bull When an appliance or devise has been taken out of service (lock out or tag out) you may not use it again until it has been approved by Biomedical Maintenance

bull These rules were made for your safety Do not endanger yourself or your patient by using faulty equipment

Bethesda Healthcare System 18

Downtime Status Codes for eCOS amp SCM Systems

The following codes pertain to eCOS and SCM and will be

utilized when these systems are down These codes are

announced overhead

ldquoStatus 1rdquo = System will be unavailable for up to 1 hour

ldquoStatus 2rdquo = System will be unavailable for up to 2 hours

ldquoStatus 3rdquo = System will be unavailable for more than 2 hours

ldquoSystem is now availablerdquo = System is back up and running

Bethesda Healthcare System 19

Your Environment

bull As with any home or office place occasionally there will be a

broken or poorly functioning plumbing appliance damage to

walls floors or ceiling broken furniture or other damage to the

hospital

bull Report any damage you find to the Engineering Department In

a real crisis situation call Engineering to initially report the

problem In all situations submit an engineering work order

You will find the form on the Intranet page under Links called

EngBio Work orders Fill out the form and submit it

bull Any broken furniture should be labeled with the problem

ldquoBrokenrdquo is not especially helpful for the people trying to fix the

problem

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 8: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 8

2 Alarm ndash Pull it Then Call it

bull Pull the nearest alarm To activate the alarm ndash In Bethesda EAST push the handle in and pull it down In Bethesda WEST just pull the handle down Do this as quickly as possible The alarm not only alerts the fire department it also shuts down the air handlers that may be helping to spread the fire

bull Then call the operator at 855 at the East hospital or 755 at the West hospital and report the fire and its location

bull The operator will announce the Code Red then call 911

ndash After office hours (nights weekend and holidays) the operator will also contact the Director of Engineering Asst Director of Engineering and the Administrator on-call

bull When the fire is out the operator will announce ldquoCode Red all clearrdquo three times

bull The Operator will only accept an all clear from a member of the fire response team

Bethesda Healthcare System 9

3 Contain

Contain the firesmoke by closing windows and doors after all

persons are out (remember to check bathrooms)

All other staff in the vicinity of the fire (not involved in the initial

discoveryresponse) are to report to the nursersquos station to

receive assignments closing all doors and windows along

the way and removing all obstacles from the hallways

All staff throughout the hospital will respond by closing all doors

and remaining on the alert for further instructions They

should not enter the fire location unless they are members of

the fire response team

Bethesda Healthcare System 10

4 Extinguish (If safe to do so)

We have many types of fire extinguishers

ABC ndash Marked with an ABC and can be used on all types of fires

Carbon Dioxide ndash used mainly for electrical fires around large pieces of

equipment

Halon Suppression Systems used on sensitive electronic equipment

K Extinguishers ndash Used on grease fires

Water Mist Extinguisher ndash Found in ORLampD best choice for protection

of hospital environments books documents and clean room facilities

To use a fire Extinguisher

P ndash pull the safety pin

A ndash aim the fire extinguisher

S ndash squeeze the handle

S ndash sweep the base of the fire with the spray

Bethesda Healthcare System 11

5 Evacuate

bull Evacuate all persons you are responsible for plus yourself to the next adjacent smoke compartment on the same floor (horizontal evacuation)

bull The charge nurse or designee will prioritize each patientrsquos evacuationcategory

bull Charge nurse or designee ensures that bag valve mask is at bedside of all ventilator dependent patients and oxygen for oxygen dependent patients

bull Staff will be assigned to conduct a methodical room-by-room search accounting for all visitors and leading all patients and visitors to safety A rubber glove will be placed on the doorknobs of all vacated rooms

bull All Emergency equipment is to be plugged into red outlets

bull Station someone at the elevator to prohibit elevator use

bull In some cases relocating patients to another floor may become necessary This is called Vertical Evacuation

Bethesda Healthcare System 12

Fire Drills

bull All staff members will actively participate in hospital-wide fire

drills The Fire Response Team is made up of specific people

throughout the hospital They have additional duties during

each fire drill and fire event

bull Each department has a fire plan Each staff member is

responsible to know that plan

bull Staff will stay alert to the fire situation until the end of the drill

when ldquoCode Red All Clearrdquo is announced three times

Bethesda Healthcare System 13

Oxygen

bull Oxygen is one of the primary ingredients of fire Special care

must be taken during a fire concerning oxygen being delivered

to patients

ndash ZONE OXYGEN valves shall only be turned off by

engineering after consultation with nursing or the nursing

supervisor (new policy 2013)

ndash Bedside oxygen may be turned off by trained employees

bull The hospital is divided into smoke compartments When the fire

alarm sounds the doors of the smoke compartments will

automatically close Do not block these doors which are the

heavy doors in the hallways Patient room doors are not smoke

compartment doors

bull Another source of free air flow in a fire is the elevator shaft

DO NOT USE ELEVATORS DURING A FIRE or FIRE ALARM

Bethesda Healthcare System 14

Electricity

bull In the event of a power outage an emergency power system will

activate within 10 seconds The emergency system will only

power emergency outlets (red outlets) switches and certain

emergency lighting (on all the time with no onoff switches)

bull Use the red outlets (emergency outlets) for ALL life sustaining

equipment

Bethesda Healthcare System 15

Electrical Hazards

bull Electricity is such a common part of our everyday lives that we

sometimes forget the hazards of using this form of energy Signs of

potential electrical hazard are

ndash frayed or damaged cords

ndash loose connections

ndash cords or connections in or near liquids

ndash electrical tools that spark shock or smoke due to damage or defect

ndash loss or lack of grounding electrical equipment

bull Extension cords are to be used only on a temporary basis and must

be approved by Engineering

bull Any appliances brought from home MUST by approved by Biomedical

Maintenance

Bethesda Healthcare System 16

Electrical Hazards

Make it common practice

bull When unplugging electrical cords from the wall outlet

bull DO NOT TO PULL or YANK on the cord when

removing ELECTRICAL CORDS FROM OUTLETS This may result in damage to the wiring and has been known to

cause a spark or a shock to the user

bull Bend (at the knees)

bull Grab the electrical cord by the plug ONLY

bull Carefully pull and ease it out from the outlet

Bethesda Healthcare System 17

Lock outTag Out

bull If you discover a problem with an electrical devise contact Biomedical Maintenance and remove the item from service Always submit a work order Try to be as detailed and specific as possible about how the equipment is malfunctioning You will find the form on the Intranet page under Links called EngBio Work orders

bull When an appliance or devise has been taken out of service (lock out or tag out) you may not use it again until it has been approved by Biomedical Maintenance

bull These rules were made for your safety Do not endanger yourself or your patient by using faulty equipment

Bethesda Healthcare System 18

Downtime Status Codes for eCOS amp SCM Systems

The following codes pertain to eCOS and SCM and will be

utilized when these systems are down These codes are

announced overhead

ldquoStatus 1rdquo = System will be unavailable for up to 1 hour

ldquoStatus 2rdquo = System will be unavailable for up to 2 hours

ldquoStatus 3rdquo = System will be unavailable for more than 2 hours

ldquoSystem is now availablerdquo = System is back up and running

Bethesda Healthcare System 19

Your Environment

bull As with any home or office place occasionally there will be a

broken or poorly functioning plumbing appliance damage to

walls floors or ceiling broken furniture or other damage to the

hospital

bull Report any damage you find to the Engineering Department In

a real crisis situation call Engineering to initially report the

problem In all situations submit an engineering work order

You will find the form on the Intranet page under Links called

EngBio Work orders Fill out the form and submit it

bull Any broken furniture should be labeled with the problem

ldquoBrokenrdquo is not especially helpful for the people trying to fix the

problem

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 9: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 9

3 Contain

Contain the firesmoke by closing windows and doors after all

persons are out (remember to check bathrooms)

All other staff in the vicinity of the fire (not involved in the initial

discoveryresponse) are to report to the nursersquos station to

receive assignments closing all doors and windows along

the way and removing all obstacles from the hallways

All staff throughout the hospital will respond by closing all doors

and remaining on the alert for further instructions They

should not enter the fire location unless they are members of

the fire response team

Bethesda Healthcare System 10

4 Extinguish (If safe to do so)

We have many types of fire extinguishers

ABC ndash Marked with an ABC and can be used on all types of fires

Carbon Dioxide ndash used mainly for electrical fires around large pieces of

equipment

Halon Suppression Systems used on sensitive electronic equipment

K Extinguishers ndash Used on grease fires

Water Mist Extinguisher ndash Found in ORLampD best choice for protection

of hospital environments books documents and clean room facilities

To use a fire Extinguisher

P ndash pull the safety pin

A ndash aim the fire extinguisher

S ndash squeeze the handle

S ndash sweep the base of the fire with the spray

Bethesda Healthcare System 11

5 Evacuate

bull Evacuate all persons you are responsible for plus yourself to the next adjacent smoke compartment on the same floor (horizontal evacuation)

bull The charge nurse or designee will prioritize each patientrsquos evacuationcategory

bull Charge nurse or designee ensures that bag valve mask is at bedside of all ventilator dependent patients and oxygen for oxygen dependent patients

bull Staff will be assigned to conduct a methodical room-by-room search accounting for all visitors and leading all patients and visitors to safety A rubber glove will be placed on the doorknobs of all vacated rooms

bull All Emergency equipment is to be plugged into red outlets

bull Station someone at the elevator to prohibit elevator use

bull In some cases relocating patients to another floor may become necessary This is called Vertical Evacuation

Bethesda Healthcare System 12

Fire Drills

bull All staff members will actively participate in hospital-wide fire

drills The Fire Response Team is made up of specific people

throughout the hospital They have additional duties during

each fire drill and fire event

bull Each department has a fire plan Each staff member is

responsible to know that plan

bull Staff will stay alert to the fire situation until the end of the drill

when ldquoCode Red All Clearrdquo is announced three times

Bethesda Healthcare System 13

Oxygen

bull Oxygen is one of the primary ingredients of fire Special care

must be taken during a fire concerning oxygen being delivered

to patients

ndash ZONE OXYGEN valves shall only be turned off by

engineering after consultation with nursing or the nursing

supervisor (new policy 2013)

ndash Bedside oxygen may be turned off by trained employees

bull The hospital is divided into smoke compartments When the fire

alarm sounds the doors of the smoke compartments will

automatically close Do not block these doors which are the

heavy doors in the hallways Patient room doors are not smoke

compartment doors

bull Another source of free air flow in a fire is the elevator shaft

DO NOT USE ELEVATORS DURING A FIRE or FIRE ALARM

Bethesda Healthcare System 14

Electricity

bull In the event of a power outage an emergency power system will

activate within 10 seconds The emergency system will only

power emergency outlets (red outlets) switches and certain

emergency lighting (on all the time with no onoff switches)

bull Use the red outlets (emergency outlets) for ALL life sustaining

equipment

Bethesda Healthcare System 15

Electrical Hazards

bull Electricity is such a common part of our everyday lives that we

sometimes forget the hazards of using this form of energy Signs of

potential electrical hazard are

ndash frayed or damaged cords

ndash loose connections

ndash cords or connections in or near liquids

ndash electrical tools that spark shock or smoke due to damage or defect

ndash loss or lack of grounding electrical equipment

bull Extension cords are to be used only on a temporary basis and must

be approved by Engineering

bull Any appliances brought from home MUST by approved by Biomedical

Maintenance

Bethesda Healthcare System 16

Electrical Hazards

Make it common practice

bull When unplugging electrical cords from the wall outlet

bull DO NOT TO PULL or YANK on the cord when

removing ELECTRICAL CORDS FROM OUTLETS This may result in damage to the wiring and has been known to

cause a spark or a shock to the user

bull Bend (at the knees)

bull Grab the electrical cord by the plug ONLY

bull Carefully pull and ease it out from the outlet

Bethesda Healthcare System 17

Lock outTag Out

bull If you discover a problem with an electrical devise contact Biomedical Maintenance and remove the item from service Always submit a work order Try to be as detailed and specific as possible about how the equipment is malfunctioning You will find the form on the Intranet page under Links called EngBio Work orders

bull When an appliance or devise has been taken out of service (lock out or tag out) you may not use it again until it has been approved by Biomedical Maintenance

bull These rules were made for your safety Do not endanger yourself or your patient by using faulty equipment

Bethesda Healthcare System 18

Downtime Status Codes for eCOS amp SCM Systems

The following codes pertain to eCOS and SCM and will be

utilized when these systems are down These codes are

announced overhead

ldquoStatus 1rdquo = System will be unavailable for up to 1 hour

ldquoStatus 2rdquo = System will be unavailable for up to 2 hours

ldquoStatus 3rdquo = System will be unavailable for more than 2 hours

ldquoSystem is now availablerdquo = System is back up and running

Bethesda Healthcare System 19

Your Environment

bull As with any home or office place occasionally there will be a

broken or poorly functioning plumbing appliance damage to

walls floors or ceiling broken furniture or other damage to the

hospital

bull Report any damage you find to the Engineering Department In

a real crisis situation call Engineering to initially report the

problem In all situations submit an engineering work order

You will find the form on the Intranet page under Links called

EngBio Work orders Fill out the form and submit it

bull Any broken furniture should be labeled with the problem

ldquoBrokenrdquo is not especially helpful for the people trying to fix the

problem

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 10: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 10

4 Extinguish (If safe to do so)

We have many types of fire extinguishers

ABC ndash Marked with an ABC and can be used on all types of fires

Carbon Dioxide ndash used mainly for electrical fires around large pieces of

equipment

Halon Suppression Systems used on sensitive electronic equipment

K Extinguishers ndash Used on grease fires

Water Mist Extinguisher ndash Found in ORLampD best choice for protection

of hospital environments books documents and clean room facilities

To use a fire Extinguisher

P ndash pull the safety pin

A ndash aim the fire extinguisher

S ndash squeeze the handle

S ndash sweep the base of the fire with the spray

Bethesda Healthcare System 11

5 Evacuate

bull Evacuate all persons you are responsible for plus yourself to the next adjacent smoke compartment on the same floor (horizontal evacuation)

bull The charge nurse or designee will prioritize each patientrsquos evacuationcategory

bull Charge nurse or designee ensures that bag valve mask is at bedside of all ventilator dependent patients and oxygen for oxygen dependent patients

bull Staff will be assigned to conduct a methodical room-by-room search accounting for all visitors and leading all patients and visitors to safety A rubber glove will be placed on the doorknobs of all vacated rooms

bull All Emergency equipment is to be plugged into red outlets

bull Station someone at the elevator to prohibit elevator use

bull In some cases relocating patients to another floor may become necessary This is called Vertical Evacuation

Bethesda Healthcare System 12

Fire Drills

bull All staff members will actively participate in hospital-wide fire

drills The Fire Response Team is made up of specific people

throughout the hospital They have additional duties during

each fire drill and fire event

bull Each department has a fire plan Each staff member is

responsible to know that plan

bull Staff will stay alert to the fire situation until the end of the drill

when ldquoCode Red All Clearrdquo is announced three times

Bethesda Healthcare System 13

Oxygen

bull Oxygen is one of the primary ingredients of fire Special care

must be taken during a fire concerning oxygen being delivered

to patients

ndash ZONE OXYGEN valves shall only be turned off by

engineering after consultation with nursing or the nursing

supervisor (new policy 2013)

ndash Bedside oxygen may be turned off by trained employees

bull The hospital is divided into smoke compartments When the fire

alarm sounds the doors of the smoke compartments will

automatically close Do not block these doors which are the

heavy doors in the hallways Patient room doors are not smoke

compartment doors

bull Another source of free air flow in a fire is the elevator shaft

DO NOT USE ELEVATORS DURING A FIRE or FIRE ALARM

Bethesda Healthcare System 14

Electricity

bull In the event of a power outage an emergency power system will

activate within 10 seconds The emergency system will only

power emergency outlets (red outlets) switches and certain

emergency lighting (on all the time with no onoff switches)

bull Use the red outlets (emergency outlets) for ALL life sustaining

equipment

Bethesda Healthcare System 15

Electrical Hazards

bull Electricity is such a common part of our everyday lives that we

sometimes forget the hazards of using this form of energy Signs of

potential electrical hazard are

ndash frayed or damaged cords

ndash loose connections

ndash cords or connections in or near liquids

ndash electrical tools that spark shock or smoke due to damage or defect

ndash loss or lack of grounding electrical equipment

bull Extension cords are to be used only on a temporary basis and must

be approved by Engineering

bull Any appliances brought from home MUST by approved by Biomedical

Maintenance

Bethesda Healthcare System 16

Electrical Hazards

Make it common practice

bull When unplugging electrical cords from the wall outlet

bull DO NOT TO PULL or YANK on the cord when

removing ELECTRICAL CORDS FROM OUTLETS This may result in damage to the wiring and has been known to

cause a spark or a shock to the user

bull Bend (at the knees)

bull Grab the electrical cord by the plug ONLY

bull Carefully pull and ease it out from the outlet

Bethesda Healthcare System 17

Lock outTag Out

bull If you discover a problem with an electrical devise contact Biomedical Maintenance and remove the item from service Always submit a work order Try to be as detailed and specific as possible about how the equipment is malfunctioning You will find the form on the Intranet page under Links called EngBio Work orders

bull When an appliance or devise has been taken out of service (lock out or tag out) you may not use it again until it has been approved by Biomedical Maintenance

bull These rules were made for your safety Do not endanger yourself or your patient by using faulty equipment

Bethesda Healthcare System 18

Downtime Status Codes for eCOS amp SCM Systems

The following codes pertain to eCOS and SCM and will be

utilized when these systems are down These codes are

announced overhead

ldquoStatus 1rdquo = System will be unavailable for up to 1 hour

ldquoStatus 2rdquo = System will be unavailable for up to 2 hours

ldquoStatus 3rdquo = System will be unavailable for more than 2 hours

ldquoSystem is now availablerdquo = System is back up and running

Bethesda Healthcare System 19

Your Environment

bull As with any home or office place occasionally there will be a

broken or poorly functioning plumbing appliance damage to

walls floors or ceiling broken furniture or other damage to the

hospital

bull Report any damage you find to the Engineering Department In

a real crisis situation call Engineering to initially report the

problem In all situations submit an engineering work order

You will find the form on the Intranet page under Links called

EngBio Work orders Fill out the form and submit it

bull Any broken furniture should be labeled with the problem

ldquoBrokenrdquo is not especially helpful for the people trying to fix the

problem

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 11: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 11

5 Evacuate

bull Evacuate all persons you are responsible for plus yourself to the next adjacent smoke compartment on the same floor (horizontal evacuation)

bull The charge nurse or designee will prioritize each patientrsquos evacuationcategory

bull Charge nurse or designee ensures that bag valve mask is at bedside of all ventilator dependent patients and oxygen for oxygen dependent patients

bull Staff will be assigned to conduct a methodical room-by-room search accounting for all visitors and leading all patients and visitors to safety A rubber glove will be placed on the doorknobs of all vacated rooms

bull All Emergency equipment is to be plugged into red outlets

bull Station someone at the elevator to prohibit elevator use

bull In some cases relocating patients to another floor may become necessary This is called Vertical Evacuation

Bethesda Healthcare System 12

Fire Drills

bull All staff members will actively participate in hospital-wide fire

drills The Fire Response Team is made up of specific people

throughout the hospital They have additional duties during

each fire drill and fire event

bull Each department has a fire plan Each staff member is

responsible to know that plan

bull Staff will stay alert to the fire situation until the end of the drill

when ldquoCode Red All Clearrdquo is announced three times

Bethesda Healthcare System 13

Oxygen

bull Oxygen is one of the primary ingredients of fire Special care

must be taken during a fire concerning oxygen being delivered

to patients

ndash ZONE OXYGEN valves shall only be turned off by

engineering after consultation with nursing or the nursing

supervisor (new policy 2013)

ndash Bedside oxygen may be turned off by trained employees

bull The hospital is divided into smoke compartments When the fire

alarm sounds the doors of the smoke compartments will

automatically close Do not block these doors which are the

heavy doors in the hallways Patient room doors are not smoke

compartment doors

bull Another source of free air flow in a fire is the elevator shaft

DO NOT USE ELEVATORS DURING A FIRE or FIRE ALARM

Bethesda Healthcare System 14

Electricity

bull In the event of a power outage an emergency power system will

activate within 10 seconds The emergency system will only

power emergency outlets (red outlets) switches and certain

emergency lighting (on all the time with no onoff switches)

bull Use the red outlets (emergency outlets) for ALL life sustaining

equipment

Bethesda Healthcare System 15

Electrical Hazards

bull Electricity is such a common part of our everyday lives that we

sometimes forget the hazards of using this form of energy Signs of

potential electrical hazard are

ndash frayed or damaged cords

ndash loose connections

ndash cords or connections in or near liquids

ndash electrical tools that spark shock or smoke due to damage or defect

ndash loss or lack of grounding electrical equipment

bull Extension cords are to be used only on a temporary basis and must

be approved by Engineering

bull Any appliances brought from home MUST by approved by Biomedical

Maintenance

Bethesda Healthcare System 16

Electrical Hazards

Make it common practice

bull When unplugging electrical cords from the wall outlet

bull DO NOT TO PULL or YANK on the cord when

removing ELECTRICAL CORDS FROM OUTLETS This may result in damage to the wiring and has been known to

cause a spark or a shock to the user

bull Bend (at the knees)

bull Grab the electrical cord by the plug ONLY

bull Carefully pull and ease it out from the outlet

Bethesda Healthcare System 17

Lock outTag Out

bull If you discover a problem with an electrical devise contact Biomedical Maintenance and remove the item from service Always submit a work order Try to be as detailed and specific as possible about how the equipment is malfunctioning You will find the form on the Intranet page under Links called EngBio Work orders

bull When an appliance or devise has been taken out of service (lock out or tag out) you may not use it again until it has been approved by Biomedical Maintenance

bull These rules were made for your safety Do not endanger yourself or your patient by using faulty equipment

Bethesda Healthcare System 18

Downtime Status Codes for eCOS amp SCM Systems

The following codes pertain to eCOS and SCM and will be

utilized when these systems are down These codes are

announced overhead

ldquoStatus 1rdquo = System will be unavailable for up to 1 hour

ldquoStatus 2rdquo = System will be unavailable for up to 2 hours

ldquoStatus 3rdquo = System will be unavailable for more than 2 hours

ldquoSystem is now availablerdquo = System is back up and running

Bethesda Healthcare System 19

Your Environment

bull As with any home or office place occasionally there will be a

broken or poorly functioning plumbing appliance damage to

walls floors or ceiling broken furniture or other damage to the

hospital

bull Report any damage you find to the Engineering Department In

a real crisis situation call Engineering to initially report the

problem In all situations submit an engineering work order

You will find the form on the Intranet page under Links called

EngBio Work orders Fill out the form and submit it

bull Any broken furniture should be labeled with the problem

ldquoBrokenrdquo is not especially helpful for the people trying to fix the

problem

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 12: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 12

Fire Drills

bull All staff members will actively participate in hospital-wide fire

drills The Fire Response Team is made up of specific people

throughout the hospital They have additional duties during

each fire drill and fire event

bull Each department has a fire plan Each staff member is

responsible to know that plan

bull Staff will stay alert to the fire situation until the end of the drill

when ldquoCode Red All Clearrdquo is announced three times

Bethesda Healthcare System 13

Oxygen

bull Oxygen is one of the primary ingredients of fire Special care

must be taken during a fire concerning oxygen being delivered

to patients

ndash ZONE OXYGEN valves shall only be turned off by

engineering after consultation with nursing or the nursing

supervisor (new policy 2013)

ndash Bedside oxygen may be turned off by trained employees

bull The hospital is divided into smoke compartments When the fire

alarm sounds the doors of the smoke compartments will

automatically close Do not block these doors which are the

heavy doors in the hallways Patient room doors are not smoke

compartment doors

bull Another source of free air flow in a fire is the elevator shaft

DO NOT USE ELEVATORS DURING A FIRE or FIRE ALARM

Bethesda Healthcare System 14

Electricity

bull In the event of a power outage an emergency power system will

activate within 10 seconds The emergency system will only

power emergency outlets (red outlets) switches and certain

emergency lighting (on all the time with no onoff switches)

bull Use the red outlets (emergency outlets) for ALL life sustaining

equipment

Bethesda Healthcare System 15

Electrical Hazards

bull Electricity is such a common part of our everyday lives that we

sometimes forget the hazards of using this form of energy Signs of

potential electrical hazard are

ndash frayed or damaged cords

ndash loose connections

ndash cords or connections in or near liquids

ndash electrical tools that spark shock or smoke due to damage or defect

ndash loss or lack of grounding electrical equipment

bull Extension cords are to be used only on a temporary basis and must

be approved by Engineering

bull Any appliances brought from home MUST by approved by Biomedical

Maintenance

Bethesda Healthcare System 16

Electrical Hazards

Make it common practice

bull When unplugging electrical cords from the wall outlet

bull DO NOT TO PULL or YANK on the cord when

removing ELECTRICAL CORDS FROM OUTLETS This may result in damage to the wiring and has been known to

cause a spark or a shock to the user

bull Bend (at the knees)

bull Grab the electrical cord by the plug ONLY

bull Carefully pull and ease it out from the outlet

Bethesda Healthcare System 17

Lock outTag Out

bull If you discover a problem with an electrical devise contact Biomedical Maintenance and remove the item from service Always submit a work order Try to be as detailed and specific as possible about how the equipment is malfunctioning You will find the form on the Intranet page under Links called EngBio Work orders

bull When an appliance or devise has been taken out of service (lock out or tag out) you may not use it again until it has been approved by Biomedical Maintenance

bull These rules were made for your safety Do not endanger yourself or your patient by using faulty equipment

Bethesda Healthcare System 18

Downtime Status Codes for eCOS amp SCM Systems

The following codes pertain to eCOS and SCM and will be

utilized when these systems are down These codes are

announced overhead

ldquoStatus 1rdquo = System will be unavailable for up to 1 hour

ldquoStatus 2rdquo = System will be unavailable for up to 2 hours

ldquoStatus 3rdquo = System will be unavailable for more than 2 hours

ldquoSystem is now availablerdquo = System is back up and running

Bethesda Healthcare System 19

Your Environment

bull As with any home or office place occasionally there will be a

broken or poorly functioning plumbing appliance damage to

walls floors or ceiling broken furniture or other damage to the

hospital

bull Report any damage you find to the Engineering Department In

a real crisis situation call Engineering to initially report the

problem In all situations submit an engineering work order

You will find the form on the Intranet page under Links called

EngBio Work orders Fill out the form and submit it

bull Any broken furniture should be labeled with the problem

ldquoBrokenrdquo is not especially helpful for the people trying to fix the

problem

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 13: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 13

Oxygen

bull Oxygen is one of the primary ingredients of fire Special care

must be taken during a fire concerning oxygen being delivered

to patients

ndash ZONE OXYGEN valves shall only be turned off by

engineering after consultation with nursing or the nursing

supervisor (new policy 2013)

ndash Bedside oxygen may be turned off by trained employees

bull The hospital is divided into smoke compartments When the fire

alarm sounds the doors of the smoke compartments will

automatically close Do not block these doors which are the

heavy doors in the hallways Patient room doors are not smoke

compartment doors

bull Another source of free air flow in a fire is the elevator shaft

DO NOT USE ELEVATORS DURING A FIRE or FIRE ALARM

Bethesda Healthcare System 14

Electricity

bull In the event of a power outage an emergency power system will

activate within 10 seconds The emergency system will only

power emergency outlets (red outlets) switches and certain

emergency lighting (on all the time with no onoff switches)

bull Use the red outlets (emergency outlets) for ALL life sustaining

equipment

Bethesda Healthcare System 15

Electrical Hazards

bull Electricity is such a common part of our everyday lives that we

sometimes forget the hazards of using this form of energy Signs of

potential electrical hazard are

ndash frayed or damaged cords

ndash loose connections

ndash cords or connections in or near liquids

ndash electrical tools that spark shock or smoke due to damage or defect

ndash loss or lack of grounding electrical equipment

bull Extension cords are to be used only on a temporary basis and must

be approved by Engineering

bull Any appliances brought from home MUST by approved by Biomedical

Maintenance

Bethesda Healthcare System 16

Electrical Hazards

Make it common practice

bull When unplugging electrical cords from the wall outlet

bull DO NOT TO PULL or YANK on the cord when

removing ELECTRICAL CORDS FROM OUTLETS This may result in damage to the wiring and has been known to

cause a spark or a shock to the user

bull Bend (at the knees)

bull Grab the electrical cord by the plug ONLY

bull Carefully pull and ease it out from the outlet

Bethesda Healthcare System 17

Lock outTag Out

bull If you discover a problem with an electrical devise contact Biomedical Maintenance and remove the item from service Always submit a work order Try to be as detailed and specific as possible about how the equipment is malfunctioning You will find the form on the Intranet page under Links called EngBio Work orders

bull When an appliance or devise has been taken out of service (lock out or tag out) you may not use it again until it has been approved by Biomedical Maintenance

bull These rules were made for your safety Do not endanger yourself or your patient by using faulty equipment

Bethesda Healthcare System 18

Downtime Status Codes for eCOS amp SCM Systems

The following codes pertain to eCOS and SCM and will be

utilized when these systems are down These codes are

announced overhead

ldquoStatus 1rdquo = System will be unavailable for up to 1 hour

ldquoStatus 2rdquo = System will be unavailable for up to 2 hours

ldquoStatus 3rdquo = System will be unavailable for more than 2 hours

ldquoSystem is now availablerdquo = System is back up and running

Bethesda Healthcare System 19

Your Environment

bull As with any home or office place occasionally there will be a

broken or poorly functioning plumbing appliance damage to

walls floors or ceiling broken furniture or other damage to the

hospital

bull Report any damage you find to the Engineering Department In

a real crisis situation call Engineering to initially report the

problem In all situations submit an engineering work order

You will find the form on the Intranet page under Links called

EngBio Work orders Fill out the form and submit it

bull Any broken furniture should be labeled with the problem

ldquoBrokenrdquo is not especially helpful for the people trying to fix the

problem

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 14: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 14

Electricity

bull In the event of a power outage an emergency power system will

activate within 10 seconds The emergency system will only

power emergency outlets (red outlets) switches and certain

emergency lighting (on all the time with no onoff switches)

bull Use the red outlets (emergency outlets) for ALL life sustaining

equipment

Bethesda Healthcare System 15

Electrical Hazards

bull Electricity is such a common part of our everyday lives that we

sometimes forget the hazards of using this form of energy Signs of

potential electrical hazard are

ndash frayed or damaged cords

ndash loose connections

ndash cords or connections in or near liquids

ndash electrical tools that spark shock or smoke due to damage or defect

ndash loss or lack of grounding electrical equipment

bull Extension cords are to be used only on a temporary basis and must

be approved by Engineering

bull Any appliances brought from home MUST by approved by Biomedical

Maintenance

Bethesda Healthcare System 16

Electrical Hazards

Make it common practice

bull When unplugging electrical cords from the wall outlet

bull DO NOT TO PULL or YANK on the cord when

removing ELECTRICAL CORDS FROM OUTLETS This may result in damage to the wiring and has been known to

cause a spark or a shock to the user

bull Bend (at the knees)

bull Grab the electrical cord by the plug ONLY

bull Carefully pull and ease it out from the outlet

Bethesda Healthcare System 17

Lock outTag Out

bull If you discover a problem with an electrical devise contact Biomedical Maintenance and remove the item from service Always submit a work order Try to be as detailed and specific as possible about how the equipment is malfunctioning You will find the form on the Intranet page under Links called EngBio Work orders

bull When an appliance or devise has been taken out of service (lock out or tag out) you may not use it again until it has been approved by Biomedical Maintenance

bull These rules were made for your safety Do not endanger yourself or your patient by using faulty equipment

Bethesda Healthcare System 18

Downtime Status Codes for eCOS amp SCM Systems

The following codes pertain to eCOS and SCM and will be

utilized when these systems are down These codes are

announced overhead

ldquoStatus 1rdquo = System will be unavailable for up to 1 hour

ldquoStatus 2rdquo = System will be unavailable for up to 2 hours

ldquoStatus 3rdquo = System will be unavailable for more than 2 hours

ldquoSystem is now availablerdquo = System is back up and running

Bethesda Healthcare System 19

Your Environment

bull As with any home or office place occasionally there will be a

broken or poorly functioning plumbing appliance damage to

walls floors or ceiling broken furniture or other damage to the

hospital

bull Report any damage you find to the Engineering Department In

a real crisis situation call Engineering to initially report the

problem In all situations submit an engineering work order

You will find the form on the Intranet page under Links called

EngBio Work orders Fill out the form and submit it

bull Any broken furniture should be labeled with the problem

ldquoBrokenrdquo is not especially helpful for the people trying to fix the

problem

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 15: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 15

Electrical Hazards

bull Electricity is such a common part of our everyday lives that we

sometimes forget the hazards of using this form of energy Signs of

potential electrical hazard are

ndash frayed or damaged cords

ndash loose connections

ndash cords or connections in or near liquids

ndash electrical tools that spark shock or smoke due to damage or defect

ndash loss or lack of grounding electrical equipment

bull Extension cords are to be used only on a temporary basis and must

be approved by Engineering

bull Any appliances brought from home MUST by approved by Biomedical

Maintenance

Bethesda Healthcare System 16

Electrical Hazards

Make it common practice

bull When unplugging electrical cords from the wall outlet

bull DO NOT TO PULL or YANK on the cord when

removing ELECTRICAL CORDS FROM OUTLETS This may result in damage to the wiring and has been known to

cause a spark or a shock to the user

bull Bend (at the knees)

bull Grab the electrical cord by the plug ONLY

bull Carefully pull and ease it out from the outlet

Bethesda Healthcare System 17

Lock outTag Out

bull If you discover a problem with an electrical devise contact Biomedical Maintenance and remove the item from service Always submit a work order Try to be as detailed and specific as possible about how the equipment is malfunctioning You will find the form on the Intranet page under Links called EngBio Work orders

bull When an appliance or devise has been taken out of service (lock out or tag out) you may not use it again until it has been approved by Biomedical Maintenance

bull These rules were made for your safety Do not endanger yourself or your patient by using faulty equipment

Bethesda Healthcare System 18

Downtime Status Codes for eCOS amp SCM Systems

The following codes pertain to eCOS and SCM and will be

utilized when these systems are down These codes are

announced overhead

ldquoStatus 1rdquo = System will be unavailable for up to 1 hour

ldquoStatus 2rdquo = System will be unavailable for up to 2 hours

ldquoStatus 3rdquo = System will be unavailable for more than 2 hours

ldquoSystem is now availablerdquo = System is back up and running

Bethesda Healthcare System 19

Your Environment

bull As with any home or office place occasionally there will be a

broken or poorly functioning plumbing appliance damage to

walls floors or ceiling broken furniture or other damage to the

hospital

bull Report any damage you find to the Engineering Department In

a real crisis situation call Engineering to initially report the

problem In all situations submit an engineering work order

You will find the form on the Intranet page under Links called

EngBio Work orders Fill out the form and submit it

bull Any broken furniture should be labeled with the problem

ldquoBrokenrdquo is not especially helpful for the people trying to fix the

problem

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 16: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 16

Electrical Hazards

Make it common practice

bull When unplugging electrical cords from the wall outlet

bull DO NOT TO PULL or YANK on the cord when

removing ELECTRICAL CORDS FROM OUTLETS This may result in damage to the wiring and has been known to

cause a spark or a shock to the user

bull Bend (at the knees)

bull Grab the electrical cord by the plug ONLY

bull Carefully pull and ease it out from the outlet

Bethesda Healthcare System 17

Lock outTag Out

bull If you discover a problem with an electrical devise contact Biomedical Maintenance and remove the item from service Always submit a work order Try to be as detailed and specific as possible about how the equipment is malfunctioning You will find the form on the Intranet page under Links called EngBio Work orders

bull When an appliance or devise has been taken out of service (lock out or tag out) you may not use it again until it has been approved by Biomedical Maintenance

bull These rules were made for your safety Do not endanger yourself or your patient by using faulty equipment

Bethesda Healthcare System 18

Downtime Status Codes for eCOS amp SCM Systems

The following codes pertain to eCOS and SCM and will be

utilized when these systems are down These codes are

announced overhead

ldquoStatus 1rdquo = System will be unavailable for up to 1 hour

ldquoStatus 2rdquo = System will be unavailable for up to 2 hours

ldquoStatus 3rdquo = System will be unavailable for more than 2 hours

ldquoSystem is now availablerdquo = System is back up and running

Bethesda Healthcare System 19

Your Environment

bull As with any home or office place occasionally there will be a

broken or poorly functioning plumbing appliance damage to

walls floors or ceiling broken furniture or other damage to the

hospital

bull Report any damage you find to the Engineering Department In

a real crisis situation call Engineering to initially report the

problem In all situations submit an engineering work order

You will find the form on the Intranet page under Links called

EngBio Work orders Fill out the form and submit it

bull Any broken furniture should be labeled with the problem

ldquoBrokenrdquo is not especially helpful for the people trying to fix the

problem

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 17: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 17

Lock outTag Out

bull If you discover a problem with an electrical devise contact Biomedical Maintenance and remove the item from service Always submit a work order Try to be as detailed and specific as possible about how the equipment is malfunctioning You will find the form on the Intranet page under Links called EngBio Work orders

bull When an appliance or devise has been taken out of service (lock out or tag out) you may not use it again until it has been approved by Biomedical Maintenance

bull These rules were made for your safety Do not endanger yourself or your patient by using faulty equipment

Bethesda Healthcare System 18

Downtime Status Codes for eCOS amp SCM Systems

The following codes pertain to eCOS and SCM and will be

utilized when these systems are down These codes are

announced overhead

ldquoStatus 1rdquo = System will be unavailable for up to 1 hour

ldquoStatus 2rdquo = System will be unavailable for up to 2 hours

ldquoStatus 3rdquo = System will be unavailable for more than 2 hours

ldquoSystem is now availablerdquo = System is back up and running

Bethesda Healthcare System 19

Your Environment

bull As with any home or office place occasionally there will be a

broken or poorly functioning plumbing appliance damage to

walls floors or ceiling broken furniture or other damage to the

hospital

bull Report any damage you find to the Engineering Department In

a real crisis situation call Engineering to initially report the

problem In all situations submit an engineering work order

You will find the form on the Intranet page under Links called

EngBio Work orders Fill out the form and submit it

bull Any broken furniture should be labeled with the problem

ldquoBrokenrdquo is not especially helpful for the people trying to fix the

problem

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 18: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 18

Downtime Status Codes for eCOS amp SCM Systems

The following codes pertain to eCOS and SCM and will be

utilized when these systems are down These codes are

announced overhead

ldquoStatus 1rdquo = System will be unavailable for up to 1 hour

ldquoStatus 2rdquo = System will be unavailable for up to 2 hours

ldquoStatus 3rdquo = System will be unavailable for more than 2 hours

ldquoSystem is now availablerdquo = System is back up and running

Bethesda Healthcare System 19

Your Environment

bull As with any home or office place occasionally there will be a

broken or poorly functioning plumbing appliance damage to

walls floors or ceiling broken furniture or other damage to the

hospital

bull Report any damage you find to the Engineering Department In

a real crisis situation call Engineering to initially report the

problem In all situations submit an engineering work order

You will find the form on the Intranet page under Links called

EngBio Work orders Fill out the form and submit it

bull Any broken furniture should be labeled with the problem

ldquoBrokenrdquo is not especially helpful for the people trying to fix the

problem

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 19: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 19

Your Environment

bull As with any home or office place occasionally there will be a

broken or poorly functioning plumbing appliance damage to

walls floors or ceiling broken furniture or other damage to the

hospital

bull Report any damage you find to the Engineering Department In

a real crisis situation call Engineering to initially report the

problem In all situations submit an engineering work order

You will find the form on the Intranet page under Links called

EngBio Work orders Fill out the form and submit it

bull Any broken furniture should be labeled with the problem

ldquoBrokenrdquo is not especially helpful for the people trying to fix the

problem

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 20: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 20

Utility Failure OR 1600 Appendix G

The Utility Management Plan applies to all employees and

departments of the hospital and to the following systems

bull electrical power amp emergency power

bull natural gas medical gases vacuum

bull steam and condensation systems

bull heating and ventilation heating ventilation and air

conditioning systems

bull water (including domestic and fire protection) sewage

plumbing

bull horizontal and vertical transport systems alarm systems

(including fire) diesel fuel and

bull communicationsdata systems

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 21: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 21

Emergency Power

bull BHE currently have two 10000-gallon fuel tanks They are

underground with the tops about 24 feet above sea level

Therefore flooding is not likely to be the cause of a fuel tank

failure

bull A fifth generator was added with the addition of the Bethesda

Heart Hospital doubled our generating capability The new

generator is located in a separate hurricane enclosure at least 8

feet higher than the existing generators The new generator is

dedicated to air conditioning and ventilation loads but still has

the capability to carry critical loads if the need arises

bull BHW has two generators with 2 above ground 10000 gallon

fuel tanks

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 22: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 22

Internal Power Failure

INTERNAL POWER FAILURE

bull In the event of a power outage the red outlets would be switched to

emergency generator power

bull Life Safety lighting will be provided which will provide marginal

lighting throughout Flashlights and other portable lights are

maintained in individual departments

bull At the time of an outage persons in charge should check all red

outlets in their areas to make sure only items critical to patient care

are connected Toasters coffee pots etc should never be plugged

into red outlets

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 23: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 23

Red Outlets

bull To ensure life safety equipment is maintained in the event of a

power failure the only equipment that should be plugged into

ldquored emergency outletsrdquo is that equipment which is necessary to

provide appropriate care of the patient ie life safety

equipment communications equipment diagnostic information

physiological monitoring lighting etc

bull Computers are the only other acceptable pieces of equipment

that may be used in the red emergency outlets because of their

relatively low power consumption

bull Radios televisions fans etc should only be plugged into the

white normal power outlets

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 24: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 24

Water and Sewer

bull Water and sewer are supplied by the Local Municipal Water

Company Water comes into the building from different points

They can be isolated from one another and all are not needed

at the same time There are booster pumps to increase city

water pressure when needed If the City cannot provide water

the Engineering Department has a written procedure to connect

the irrigation well to the Hospital water supply if needed

bull Water samples are collected for testing of Legionella bacterium

annually

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 25: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 25

HVAC ndash Air Quality

bull Air quality throughout the building is monitored by

computer Filter changes on air handlers and isolation fans are

performed by maintenance schedules Critical care air handlers

controls pumps and fans are connected to the emergency

power system

bull Ultraviolet lighting is also used for more thorough filtration in

areas where invasive procedures are done

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 26: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 26

Medical Gasses

bull Medical Gases are supplied by several methods The

purchased gases are stored in the tank farm

bull The Hospitalrsquos main distribution for oxygen and nitrous oxide

resides there

bull The supply of oxygen is 3500 gallons with a reserve of 500 gallons

Nitrous oxide back-up is kept in the tank farm and a procedure for

connecting tanks to the manifold is an Engineering Departmental

procedure Procedures for changing other tanks are also covered

bull Medical vacuum and air are produced on site and the pumps are

connected to the emergency power system with engineering

procedures to bypass or tie together separate systems for

redundancy

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 27: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 27

Communications

bull Communication systems are connected to the emergency power

system with battery back-up capable of holding the system up

for 30 minutes without the generators

bull If the phone system is out of service the Hospital has portable

walkie-talkies for distribution to critical areas

bull In the event of a hurricane employees are encouraged to bring

their cell phones to work

bull Battery back-up systems are maintained semi-annually

They include the Laboratory Telephone system Information

systems and battery operated light packs

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 28: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 28

OR 1600- Plan Delta And OR 1600 Environment of Care Plans

bull OR 1600 - The framework of the Emergency Operations Plan is designed as an ldquoAll Hazardsrdquo guide to mitigate prepare respond and recover from a variety of emergency eventshazards

bull OR 1600 identifies the roles and responsibilities in the command structure in the event of an emergency or disaster

bull OR 1600 can be reviewed on the intranet under administrative policies

bull OR 1600 ndash Environment of Care Plans - The environment of care plans cover the 6 areas of the environment of care and can be found on the intranet under administrative policies

bull Safety Management

bull Security Management

bull Hazardous Materials and Waste Plan

bull Fire Safety Management Plan

bull Utilities Management

bull Medical Equipment Management Plan

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 29: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 29

Code Pink

Code Pink is used to alert the hospital to an infant or child abduction with a registered patient

Code Amber is used for an unregistered child

bull In the unit where the abduction occurred call the Operator by dialing 855 at the East or 755 at the West hospital and give the age and sex of the infant or child Notify the Charge Nurse immediately

bull Seal off the unit from which the child was taken Get names addresses and telephone numbers of anyone leaving the area Do not allow anyone to enter or touch the room where the child was taken Account for all patients on the unit

bull Upon hearing the announcement indicating a male child age 5 ldquoCode Pink Male 5 yearsrdquo for example do the following

bull In your department conduct a room-by-room search

bull In the rest of the hospital when Code Pink is announced secure the building by taking a position at all exits Look for persons carrying an infant or parcel large enough to hold an infant or a child

bull Security will contain the hospital grounds contact authorities and direct any press inquiries to Public Relations or Administration

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 30: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 30

Code Yellow

bull Code Yellow is used to refer to a bomb threat This code is not

used over the loudspeakers

bull The two basic methods of discovering the threat of a bomb is to

ndash notice a suspicious looking package

ndash receive a threatening call on the telephone

bull If you notice something you suspect is a bomb ndash do not touch it

Immediately notify security and quietly evacuate the area

bull If you receive a threatening call ndash keep the caller on the line as long as

possible while sending another employee to notify security and the

Safety Officer USE THE BOMB THREAT CHECKLIST While talking

note as much information as you can about the caller and any

background noises you may hear Do not challenge the person in

any way

bull During a Code Yellow do not use cell phones or pagers as these are

possible detonation devises

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 31: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 31

Code Strong

bull Code Strong is called in any situation involving a disorderly or violent visitor patient or employee when additional personnel are needed on a short-term emergency basis

bull Procedure

ndash The first person to come upon this situation should dial ldquo855rdquo for BHE or ldquo755rdquo for BHW and call a Code Strong

ndash The code strong team will respond immediately to the call to give assistance

ndash While waiting for the team to arrive individuals should

bull not escalate the situation

bull clear the area if indicated

ndash The Administrative Supervisor is responsible for directing the Code Strong If necessary the Administrative Supervisor or Security will call 911 for police assistance

ndash The Charge Nurse Department Supervisor or designee must fill out a ldquoCode Strong Reportrdquo (Ops Reg 2608 Appendix A)

ndash When the situation is concluded the Operator announces overhead ldquoALL Clear Code Strongrdquo three times

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 32: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 32

Code Orange

bull Code Orange refers to a hostage situation

bull Upon announcement you should

ndash remain calm

ndash return to your department IF SAFELY ABLE TO DO SO

ndash do not discuss the threat in public

ndash close all doors

ndash use telephones for emergency only

bull If you are in the vicinity of the Hostage area do the following

ndash cordon off the area and restrict traffic

ndash notify Security

ndash remain calm

ndash keep other patients visitors and staff out of immediate area of danger

ndash consider whether it is prudent to move patients from nearby rooms

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 33: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 33

Code Orange

bull If you become the hostage the following behavior is recommended

bullAccept your situation

bullDo as you are told (no more no

less)

bullTry to retain your composure

bullWhen police arrive ndash follow their

instructions

bullBe observant

bullDo not make quick movements

bullDo not make suggestions

bullDo not argue

bullDo not lose hope

bullRequest medication if needed

bullOnly attempt to escape if you

are 100 positive you can get away

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 34: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 34

Code Gamma

bull This indicates a radiation accident has occurred

bull This code is part of the Plan Delta similar to chemical and biological

bull Radiation accidents can happen in many ways The accident may be

ndash Internal An I-131 Therapy patient on the Oncology Unit (who is in Radiation Isolation) that has had cardiac or respiratory arrest

ndash External A community event like a nuclear plant meltdown Cyclotron accident or a ldquoDirty Bombrdquo

bull If Code Gamma is called all departments will respond the same (as outlined in the Plan Delta Document) for all Plan Deltarsquos whether it is chemical biological or radioactive

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 35: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 35

Code Gamma ndash Policy References

bull The Code Gamma Policy can be found under

the Disaster Plan in Ops Reg 1603

bull In addition there is also an amendment to the

Code Blue Policy to help aide in event an I-

131 in-house patient suffers a cardiac or

respiratory arrest Ops Reg 2105

Attachment C

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 36: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 36

Radiation Accident during a Code Blue

bull To help aide personnel in the response to a radiation incident a radiation cart has been created It is kept and stocked by the Nuclear Medicine Department It contains items such as a GM survey meter pocket dosimeters gowns gloves signs absorbent barrier pads (chucks) hazard tape etc

bull If there is an I-131 Therapy inpatient on the Oncology floor (only 6 ndash 8 of these a year) the radiation cart will be kept in the patientrsquos room during hisher hospital stay (Since this is the most likely scenario to cause a Code Gamma) Otherwise it will be kept in Nuclear Medicine

bull The most important thing to keep in mind is to try not to spread radioactive contamination around the facility Check your shoes stretcher or any other possibly contaminated equipment with a GM survey meter

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 37: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 37

Radiation Accident during a Code Blue

bull If you are a nurse on Oncology and caring for an I-131 patient

and you find them unresponsive or in cardiacrespiratory arrest

call a Code Blue and a Code Gamma by dialing 855 at the East

hospital or 755 at the West hospital and announcing the both

codes and the location

bull Access the Radiation Cart in the patientrsquos room for handy

protection supplies during the Code Blue process

bull Check anything leaving the room for contamination This

includes BP cuffs defibrillator or stretcher even you own

shoes A trained staff member can do this with a GM survey

meter

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 38: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 38

MRI Safety

MRI Safety

There are potential risks

in the MR environment

that can affect the

patient accompanying

family members health

care personnel and

anyone finding

themselves within the

very powerful magnetic

field of an MR scanner

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 39: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 39

How safe is an MRI

The powerful magnetic field of the MR scanner IS ALWAYS ON Even when a scan is not being performed the magnet is still on

bull This powerful magnetic field can cause ferromagnetic objects to become airborne projectiles (similar to fired missiles) potentially injuring anyone within its path

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 40: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 40

Missile effect of magnetic field

bull Anything ferromagnetic being brought within the MRI scan room can become a projectile from anywhere within the room and without warning Ferromagnetic objects are drawn rapidly into the scanner and with extreme force

bull For this reason it is imperative that all people and objects be properly screened prior to coming into contact with the magnetic field

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 41: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 41

Non safe objects within the bodyhellip

bull DO NOT ENTER THE MRI SCAN ROOM WITH THE FOLLOWING

ndash cardiac pacemakers defibrillators aneurysm clips metallic foreign bodies (especially within the eye) cochlear implants and neuro or bone stimulators implanted drug infusion devices

bull Below is an image of an implanted cardiac pacemaker

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 42: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 42

Other non safe objects

Other non safe objects

bull Stethoscopes

bull Hemostats

bull Pagers

bull Cell phones

bull Watches

bull Jewelry

bull Ferromagnetic needles

bull Metallic clothing

bull Tattoos with ink containing iron oxide

bull Money clips

bull Cameras

bull Calculators

bull Hearing aids

bull Anything ferromagnetic

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 43: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 43

Pay attention to the MRI Zones

bull Zone I Open to general public The surrounding hallways leading to MRI

bull Zone II The interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zones III and IV (Front desk including inpatient and outpatient waiting rooms)

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 44: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 44

Pay attention to the MRI Zones

bull Zone III this area is where free access by unscreened personnel patients or visitors could result in serious injury or death as a result of the interactions with the MRI environment This region is restricted from the general public access by a badge swipe door opening

bull Zone IV The MR scanner magnet room Zone IV is clearly marked and has a red-lighted sign stating ldquoMAGNET ALWAYS ONrdquo This zone is restricted to screened MR patients under constant supervision of trained MR personnel

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 45: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 45

Medical Codes

Life-saving instruction is a part of the days program at Camp Timpoochee

where everybody goes swimming in Choctawhatchee Bay August 1 1935

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 46: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 46

Code Blue

bull Dial 855 at the East hospital and 755 at the West hospital and request the Operator announce ldquoCode Blue and the Location (including room and bed number if applicable)

bull The person identifying the arrest will establish unresponsiveness and using standard precautions initiate Cardiopulmonary Resuscitation (CPR) if qualified UNTIL THE CODE TEAM ARRIVES

bull The next person responding is responsible for bringing the Crash Cart and setting up the equipment

bull All members of the Code Blue Team will receive notice of the Code BlueLocation via Alpha pager and respond accordingly

bull Be sure to relieve the person performing compressions every 2 minutes or 5 cycles of CPR

bull If there is an equipment malfunction during a Code Blue the equipment must be isolated bagged properly and sent to Risk Management immediately

bull All persons not needed for the emergency will stay clear of the area

Cardiac Respiratory Arrest or Medical Emergency

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 47: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 47

BEE Team- TO BEEhellipOR NOT TO BLUE

bull The Bethesda Emergency Evaluation (BEE) Team consists of the on-duty Critical Care Charge Nurse or designee and the on-duty Charge Respiratory Therapists or designee

bull The purpose of the BEE Team is to provide prompt and timely assessment and intervention for patients who demonstrate acute changes in their physical well-being

bull In the event of an unstable or rapidly deteriorating patient the floor RN Charge RN or any ancillary department staff will request the BEE Team by dialing Ext 855 at the East hospital and 755 at the West hospital and saying ldquoBEE Team to Room XXXXrdquo

bull Stay with the patient and assist the BEE Team when they arrive It will be a learning experience for you and you in turn will provide needed information for the Team

bull Donrsquot forget to complete a BEE Team feedback form available on your unit or under Clinical OR 2106 (Attachment B)

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 48: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 48

BEE Team (Cont)

Why should you take advantage of the BEE Team

bull It has been shown to increase survivability of our

patients

bull Our goal to reduce or eliminate Code Blue calls

outside of the Critical Care Units since it has been

shown that the survivability from Code Blue is better

in the Critical Care Units

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 49: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 49

BEE Team-Family Initiated

Can family membersvisitors initiate BEE team response Yes

bull Familyvisitors may activate the team by dialing ext 83111 from any hospital phone

bull The operator will use the following guidelines to determine if the rapid response team should be activated for example patient is bleeding difficulty breathingshortness of breath chest pain ldquosomething just isnrsquot rightrdquo states ldquothis is an emergencyrdquo says they are in pain or difficulty speaking

bull if the operator is in doubt the team should be activated

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 50: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 50

BEE Team-Family Initiated

bull Do not activate BEE Team for customer service issues such as

ndash Diet concerns

ndash Television problems etc

bull When the team is not activated the operator notifies the charge nurse and the RN Patient Advocate so they know and respond to the customer service issue The Patient Advocates may be reached at either extension 85013 or 85105

bull If the Patient Advocates are not available such as during the evening or weekend leave a message stating the customer service issue and also notify the Administrative Supervisor

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 51: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 51

Special Code Response Situations

bull Code Grey ndash Stroke - Operations Regulation 2134 with

Appendix A establishes a protocol for the management of

ischemic stroke before the occurrence of irreversible brain

damage occurs

bull Code HIT (Hemorrhagic Intravascular Team) ndash Operations

Regulation 2140 outlines the procedure for notification of the

appropriate personnel for the treatment and care of a

hemorrhagic condition ruptured or dissecting aortic aneurysm

or trauma to the vascular system

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 52: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 52

Signs of Abuse

bull In watching out for safety the hospital employee should be

aware that there are times when patients family members or co-

workers show signs of ill treatment This treatment can be

broken down into two broad categories

ndash Neglect ndash where basic needs such as housing clothing

nutrition or supervision are not provided and medical care is

needed

ndash Abuse ndash where a person is treated in a way that results in

damage to that person

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 53: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 53

Neglect

bull Neglect can be self inflicted or inflicted by a caregiver upon a dependent adult or child Neglect can be done on purpose but can also be unintentional

bull Signs of Neglect may include

Physical Indicators

-malnourishment

-dehydration

-poor hygiene

-overunder medication

-lack of medical care

Behavioral Indicators

-beggingstealing food

-extended stay at school

-alcohol or drug abuse

-delinquency

-consistent fatigue

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 54: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 54

Abuse

bull Abuse can be self inflicted or inflicted by a caregiver upon a dependent

adult or child Abuse can take several forms

ndash Emotional ndash aggressive or unreasonable behavior that lowers the

self esteem of the dependent person

ndash Physical -- causing non-accidental injury to the dependent

ndash Sexual ndash unethical use of a person for personal pleasure

bull All hospital personnel with direct patient contact will be alert for

signs of childadultabuseneglectdomestic violence and will report

potential abuse as required by Florida Statute

bull If you notice a situation in the hospital that you think is a sign of neglect

or abuse discuss the situation with your supervisor This is always a

highly charged emotional situation that is often best handled with

careful consideration

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 55: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 55

Incident Reporting

bull An incident is an unexpected happening

bull It could be

ndash an accident to a person

ndash faulty equipment

ndash violation of a policy or regulation

ndash medication error

bull An incident is something that needs to be

fixed The hospital cannot fix it if they donrsquot

know about it

bull If an incident occurs immediately complete

an incident report and tell your supervisor

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 56: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 56

bull An incident report is completed via the online form found on Bethesdas Intranet under Forms Tab em2-Incident reporting Detailed instructions including examples and a training program can be found on the Intranet under HELP Tab em2-Incident reporting

bull Your managerDirector or Clinical Educator can assist you with completing an incident report

bull For questionsproblems call the Quality Improvement office at extension 83653 between 8 AM and 430 PM or Risk Management at extension 84017 between 9 AM to 5 PM

How to complete an Incident Report

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 57: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 57

Sentinel Event

bull A Sentinel Event is an unanticipated death or major permanent loss

of function or one of the following

ndash infant abduction

ndash infant discharged to the wrong family

ndash rape

ndash hemolytic transfusion reaction involving major blood group

incompatibilities

ndash surgery on the wrong site or wrong patient

ndash an infection caught in the hospital that was not related to the patientrsquos

illness or condition and resulted in death or major injury

bull A Sentinel Event must be reported within 24 hours Complete an

incident report and notify your supervisor

bull The hospital cannot fix a dangerous process or lack of process they donrsquot

know about it Never hide an incident or sentinel event report

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 58: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 58

Near Miss

bull A near miss is an incident or sentinel event that was narrowly

avoided

bull A near miss is an event that signals a weakness that if not remedied

could lead to significant consequences in the near future

bull Again a dangerous process or lack of process cannot be fixed if it is not

recognized

bull Near misses are to be reported in an incident report and the supervisor

notified

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 59: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 59

Hazardous Materials

bull In our efforts to increase the health of our patients ndash we are

exposed to the presence of hazards ourselves both chemical

and biological hazards are present in the hospital

bullA copy of our Hazard Communication Program can be found in

the Operations Manual and the Human Resource Manual

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 60: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 60

Definition of Biomedical Waste (BMW) from Florida

Administrative Code Chapter 64E-16

ndashAny solid or liquid waste which may present a threat of

infection to human

ndashAbsorbent materials saturated with blood or body fluids

Body excretions such as vomit urine feces and

sputum etc are NOT considered biomedical waste

unless visibly contaminated with blood

ndashDisposable devices contaminated with blood or body

fluids

Biomedical Waste Definition

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 61: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 61

bull International biological hazard symbol on the container that

transports the waste

bull Red bags are inscribed with the biological symbol and phrases

such as ldquoBiohazard Infectious Wasterdquo

Biomedical Waste Identification

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 62: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 62

bull Biomedical waste will be identified and segregated from non-regulated

waste into two separate bins at point of origin (dirty utility room)

bull Biomedical waste red bags will be labeled with the hospital name and

address

bull Red bags must be securely tied by one of two methods

ndash Twist tightly tie in single knot

ndash Twist tightly fold over tie with cable lock

bull Biomedical waste must be transferred in a covered leak resistant

container labeled with the international biological hazard symbol

Handling Biomedical Waste

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 63: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 63

bull BMW transported off hospital property will be hauled away by a

licensed biomedical trash hauler per chapter 64E-16 Biomedical Waste

bull All BMW will be stored in a designated area that is maintained in a

sanitary condition and secured from vermin insects or unauthorized

entry and clearly labeled with the international biological hazard

symbol

bull All BMW will be incinerated on site unless there is an incinerator failure

and the contingency plan Clinical Operations Regulation 2609 is

implemented

ndash Red Bags are for Biomedical Waste (BMW) only

ndash Never reopen a Red Bag

Handling Biomedical Waste continued

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 64: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 64

bull Wear your Personal Protective Equipment

bull Use absorbent material to clean up spill

bull Discard BMW spill into into an appropriate biomedical waste container

bull Disinfect area

bull If you encounter broken glass

ndash Donrsquot pick up glass with your hands

ndash Use a dust pan amp broom tongs etc

ndash Place glass into a sharps container

Handling Biomedical Waste Spills

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 65: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 65

Chemical Hazards

bull A chemical is considered hazardous if it is flammable explosive toxic

andor corrosive Accidental exposure to hazardous chemicals can have

serious health effects for health care workers and clients

bull To be considered a hazardous chemical a substance must be

characterized by at least one of the following traits

ndash Flammable can burn or catch fire easily

ndash Explosive can explode under certain conditions

ndash Toxic has been found to be potentially poisonous

ndash Corrosive can react and damage a personrsquos skin or a container

made of certain metals or other materials

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 66: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 66

Chemical Hazards continued

bull You have the ldquoRight to Knowrdquo what hazardous materials are involved in your job and how to protect yourself

ndash The employer has the responsibility to provide the information and make it available

ndash The employee has the responsibility to ask questions read labels following instructions and adhere to all warnings

bull Safety Data Sheets (SDS) Hazardous Material Tracking Forms and Hazardous Material Inventory for your department are in a manual that is readily available Be sure to know where it is

bull SDS provide information on health amp physical hazards safety procedures spill clean up methods of disposal recommended personal protective equipment and other relevant information about each hazardous material

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 67: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 67

Procedure for Hazardous Spill

These rules apply to spills of known or unknown substances

1 Immediately secure the area (close doors windows and move

patients if they are in the area)

2 Request assistance by contacting the Infection ControlEnvironmental

Regulations Coordinator on beeper 456-2605

3 Follow the written instructions for that hazardous substance (check

MSDS or the Tracking Form ndash both in the Hazardous Material

manual)

4 Attempt to clean up the spill ONLY if you have been trained and have

proper safety equipment on You must contact the Hazardous

Material Coordinator for any large spill any mercury spill and any

chemotherapy spill

5 Ensure that the material is properly disposed before returning

patients to the area Complete an incident report through the eM2

System

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 68: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 68

Mercury Spill

bull If you come upon a mercury spill do

not clean it up Contact the

Environmental Services Supervisor

on duty They are responsible for

using mercury spill kits

bull You will find an MSDS and Tracking

Form in all departments where

mercury is used and stored

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 69: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 69

Radioactive Spill

bull Evacuate the room if possible (Shoes may be contaminated Do not track through the building)

bull Isolate the affected area by closing all doors and windows (only if to do so you do not risk further contamination)

bull Limit access to the contaminated area

bull Provide first aid to anyone who may have been injured

bull Contact the Radiation Safety Officer by paging 456-0819

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 70: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 70

Portable Oxygen Cylinders

bull Portable oxygen cylinders must be placed in a rack when not in

use

bull Empty and full oxygen cylinders need to be segregated within the

rack

ndash Full cylinders must be placed on one side of the rack

ndash Empty cylinders must be placed on the other side of the rack

bull The number of e size oxygen cylinders (empty or full) per smoke

compartment may not exceed 12

bull If you exceed the number of oxygen cylinders on your unit please

call Respiratory Therapy to return

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 71: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 71

Biological Hazards

bull Tuberculosis or TB is a disease that infects over 25000 people a

year in the US

bull TB is a disease that damages a personrsquos lungs and other parts of the

body

bull TB is spread when people who have active untreated TB germs in

their lungs (or throat) cough sneeze or speak and send their germs

into the air If you breath these germs into your lungs you can become

infected

bull TB infection means that the TB germs are in the body but in an

inactive state In most cases the body defenses control the germs by

building a wall around them The germs can stay alive inside these

walls for years in an inactive state The person is infected but not sick

bull TB disease is when the TB germs break through the walls The

germs multiply and damage the lungs or other organs

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 72: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 72

Signs amp Symptoms of TB

bull The signs of TB disease are

ndash A cough that hangs on

ndash fevers

ndash weight loss

ndash night sweats

ndash constant tiredness

ndash loss of appetite

ndash in some advanced cases coughing up blood streaked

sputum

bull People with active TB disease may have only mild symptoms

and not know that they have the disease

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 73: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 73

TB ndash Risks and Precautions

bull Some people who are infected with TB get TB disease shortly after the

germs enter the body if the defenses are weak

bull For some people the inactive TB germs become active when the body

defenses are weakened due to aging serious illness drug or alcohol

abuse or HIV infection

bull People with TB can be cured if they have proper medical treatment and

take their medication as prescribed

bull As an employee of Bethesda hospital you are required to have a TB

test every year and follow any recommendations given by the

employee nurse If you are in contact with patients with active disease

you must wear a properly fit-tested respirator to protect yourself from

infection

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 74: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 74

HIVAIDS

bull The AIDS Update and AIDS Primer CBLrsquos discuss what this

disease is and how to avoid contracting it

bull The Confirmation of Exposure Education CBL and the Infection

Control CBLs add important information on how to protect

yourself from being infected by this virus

bull If you have questions about HIVAIDS after going through the

required courses please contact the Employee Nurse for

answers

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 75: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 75

Flu Season

bull Flu season comes around every year So we want all hospital

employees to be aware of the impact of Influenza among Health

Care Workers and what you can do about it

bull Influenza is highly contagious viral disease Adults are

typically infectious 1 day before symptoms begin through

approximately 5 days after onset of illness Approximately

30-50 percent of infected person may remain asymptomatic

but they can still transmit the virus to others So the best

way to prevent this is through vaccination

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 76: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 76

Flu Season

bull When influenza affects patients disease can be severe An

increase in mortality generally accompanies influenza

epidemics this increased mortality results not only from

respiratory illness including pneumonia but also from

exacerbation of preexisting conditions such as heart lung and

kidney diseases

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 77: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 77

Flu Season

bull So every healthcare worker will want to receive the flu vaccine for their protection as well as for the protection of their patients

bull The flu vaccine is an inactivated virus so it cannot give you the flu You could develop redness or swelling at the injection site

bull Flu season peaks in January in Florida

bull After you receive the vaccine it will take 10-14 days for your body to develop antibodies to the vaccine

bull The flu vaccine will not prevent every cough or cold but it can prevent you from getting the type of influenza that can lead to serious complications like pneumonia

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 78: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 78

Flu Season Requirements

bull Bethesda is requiring the influenza vaccine for all employees

medical staff students Contractagency and volunteers by the

designated deadline They may receive the vaccine here or if

they receive it at another facility then they will need to provide

proof of receipt to Employee Health by the deadline

bull Failure to comply with this will result in disciplinary actions for

the employee Medical staff can provide documentation to

Medical staff office Volunteers can provide documentation to

Volunteer office students can provide documentation to

Education Resource Center and ContractAgency staff can

provide documentation to the Patient Services Staffing Office

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 79: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 79

Flu Season Requirements

bull We will allow declination of the vaccine for any reason but all

employees will need to sign a declination form and provide that

to Employee Health by the designate deadline If they decline to

receive the vaccine they will be required to wear a surgical mask

during all interaction with patients or within 6 feet of a patient

Failure to comply with returning the form and wearing the mask

will result in disciplinary actions for the employee

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 80: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 80

Flu Season Requirements

bull Employee Health will be providing a sticker to employees

medical staff and volunteers who receive the flu vaccine to

adhere to their badge so that they can be identified If they

receive the vaccine somewhere else they will need to bring their

proof of receipt to Employee Health to receive the sticker

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 81: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 81

Summary

Operation Reg 2106 Code Blue

Bethesda Emergency Evaluation (BEE) Team 2106

Operation Reg 2134 Code Grey

Operation Reg 2140 Code HIT

Operation Reg 2608 Code Strong

Operation Reg 2614 Code Pink

Operation Reg 1601 Code Red

Operation Reg 1606 Code Yellow

Operation Reg 1603 Disaster Plan

Operation Reg 1612 Hazardous Materials

Operation Reg 1600 Appendix F Medical Equipment Management Plans

Operation Reg 1605 Incident Reports

Operation Reg 2604 Sentinel Events

bull This course is itself a summary of some of the more common hazards that

can be found in the hospital setting It is the responsibility of every employee

to be aware of these hazards and to know what to do in the event the hazard

happens

If you need more information you can read the following policies andor

contact your supervisor

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 82: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 82

Suspicious package

bull title but no name in address

bull excessive postage

bull oil stains or discolorations

bull excessive weight

bull lopsided or uneven envelop

bull visual distractions

bull incorrect titles

bull excessive security material such

as tape or string

bull misspellings of common words

bull incorrect titles

bull no return address

bull rigid envelop

bull foreign mail air mail or special

delivery

bull restrictive markings such as

ldquoconfidentialrdquo or ldquopersonalrdquo

bull Hand written or poorly typed

address

bull protruding wires or tinfoil

Letter or parcel bomb recognition points include

Return to Course

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 83: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 83

Primary Ingredients for a Fire

There are three parts to every fire If you get rid of one ndash the fire

will stop They are

ndash Oxygen found in the air we breathe as well as in medical

gases used for patient treatment

ndash Heat the source of ignition for example a spark a cigarette

a heating element or static electricity

ndash Fuel Any material which contributes to the combustion of a

fire for example furniture clothing linens and flammable

materials such as light fluid and rubbing alcohol

Return to Course

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 84: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 84

Smoke Compartments

bull Not every door that is controlled with a magnet is a smoke door Therefore smoke

door signs have been placed above smoke compartment doors throughout the

hospital to assist you in locating smoke compartments

bull Whats a smoke compartment Hospitals are designed with smoke

compartments smoke safe areas of refuge in a firesmoke condition

bull As a rule hospitals do not require full building evacuation when there is a fire due

to their compartmentalized design In the event of a firesmoke condition we first

evacuate horizontally to the next smoke compartment on the same level (floor)

bull How do you know where the next smoke compartment is Look for the

smoke door sign above the door If the next smoke compartment is not safe

then evacuate vertically to a smoke compartment on the floor above or

below A full building evacuation is unlikely and would only be performed

under direction of the fire department

Return to Course

Smoke Doors

What are these signs

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 85: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 85

Mercury

bull The element MERCURY (Hg) is a metal which is liquid at room temperature Mercury is a bit like LEAD but its liquid You can hold it in your hand (Not recommended - its toxic) Heavy (density 136) in fact so heavy that objects such as bricks cannonballs and lumps of lead or iron will FLOAT in Mercury Gold doesnt float in mercury - it behaves more like sugar in tea Mercury does NOT stick to magnets so if it gets into your carpets or under your floorboards it will be a long-term problem Mercury vapor makes nice bright lights but is not for breathing

bull The highly reflective surface of the Mercury or Quicksilver as it is sometimes known makes it the stuff of mirrors Its also used for thermometers barometers electrical devices etc However the problem is the cumulative poisonous nature In the pure metal form its relatively inert so not so deadly but in compounds such as mercuric chloride its skull-and-crossbones stuff

(Continued on next page)

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 86: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 86

Mercury continued

bull Although mercury is a liquid it is NOT WET It has a negative

coefficient of surface tension which means it does not soak into

material but more runs off in the style of water off a ducks

back

bull Mad as a Hatter A great many hatters were mad in the old

days because mercury was used for part of the process of felt

hat-making

bull The above information comes from the website zyraorguk

Return to Course

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 87: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 87

Fire Response Team

bull Nursing DirectorAdmin Supervisor will go at once to the

location of the fire and determine the extent of the fire and

immediate danger to patients

bull Charge Nurse of the fire affected unit will determine the

number of patients using oxygen and insure their safety then

give orders to Engineering to shut off oxygen

bull Director of Engineering is the Hospital Fire Chief will direct

the fire response until the arrival of the Fire Department In his

absence the senior person from Engineering will act as Chief

bull Fire Response Team will go to the location of the fire bringing

fire extinguishers and remain on duty until released by Fire

Chief Team is made up of all Engineering employees and

designated Environmental Services employees

(continued on next page)

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 88: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 88

Fire Response Team (cont)

bull Director of Facilities or Engineer on Duty responsible for

turning off the air conditioning ventilating systems oxygen

systems and placing the elevators under manual control

bull Respiratory Therapy Personnel report to their department

and standby to deliver portable oxygen cylinders if needed for

patients

bull Security Guards report to the location of the fire to provide

radio communications with the telephone operator

bull Fire Personnel Pool directed by HR Mon-Fri 800A ndash 500P

and directed by Admitting on nights and weekends Pool will

assemble in the hospital lobby (or radiology lobby if necessary)

(continued on next page)

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 89: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 89

Fire Response Team (cont)

Fire Personnel Pool (cont)

bull The Pool will be made up of

bull 1 person from each Nursing Unit

bull As many as possible from Environmental Services

bull 5 people from Food and Nutrition

bull 2 people from admittingregistration

bull All Transporters

bull All other employees will remain in their departments noting

the location of the fire and immediately close all doors and

windows Evacuation of personnel only as directed by the Fire

Marshal Nursing Admin Supervisor or the Engineer on Duty

Return to Course

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 90: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 90

Code Strong Team Membership

bull Security Personnel (except those assigned as

Emergency Department Security Guards) will

respond)

bull A designated person from the Engineering staff

trained in Crisis Prevention Intervention (CPI) will

respond

bull The Administrative Supervisor will respond and direct

the Code Strong

bull Any staff trained in CPI will respond to the Code

Strong

Return to Course

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course

Page 91: Life Work Safety · 2018. 11. 30. · Bethesda Healthcare System 6 CODE RED • Code Red is the code for fire. If you discover a fire or smoke you must carry out the following steps

Bethesda Healthcare System 91

Fire Procedures for Health City Service Center or the Plaza

The person discovering a fire will carry out the following steps

in the order presented

ndash Remove any patients that might be in the immediate

vicinity of the fire

ndash Sound the nearest fire alarm

ndash Dial 911 Tell the operator your name and the exact

location of the fire

ndash Isolate the fire by closing doors to the area and insure

all fire doors are closed

ndash Notify the facility administrator and the Hospital Risk

Manager of the situation

Call Facility Administrator amp Risk

Manager

Close the

Door

Return to Course