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Basic Safety and Infection Control

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1 Basic Safety and Infection Control
6 Basic Safety and Infection Control

2 Learning Outcomes 6.1 Describe the components of a medical office safety plan. 6.2 Identify OSHA’s role in protecting healthcare workers. 6.3 Describe basic safety precautions you should take to reduce electrical hazards. 6.4 Illustrate the necessary steps in a comprehensive fire safety plan.

3 Learning Outcomes (cont.)
6.5 Summarize proper methods for handling and storing chemicals used in a medical office. 6.6 Explain the principles of good ergonomic practice and physical safety in the medical office. 6.7 Illustrate the cycle of infection and how to break it.

4 Learning Outcomes 6.8 Summarize the Bloodborne Pathogens Standard and Universal Precautions as described in the rules and regulations of the Occupational Safety and Health Administration (OSHA). 6.9 Describe methods of infection control including those preventing healthcare- associated infections Describe Centers for Disease Control and Prevention (CDC) requirements for reporting cases of infectious disease.

5 Introduction Accidents can occur in healthcare settings
Remove or correct hazards Physical Chemical Biohazardous Removal or correction of hazards is integral to risk management Learning Outcome: 6.1 Describe the components of a medical office safety plan. The healthcare setting is no stranger to accidents. As a medical assistant, you have an important responsibility to remove or correct hazards that might cause injury to patients or staff. This responsibility constitutes an integral part of a risk management plan.

6 Medical Office Safety Plan
Minimize risk Establish a safety plan Education about potential dangers facilitates the removal or correction of these hazards Learning Outcome: 6.1 Describe the components of a medical office safety plan. It is essential to create a safe environment in the medical office. The office should have an established, routinely updated safety plan. Awareness and understanding of potential dangers facilitates the removal or correction of these hazards

7 Medical Office Safety Plan (cont.)
Comprehensive written safety plan Easily accessible Updated annually Know and follow the plan’s policies and procedures Learning Outcome: 6.1 Describe the components of a medical office safety plan. Every medical office must have a comprehensive written safety plan that is easily accessible to all employees and updated annually. Every employee is responsible for becoming familiar with and following the safety plan’s policies and procedures. The safety plan must contain but is not limited to: OSHA Hazard Communication Electrical Safety Fire Safety Emergency Action Plan Chemical Safety Bloodborne Pathogen Exposure Personal Protective Equipment Needlestick Prevention

8 Right! Apply Your Knowledge
Why is it important to have a safety plan in a medical office and what should the plan cover? ANSWER: It is important to have a safety plan to help minimize risk and make everyone aware of potential hazards. A safety plan should contain: OSHA Hazard Communication Electrical and fire safety Emergency action plan Chemical safety Blood borne pathogen exposure Personal protective equipment Needlestick prevention Right! Learning Outcome: 6.1 Describe the components of a medical office safety plan.

9 Occupational Safety and Health Administration
Employee safety Specific standard vs. General Duty Clause Enforces guidelines established by the Centers for Disease Control and Prevention (CDC) Learning Outcome: Identify OSHA’s role in protecting healthcare workers. The Occupational Safety and Health Administration was created in 1970 within the Department of Labor to ensure employee safety in the workplace. If specific standards exist, their guidelines must be followed. The General Duty Clause takes effect when there is no specific standard and requires an employer to maintain a workplace free from hazards that are recognized as likely to cause death or serious injury. OSHA also enforces guidelines developed by the Centers for Disease Control and Prevention (CDC), in particular the guidelines for Standard Precautions.

10 OSHA Hazard Communication
Biohazard labels Warning signs Material Safety Data Sheets (MSDSs) Hazard labels Learning Outcome: Identify OSHA’s role in protecting healthcare workers. Hazardous materials must be correctly labeled, and employees must have access to this information, including the measures they can take to protect themselves against harm from these substances. All containers used to store waste products, blood, blood products, or other specimens that may be contaminated with bloodborne pathogens must have a biohazard label. Warning signs identifying the presence of biohazardous material must be posted in the laboratory itself. These signs must list important safeguards to follow. MSDSs – the office must have one for every hazardous chemical. Information on the sheet includes: Substance name, as it appears on the container label Chemical name(s) of each ingredient Common name(s) of each ingredient Chemical characteristics of the product Physical hazards posed by the product Health hazards posed by the product Guidelines for safe handling of the substance Emergency and first-aid procedures to be followed in the event of exposure Hazard labels – shortened version of the MSDS that is permanently affixed to the substance container. It must list the name of the material contained, either trade or chemical, and a brief statement of the chemical’s hazardous effects.

11 OSHA Final rule Standardize Right to understand Changes Labeling
Safety information Right to understand Changes Hazard classification Labels MSDSs Learning Outcome: Identify OSHA’s role in protecting healthcare workers. . OSHA’s final rule on Hazard communication is designed to standardize the labeling systems and safety information for hazardous materials. The goal of this new standard is to transition from the workers’ “right to know” to the workers “right to understand” the workplace hazards they may encounter. Required final implementation of this rule is June 1, 2016. A Summary of the major changes Hazard classification – chemical manufacturers and importers are required to determine the hazards of the chemicals they produce. This includes the health and physical hazards and classification of chemical mixtures. Labels – all labels must include a signal word, pictogram, hazard statement, and precautionary statement for each hazard class and category. Labels must have a red border. Material Safety Data Sheets – are simply called Safety Data Sheets and are standardized to include 16 sections and must follow a uniform format including section numbers and headings.

12 Apply Your Knowledge Good Answer!
Why is it important for hazardous materials be correctly labeled? ANSWER: So employees can take measures to protect themselves against harm. Learning Outcome: Identify OSHA’s role in protecting healthcare workers. Good Answer!

13 Electrical Safety Know location of power shutoffs
Avoid using extension cords Observe for frayed electrical wires Dry hands before working with electrical devices Do not position electrical devices near sources of water Learning Outcome: 6.3 Describe basic safety precautions you should take to reduce electrical hazards. You must know how to respond to an electrical accident as the medical office is especially vulnerable to electrical hazards. Familiarize yourself with the location of circuit breakers and emergency power shutoffs, practice with these safeguards, which reduce electrical hazards: Avoid using extension cords. If they must be used, be sure the circuit is not overloaded. Tape extension cords to the floor to avoid tripping. Frayed electrical wires, overloaded outlets, and improperly grounded plugs present a danger of electric shock and fire. Contact a licensed electrician to remedy these problems. Repair or replace equipment that has a broken or frayed cord. Dry your hands before working with electrical devices. Do not position electrical devices near sinks, faucets, or other sources of water. Be sure electrical cords do not run through water.

14 Right! Apply Your Knowledge
List three electrical safeguards to practice in the healthcare setting? ANSWER: Avoid using extension cords. Tape extension cords to the floor to avoid tripping. Repair or replace equipment that has a broken or frayed cord. Dry your hands before working with electrical devices. Do not position electrical devices near sinks, faucets, or other sources of water. Learning Outcome: 6.3 Describe basic safety precautions you should take to reduce electrical hazards. Right!

15 Fire Safety Many potential hazards in a medical office Fire Prevention
Hazards in the exam room Office laboratory ~ open flame Learning Outcome: 6.4 Illustrate the necessary steps in a comprehensive fire safety plan. Any electrical instrument in the exam room is a potential fire hazard. Other potentially hazardous items are gas tanks and flammable chemicals. If you cannot correct the situation yourself, report the hazard to your supervisor. Extremely flammable materials include alcohol and some disinfectants. Supplies such as paper table coverings can ignite if a fire occurs. Be sure that all flammable items are stored and disposed of properly. Check the manufacturer’s label or MSDS Smoking should not be permitted anywhere in a medical facility. Inoperative smoke detectors – make sure that smoke detectors are working properly. If possible, alarms should have both sound and visual modes. Using a flame in an office laboratory Extinguish it immediately after use. Keep your hair, clothing, and jewelry away from the flame source. When using chemical in a procedure that requiring an open flame, double-check the MSDS to identify the fire risk level. Have a fire extinguisher nearby. Never lean over an open flame and never leave an open flame unattended Turn off gas valves immediately after use. Make sure there is adequate ventilation.

16 In Case of Fire (cont.) Using safety equipment
Fire extinguisher – “PASS” system Fire blanket Learning Outcome: 6.4 Illustrate the necessary steps in a comprehensive fire safety plan. You must be prepared to use fire safety equipment and to evacuate the building safely in the event a fire breaks out. An all-purpose fire extinguisher should be located in or close to each exam room and serviced once a year to ensure its effectiveness. All employees must learn how to use a fire extinguisher. PASS system Pull the pin Aim at base of fire Squeeze trigger Sweep side to side If a fire blanket is available it can be used to smother burning clothing, wrap the victim in the blanket and roll him on the floor. You also can contact your local fire department for more information about fire safety training.

17 Emergency Action Plans and Drills
Responsibility Reporting fire Overseeing evacuation Building evacuation routes Current location Nearest exit Learning Outcome: Illustrate the necessary steps in a comprehensive fire safety plan. An emergency action plan outlining the employees’ responsibilities is needed in order to reduce panic in an emergency, and to reduce the likelihood of severe bodily injury. Participation in periodic fire drills is an essential part of this plan. The plan should include the name of the person or persons responsible for reporting the fire and overseeing the entire operation. Building Evacuation Routes Maps of the office floor plan should be located throughout the office, and marked with the current location and nearest exit. Halls leading to the exit should have emergency lighting so they remain lit in the event of a power failure. Halls should also be clutter free at all times. Exit routes should be large enough to accommodate all evacuees, including those with disabilities.

18 Emergency Action Plans and Drills (cont.)
Evacuation Procedure Ensure patients and staff are evacuated Check that everyone has left Take MSDS book Assembly area Emergency action plan drills Local emergency contacts Learning Outcome: 6.4 Illustrate the necessary steps in a comprehensive fire safety plan. Several employees should be responsible for ensuring that patients and staff are appropriately evacuated from the building. Those responsible for evacuation should be the last to leave and should perform a quick search of bathrooms, break rooms, and other areas to ensure everyone has left the building. Someone must be responsible for retrieving the MSDS book and handing it over to the first responders at the scene. Assembly area: have plan for accounting for all employees and patients Emergency action plan drills. Practice the emergency action plan on a regular basis Conduct unannounced drills so that each individual better understands their role. Emergency action plan drills allow for evaluation and refinement of the plan. Local emergency contacts. Dialing 911 is the most common way to report an emergency. There may be internal numbers if your facility is large. ‘ A list of Fire and EMS numbers should be readily available at all times and updated regularly. Develop and maintain a relationship with local emergency authorities. Most local fire departments will come to your office and assess for fire hazards at your request.

19 Nice Job! Apply Your Knowledge
Once at the assembly area after an evacuation how would you account for employees and patients? ANSWER: Conduct a roll call of all employees. You can use the check-in roster to account for patients. Learning Outcome: 6.4 Illustrate the necessary steps in a comprehensive fire safety plan. Nice Job!

20 Chemical Safety Proper handling and storage MSDS General precautions
Eye wash station Learning Outcome: 6.5 Summarize proper methods for handling and storing chemicals used in a medical office. When handling chemicals in a medical office, you must handle them appropriately and store it properly. The MSDS is a good source of information regarding proper chemical storage and handling. General precautions include the following: Store caustic chemicals and other hazardous substances below eye level to reduce the risk of upsetting the container and spilling the substance into your eyes. Wear protective gear to prevent harm to your skin or damage to your clothing. (Properly remove the protective gear before leaving the laboratory.) Always carry chemical containers with both hands as you gather supplies. Make sure you work in a properly-ventilated area. If there is an eyewash station in your lab, you should know where it is and be able to find it with limited or no vision. The eyewash station should be checked monthly to make sure it is working properly.

21 Chemical Safety (cont.)
Do not hold under nose Use fume hood or personal ventilation device Only combine chemicals as required No mouth pipetting Add acid to other substances Clean up spills properly Learning Outcome: 6.5 Summarize proper methods for handling and storing chemicals used in a medical office. When you work with hazardous chemicals, adhere to these guidelines: If you must smell the chemicals you are using, do not hold them directly under your nose. Instead, hold them a few inches away, and fan air across them and toward your nose. Work inside a fume hood if the chemical vapor is hazardous. Wear a personal ventilation device when working with certain chemicals, as specified by the MSDS. Never combine chemicals in ways not specifically required in test procedures. Mouth pipetting is prohibited at all times. If you are combining acids with other substances, always add the acid to the other substance. Adding substances to acid increases the risk of splashing. If you encounter a spill of an unknown chemical substance, do not pour any other chemicals on it. Clean it up following strict hazardous waste control procedures. Never touch an unknown substance with your bare hands.

22 Apply Your Knowledge Great!
What are the precautions you should take when working with hazardous substances? ANSWER: Store below eye level Wear protective gear Carry with both hands Properly ventilated Great! Learning Outcome: 6.5 Summarize proper methods for handling and storing chemicals used in a medical office. General precautions as you prepare include the following: Store caustic chemicals and other hazardous substances below eye level to reduce the risk of upsetting the container and spilling the substance into your eyes. Wear protective gear to prevent harm to your skin or damage to your clothing. (Be sure to properly remove the protective gear before leaving the laboratory.) Always carry chemical containers with both hands as you gather supplies. Make sure you work in a properly-ventilated area.

23 Ergonomics and Physical Safety
Maintain a healthy and safe posture Do not over reach Lift properly Learning Outcome: 6.6 Explain the principles of good ergonomic practice and physical safety in the medical office. Protecting yourself from ergonomic and physical hazards reduces office costs by limiting unnecessary sick time. Ergonomics is the study of the way people work. Workplace injuries may be the result performing repetitive tasks, poor posture, or poor technique. Good ergonomic practice is designed to reduce the likelihood of injury at work. The CDC’s National Institute for Occupational Safety and Health (NIOSH) has specific recommendations for reducing work-related musculoskeletal injuries. These include: Do not overextend your reach when attempting to grasp supplies. Use only approved equipment to reach high shelves. Do not climb onto chairs, desks, or tables to reach anything. When lifting an object, squat close to the object. Keep your back straight but not rigid. Lift the item by pushing up with your legs, not by pulling with your back. Hold the load firmly with both hands, close to your body. If necessary, put on a back- support belt before attempting to move heavy loads.

24 Ergonomics Transferring a patient Adjust seat
Lift with knees Ask for assistance Use transfer device Adjust seat Take frequent breaks from the computer Learning Outcome: 6.6 Explain the principles of good ergonomic practice and physical safety in the medical office. NIOSH recommendations continued: When transferring a patient, always bend at the knees to lift and ask for assistance if you are not sure you can lift or move the patient by yourself. When performing the transfer, move the patient’s wheelchair as close to the exam table as possible to reduce the distance the patient must be moved. Remove the wheelchair footrests if possible. Have the patient help as much as possible. If a transfer device is available, use it. Transfer devices include; gait belts, sliding boards, pivot discs, and sling-type transfer equipment. Adjust your seat to the correct position to prevent back strain. If you are using a computer, take frequent breaks to reduce eyestrain and hand cramping. Your employer has the responsibility to provide a safe work environment, including equipment designed to reduce injury and workstations that adjust to the worker. Many employers offer training seminars for reducing work-related injuries. It is your responsibility to follow safe practice when using equipment or performing tasks where there is a possibility of work-related injury.

25 Physical Safety Walk, do not run, in the office.
Wipe up spills immediately Clear the floor of dropped objects Be sure there are no snags or tears in the carpet Destroy and dispose of medications that are dropped on the floor Learning Outcome: 6.6 Explain the principles of good ergonomic practice and physical safety in the medical office. You must understand and apply all the appropriate safeguards to ensure physical safety in the medical office. Many safeguards only require common sense. Safeguards include: Walk, do not run, in the office. Prevent falls by wiping or mopping up spills immediately. Clear the floor of dropped objects. If the floor is carpeted, make sure there are no snags or tears that could cause someone to trip and fall. Spilled medications, chemicals, and other substances pose a threat to young children, who may ingest anything they find on the floor. Destroy and dispose of medications that are accidentally dropped on the floor.

26 Physical Safety (cont.)
Be careful when carrying objects Close cabinets, doors, and drawers Inspect furniture for rough edges Tape down cords and equipment cables Never use damaged equipment or supplies Learning Outcome: 6.6 Explain the principles of good ergonomic practice and physical safety in the medical office. Safeguards continued: Be careful when carrying objects through the facility, especially when approaching blind corners. Close all cabinets, closet doors, desks, and worktable drawers. Routinely inspect the furniture in the exam room and reception area. Make sure there are no rough edges or sharp corners on the examining table, countertop, chairs, or other furniture. Electrical cords and medical and office equipment cables should run along the walls and be taped or fastened down securely. Never use damaged equipment or supplies, such as cracked or chipped glassware.

27 Physical Safety (cont.)
Safeguards for the laboratory environment Wear protective gear Follow manufacturer’s guidelines Learning Outcome: 6.6 Explain the principles of good ergonomic practice and physical safety in the medical office. Safeguards for the laboratory environment: Do not eat or drink in the laboratory, and do not store food there. Never use laboratory supplies, such as beakers or flasks, for eating or drinking. Do not put anything in your mouth while working in the laboratory. Do not apply makeup or lip balm or insert contact lenses in the laboratory. Familiarize yourself with the location of the first-aid kit. Wear appropriate protective gear, clothing, shoes, avoid dangling jewelry, and keep hair pulled back or covered. Always follow manufacturers’ guidelines when using laboratory equipment. Do not attempt to grasp bottles, jars, or other containers if your hands or the containers are wet. Close containers immediately after use. Clean up spills immediately. Clean up broken glass with a broom. Do not handle the debris. If the material is biohazardous, use tongs or forceps to pick up the glass. Package the pieces in a sturdy container with a label identifying the contents.

28 Physical Safety (cont.)
Special safety precautions Children Patients with physical disabilities Safe flooring Handrails Learning Outcome: 6.6 Explain the principles of good ergonomic practice and physical safety in the medical office. Children: Keep sharp instruments out of the reach of children. Store toxic items in high cabinets. Keep all medications and objects out of the reach of young children. Keep children’s toys and books picked up and stored safely when not in use. Toys should be washable and made of safe materials. Sanitize toys that children put in their mouths daily; and sanitize other toys weekly. Sanitize and disinfect toys after sick children play with them. Periodically check toys for sharp edges that might cause cuts. Ensure toys do not have small parts or pieces that could cause choking if swallowed. Patients with physical disabilities: They are more likely than other patients to fall. Provide assistance as needed with disrobing prior to an exam or redressing afterward. Never leave severely disabled patients alone in an exam room Check office policies for guidelines regarding appropriate chaperones for patients with disabilities.

29 Apply Your Knowledge SUPER!
Whose responsibility is it to ensure a safe work environment? ANSWER: The employer Whose responsibility is it to follow safe work practices? ANSWER: The employee Learning Outcome: 6.6 Explain the principles of good ergonomic practice and physical safety in the medical office. SUPER!

30 Infection Control Medical assistant
Help to create and maintain a safe and healthy environment Understand how infections Occur Are transmitted in the population Practice infection control precautions Learning Outcomes: 6.7 Illustrate the cycle of infection and how to break it. Your role in helping to create and maintain a safe and healthy environment for both patients and employees includes: Understanding how infections occur and are transmitted in the population. Practicing all necessary infection control precautions.

31 Cycle of Infection Back
Learning Outcomes: Learning Outcomes: 6.7 Illustrate the cycle of infection and how to break it. . Back

32 Cycle of Infection (cont.)
Reservoir Host – body capable of sustaining pathogen growth Carrier Endogenous infection Exogenous infection Means of Exit - how the pathogen leaves the host Learning Outcomes: Learning Outcomes: 6.7 Illustrate the cycle of infection and how to break it. Many pathogens require a reservoir host to provide nutrition and a place to multiply. This can be an animal, insect, or human whose body is capable of sustaining the growth of a pathogen. A human carrier is a reservoir host who is unaware of the presence of the pathogen and so spreads the disease. The carrier exhibits no symptoms of infection. The reservoir host may have only a subclinical case, which is a manifestation of the infection that is so slight that it is unnoticeable. Infections may be An endogenous infection - an abnormality or malfunction in routine body processes has caused normally beneficial or harmless microorganisms to become pathogenic An exogenous infection is one that is caused by the introduction of a pathogen from outside the body. Click for Cycle of Infections

33 Cycle of Infection (cont.)
Means of transmission – how the pathogen spreads to a host Airborne Bloodborne During pregnancy or birth Learning Outcomes: Learning Outcomes: 6.7 Illustrate the cycle of infection and how to break it. Means of transmission: Direct transmission – the pathogen moves immediately from one host to another Indirect transmission –the pathogen must be capable of existing independently of the reservoir host so it can survive until it encounters a new host. Airborne transmission – transmitted to a new host through the air. Bloodborne transmission: spread through contact with blood or blood products. Indirectly – transferred through blood transfusions, needlesticks, or improperly sterilized dental equipment Directly – contaminated blood of one person comes into contact with another person’s broken skin or mucous membrane. Transmission during pregnancy or birth. An infection may be transmitted while the fetus is in the mother’s uterus. Other infections may infect the baby during passage through the birth canal. Click for Cycle of Infection

34 Cycle of Infection (cont.)
How the pathogen spreads to a host Foodborne Vector-borne Touching Direct – contact with an infected persons mucous membranes Indirect – fomites Learning Outcomes: Learning Outcomes: 6.7 Illustrate the cycle of infection and how to break it. Foodborne transmission. A new host may be exposed to pathogens by ingesting contaminated food or liquids. Food can become contaminated when it is handled by an infected person who has poor hygiene habits. Vector-borne transmission. A living organism that carries microorganisms from an infected person to another person is known as a vector. Most common vectors Fleas carry the organism responsible for plague. Houseflies carry pathogens from garbage and feces on their bodies and feet. Mosquitoes carry the organisms responsible for West Nile Virus and malaria. Ticks carry the microorganisms responsible for Lyme disease and Rocky Mountain spotted fever. Transmission by touching : indirect through fomites A fomite is any inanimate reservoir of pathogenic microorganisms. Objects that can be contaminated by an infected person and then transmit the infective agent to a susceptible host Click for Cycle of Infection

35 Cycle of Infection (cont.)
Means of Entrance Any cavity lined with mucous membrane Breaks in the skin Susceptible Host An individual with little or no immunity Factors influencing susceptibility Learning Outcomes: Learning Outcomes: 6.7 Illustrate the cycle of infection and how to break it. For the infection cycle to remain intact, the person to whom the pathogen has been transmitted must have little or no immunity to infection by that organism Host factors: Age Genetic predisposition to certain illnesses Nutritional status Other disease processes Stress levels Hygiene habits General health Pathogen factors: Environmental factors: The Number and concentration of pathogens  Host’s living conditions The strength (virulence) of the pathogen  Exposure to hazardous Point of entry substances Once the new host is infected, the cycle continues and this host becomes the reservoir host. Click for Cycle of Infection

36 Cycle of Infection (cont.)
Environmental factors Dense populations Animals and insects Economic and political factors Availability of transportation Urbanization and population growth rates Sexual behavior Learning Outcomes: 6.7 Illustrate the cycle of infection and how to break it. In a highly dense population, the infection rate may be higher because pathogens spread more quickly from person to person when people are in closer proximity. Animals can also play a role in infection, as infections related to pathogens are found in domestic and wild animals. Unpasteurized milk from an infected cow may cause disease. Some pathogens can infect both animals and people. The environment affects the incidence of diseases carried by insects since they must have the appropriate climate and environment to live. Economic and political factors also influence the pattern of infection transmission. They help determine the cleanliness of an area, the availability of medical care, and people’s knowledge about preventing infection.

37 Breaking the Cycle Asepsis Maintain strict housekeeping standards
Adhere to government guidelines Educate patients Hygiene Health promotion Disease prevention Learning Outcomes: 6.7 Illustrate the cycle of infection and how to break it. Asepsis is the condition in which pathogens are absent or controlled. The principles of asepsis must be applied to break the cycle of infection and its spread. Specific measures to help break the cycle of infection include: Maintaining strict housekeeping standards to reduce the number of pathogens present. Adhering to government guidelines to protect against diseases caused by pathogens. Educating patients in hygiene, health promotion, and disease prevention.

38 Correct! Apply Your Knowledge
What is your role as a medical assistant in breaking the cycle of infection in the medical office? ANSWER: To apply these measures: Maintain strict housekeeping standards to reduce the number of pathogens present Adhere to government guidelines to protect against diseases caused by pathogens Educate patients in hygiene, health promotion, and disease prevention.. Learning Outcomes: 6.7 Illustrate the cycle of infection and how to break it. Correct!

39 OSHA Bloodborne Pathogens Standard and Universal Precautions
Disposal of infectious or potentially infectious waste Laws protect healthcare workers and patients Training personnel Record keeping Housekeeping Wearing protective gear Learning Outcome: 6.8 Summarize the Bloodborne Pathogens Standard and Universal Precautions as described in the rules and regulations of the Occupational Safety and Health Administration (OSHA). Federal regulations related to infection control and asepsis were developed OSHA and described in the OSHA Bloodborne Pathogens Standard of These laws protect healthcare workers from health hazards on the job and also help protect patients and others from health hazards. It dictates how to handle infectious or potentially infectious waste generated during medical or surgical procedures. Any potentially infectious waste materials must be appropriately discarded or held for processing in biohazardous waste containers. The disposition and handling of contaminated sharps are of special concern because these instruments can easily puncture the skin and expose you to extremely dangerous viruses. Never bend, break, recap, or otherwise tamper with used sharps OSHA’s laws for hazardous waste disposal and regulations about measures to prevent the spread of infection ensure that medical facilities meet at least the minimal criteria for asepsis. These laws include requirements for training personnel, keeping records, housekeeping, wearing protective gear, and other measures. Individual states have some discretion in applying them. You should become familiar with the laws in your state.

40 OSHA Bloodborne Pathogens Standard
Employers must Develop an OSHA Exposure Control Plan Provide training to all employees Documentation PPE, Universal Precautions, engineering controls What to do if exposure occurs Provide the hepatitis B vaccine Learning Outcome: 6.8 Summarize the Bloodborne Pathogens Standard and Universal Precautions as described in the rules and regulations of the Occupational Safety and Health Administration (OSHA). To be in compliance with the Bloodborne Pathogens Standard, an employer must meet these requirements: OSHA Exposure Control Plan must be created and updated. The plan must be available to all employees and to authorized OSHA authorities. Training must be provided to all employees: describing the documentation mandated by the standard. Use of PPE, Universal Precautions, and engineering controls designed to prevent exposure. Procedures to follow in the event of exposure or emergency situations. New employee training is required before the worker can perform task that might pose a risk of occupational exposure and then annually. When a new task or procedure is introduced that may alter occupational exposure risk. Provide the hepatitis B vaccine at no charge to all employees who are at risk for occupational exposure. Employees must either receive the vaccination or decline it in writing.

41 Universal Precautions (cont.)
Universal Precautions apply to all blood and body fluids Standard Precautions Used in healthcare facilities for the care of all patients Prevents the transmission of disease Learning Outcome: 6.8 Summarize the Bloodborne Pathogens Standard and Universal Precautions as described in the rules and regulations of the Occupational Safety and Health Administration (OSHA). OSHA requires that medical professionals follow specific “universal blood and body fluid precautions” that have been issued by Department of Health and Human Services’ Centers for Disease Control and Prevention (CDC). They prevent healthcare workers from exposing themselves and others to infections. Universal Precautions apply to: Blood and blood products Human tissue Semen and vaginal secretions Saliva from dental procedures Cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids Other body fluids, if visibly contaminated with blood or of questionable origin Standard Precautions apply to: Blood All body fluids, secretions, and excretions except sweat Non-intact skin Mucous membranes . Refer to Connect for video: Applying Standard Precautions

42 Universal Precautions (cont.)
Risk categories Tasks that require specific protective measures Tasks that require precautions in certain situations Tasks requiring no special protection Learning Outcome: 6.8 Summarize the Bloodborne Pathogens Standard and Universal Precautions as described in the rules and regulations of the Occupational Safety and Health Administration (OSHA). OSHA outlines the routine safeguards to take when performing each medical procedure or task, depending on that task’s level of risk. The degree of risk is determined by how much exposure to potentially infectious substances you are likely to encounter. Categories of tasks Category I tasks are those that expose a worker to blood, body fluids, or tissues or tasks that have a chance of spills or splashes. These tasks always require specific protective measures. Category II tasks do not usually involve risk of exposure. Because they may involve exposure in certain situations, however, OSHA requires that precautions be taken. Category III tasks do not require any special protection. These tasks, such as taking a patient’s blood pressure, involve no exposure to blood, body fluids, or tissues. (Observe patients for open wounds before you touch them to perform such tasks.)

43 Written Exposure Plan Determination of exposure
Implementation of control methods Post-exposure evaluation and follow-up Communication and training Recordkeeping Evaluation of exposure incidents Learning Outcome: 6.8 Summarize the Bloodborne Pathogens Standard and Universal Precautions as described in the rules and regulations of the Occupational Safety and Health Administration (OSHA). OSHA requires a Written Exposure Plan to reduce the risk of bloodborne pathogen exposure. Employees who are at risk of bloodborne exposure must have access to the ECP. This plan must be reviewed with new employees at the onset of employment and with all employees on an annual basis. The Exposure Control Plan must include the following: Determination of employee exposure Implementation of exposure control methods including Universal Precautions, engineering and work practice controls, personal protective equipment, and housekeeping Hepatitis B vaccination Post-exposure evaluation and follow-up Communication of hazards to employees and hazard training Recordkeeping Procedures for evaluating circumstances surrounding exposure incidents

44 Exposure Incidents Notify the physician or employer immediately
Refer the employee to a licensed healthcare provider Counsel the employee Draw blood and prescribe treatment Written report Learning Outcome: 6.8 Summarize the Bloodborne Pathogens Standard and Universal Precautions as described in the rules and regulations of the Occupational Safety and Health Administration (OSHA). An exposure incident is one in which a worker, despite all precautions, has reason to believe that he has come in contact with a substance that may transmit infection. A puncture exposure incident is the most common kind of exposure. The physician or employer must be notified immediately. Reporting the incident helps to prevent the same type of accident from happening again. The employer must refer the employee to a licensed healthcare provider who can Counsel the employee about what happened as well as about how to prevent the spread of any potential infection. Draw a blood sample and prescribe appropriate treatment. If the employee does not want to participate in the medical evaluation and treatment, he has the right to refuse it. If this occurs, the employee’s refusal should be documented.

45 Other OSHA Requirements
HBV vaccine Needlestick Safety and Prevention Act Engineered safety devices Employer recommendations Engineering controls Needlestick safety programs Learning Outcome: 6.8 Summarize the Bloodborne Pathogens Standard and Universal Precautions as described in the rules and regulations of the Occupational Safety and Health Administration (OSHA). All healthcare workers who have occupational exposure to blood or other potentially infectious materials must be offered the HBV vaccine free of charge. Needlestick Safety and Prevention Act – in response to the Needlestick Safety and Prevention Act, OSHA revised the Bloodborne Pathogens Standard. NIOSH has specific recommendations for employers and employees regarding engineered safety devices that are specifically designed to isolate or remove the hazard, and work practice controls. Employer recommendations include: Engineering Controls Eliminate the use of needles where safe and effective alternatives are available. Implement the use of engineered safety devices and evaluate their use on a regular basis. Needlestick Prevention Programs Analyze sharps injuries to identify hazard trends in the workplace. Ensure employees are properly trained in the proper use and disposal of sharps. Adapt work practices that involve sharps to make them safer. Make safety awareness in the workplace a priority. Have established procedures for reporting all needlestick injuries. Evaluate prevention procedures and provide feedback to employees

46 Other OSHA Requirements (cont.)
Employee recommendations Avoid using needles Help choose devices Use devices provided Do not recap needles Dispose of sharps correctly Report injuries and hazards Participate in training Learning Outcome: 6.8 Summarize the Bloodborne Pathogens Standard and Universal Precautions as described in the rules and regulations of the Occupational Safety and Health Administration (OSHA). NIOSH recommendations for employees include: Avoid using needles if a safe alternative exists. Paticipate in choosing engineered safety devices. Use the engineered safety devices provided by your employer. Do not recap needles if possible. Before beginning a procedure, make sure you have a means of safe sharps disposal close by and ready for use. Dispose of used needles promptly and appropriately. Promptly report all sharps-related injuries. Advise your employer if you see sharps hazards in the workplace. Participate in bloodborne pathogen training.

47 Apply Your Knowledge Correct
OSHA divides medical tasks by level of risk. What are these risk categories? Correct ANSWER: There are three categories of risk: Category 1: Expose a worker to blood, body fluids, or tissues and require specific protective measures Category 2: Usually do not involve risk of exposure, but precautions are required in certain situations Category 3: No risk of exposure, so no special protection is required Learning Outcome: 6.8 Summarize the Bloodborne Pathogens Standard and Universal Precautions as described in the rules and regulations of the Occupational Safety and Health Administration (OSHA).

48 Infection Control Methods
Knowledge of Medical asepsis Based on cleanliness As few microorganisms as possible Surgical asepsis Sterile environment No microorganisms Learning Outcomes: 6.9 Describe methods of infection control including those preventing healthcare-associated infections. As a medical assistant, you will take measures to eliminate the elements that must be present for disease to occur. Medical asepsis, or clean technique, is based on maintaining cleanliness to prevent the spread of microorganisms and to ensure that there are as few microorganisms in the medical environment as possible. The goal of medical asepsis is to reduce/control microorganisms after they leave the body. Surgical asepsis, or sterile technique, depends on a completely sterile environment that eliminates all microorganisms. The goal of surgical asepsis is to keep organisms from entering the body. Each individual who works in a medical setting must recognize the importance of asepsis and strictly adhere to aseptic procedures in daily routines Medical asepsis and surgical asepsis are required by law.

49 Infection Control Methods (cont.)
Keep office clean Prevent cross-contamination Follow guidelines Use protective gear Learning Outcomes: 6.9 Describe methods of infection control including those preventing healthcare-associated infections. All employees must observe and practice the principles of asepsis to ensure a safe environment. Office Procedures – Other physical aspects of the medical office that contribute to asepsis include: A reception room that has designated waiting areas for well and sick people. If there is not enough space, sick patients should be led immediately to an examination room. An office that is cleaned daily. An office that is well lit and ventilated, has no drafts, and has a temperature of approximately 72º F. Furniture that is kept in good repair and is replaced when necessary. A strict “no eating or drinking” policy in the lab, clinical, and other patient areas. Trash that is emptied as necessary and at least once daily. An insect-free environment. A sign stating that any safety or health hazard should be reported to the receptionist. A sign asking that patients use tissues for coughs or sneezes, put all waste in the trash can, and tell the receptionist if they are nauseated or have to use the restroom.

50 Hand Hygiene Handwashing Alcohol-based hand disinfectants (AHD)
Fingernail length Nail polish and artificial nails Learning Outcomes: 6.9 Describe methods of infection control including those preventing healthcare-associated infections. Transmission by touching is the most common means of transmitting pathogens. The single most important aseptic procedure for a medical assistant is proper hand hygiene. Handwashing: aseptic handwashing removes accumulated dirt and microorganisms that could cause infection under the right conditions. In most cases, plain soap and water are adequate; only use anti-microbial soap after assisting with exams and procedures where body fluids are present. Refer to Procedure 6 – 5 Aseptic Handwashing Alcohol-Based Hand Rubs: may be used if water is not readily available. Refer to Procedure 6 – 6 Using an Alcohol-Based Hand Disinfectant They should not be used: When hands are visibly dirty or contaminated Before and after eating After using the bathroom If you suspect you have come in contact with a spore-forming bacteria Fingernail Length: The CDC recommends that natural nail length does not exceed one- quarter inch. Nail Polish and Artificial Nails: The use of nail polish and artificial nails is discouraged in healthcare workers. The CDC recommends that healthcare workers not wear artificial nails or extensions when working with high-risk patients. Refer to Connect for Video: Aseptic Handwashing

51 Other Aseptic Precautions
Avoid leaning against sinks, etc. Avoid touching your face and mouth Use tissues for coughing or sneezing; wash hands afterward Avoid working with patients if you have a cold; wear gloves and mask Stay home if you have a fever Learning Outcomes: 6.9 Describe methods of infection control including those preventing healthcare-associated infections. You need to make certain precautions part of your daily routine. For example, take these safeguards: Avoid leaning against sinks, supplies, or equipment. Avoid touching your face or mouth. Use tissues when you cough or sneeze, and always wash your hands afterward. Whenever possible, avoid working directly with patients when you have a cold. Wear gloves and a mask if you have a cold and must work with patients. Stay home if you have a fever, and remain there until you have maintained a normal temperature for 24 hours.

52 Personal Protective Equipment
Gloves Masks and protective eyewear or face shields Protective clothing Use of multiple types of PPE Learning Outcomes: 6.9 Describe methods of infection control including those preventing healthcare-associated infections. Employers are required by law to supply personal protective equipment (PPE) . Gloves – worn for procedures that involve exposure to blood, other body fluids, or broken skin. Disposable – examination and sterile gloves that are worn once and then discarded Examination – worn during procedures that do not required a sterile environment Sterile – used for sterile procedures Utility – used when cleaning up; stronger than disposable gloves Masks and protective eyewear or face shields: worn if there is a potential for spraying or splashing blood. Protective clothing – worn for procedures that have a potential for spraying or splashing blood. You may also need to wear a hair covering and/or shoe coverings. Use of multiple types of PPE – when wearing more than one type of PPE, the order in which you put these on and take them off is important. On: gown, mask/face shield, and gloves. Off: gloves, mask/face shield, and gown (reduce the possibility of cross contamination) Refer to: Procedure 6 – 7 Removing Contaminated Gloves and Procedure 6 – 8 Removing a Contaminated Gown

53 Transmission from Healthcare Workers
Healthcare-associated infections (HAI) Adhere to OSHA Standards High risk procedures HIV, HBV status of healthcare workers Learning Outcomes: 6.9 Describe methods of infection control including those preventing healthcare-associated infections. An infection acquired in a healthcare facility is known as a healthcare-associated infection (HAI) or a nosocomial infection. The risk of transmission of an infection from a healthcare worker to a patient is small if OSHA standards are followed. Additional precautions are advised for high-risk procedures which include: Those that are thought to have caused the transmission of infection from a medical worker to a patient in the past. Those that may carry a high risk of infection, such as oral, obstetric, and gynecologic procedures. Those that involve needles, especially if a needle is in a body cavity or a body space that is difficult to see and the healthcare worker’s fingers are nearby. Workers who perform high-risk procedures should know their HIV and HBV status and if infected with HIV or HBV should not perform procedures that might result in exposure for the patient without the advice of an expert review panel. The panel advises the worker on whether procedures may be performed and includes requiring the worker to inform potential patients of the infection before the procedure. It is the healthcare worker’s ethical duty to protect a patient from known exposure to bloodborne pathogens.

54 Apply Your Knowledge Good Answer!
Describe the difference between medical and surgical asepsis. ANSWER: Medical asepsis is based on cleanliness and reducing the number of microorganisms as much as possible. Surgical asepsis is maintaining a sterile environment by eliminating all microorganisms. Learning Outcomes: Discuss OSHA standards for preventing healthcare-associated infections. Good Answer!

55 Reporting Guidelines for Infectious Diseases
State or county health department Information is forwarded to the CDC National Notifiable Disease Surveillance System Learning Outcomes: Describe Centers for Disease Control and Prevention (CDC) requirements for reporting cases of infectious disease. Certain diseases must be reported to state or county departments of health. This information is forwarded to the CDC and helps research epidemiologists control the spread of infection. Refer to Table 6-3 The Notifiable Disease Surveillance System for diseases that must be reported through your state or county health department.

56 Reporting Guidelines (cont.)
Reporting – correct form Disease identification Patient identification Infection history Reporting institution name Learning Outcome: Describe Centers for Disease Control and Prevention (CDC) requirements for reporting cases of infectious disease. You must obtain the correct form and a disease identification number from the health department every time you report a communicable disease. To fill out such a form, you need access to the following information: Disease identification (usually a code number as well as the name of the disease); Patient identification (including name, address, date of birth, sex, ethnic origin, and occupational or educational status) if required; Infection history (date of onset, vaccination history, laboratory results); and Reporting-institution information (name of person completing report, title, contact information). Reporting guidelines also must be followed if a worker comes in contact with a substance that may transmit infection. Refer to Procedure 6 – 9 Notifying State and County Agencies About Reportable Diseases

57 Good Answer! Apply Your Knowledge
How is the information on reportable diseases used by the CDC? ANSWER: The CDC uses the information reported to them to help control the spread of infection. Learning Outcome: Describe Centers for Disease Control and Prevention (CDC) requirements for reporting cases of infectious disease. Good Answer!

58 In Summary 6.1 The medical office safety plan should include OSHA’s Hazard Communication; electrical, fire, and chemical safety; emergency action plans; bloodborne pathogen exposure plans; PPE; and needlestick prevention plans. 6.2 The U.S. Department of Labor created OSHA to protect the employees’ safety in the workplace. Through the creation and enforcement of standards such as the Bloodborne Pathogens Standard, Hazard Communication, and the Needlestick Safety and Prevention Act, OSHA serves to protect healthcare workers from hazards.

59 In Summary (cont.) 6.3 To reduce electrical hazards in the medical office, you should avoid using extension cords, repair or replace damaged cords, avoid overloading circuits, ensure that all plugs are grounded, dry your hands before using electrical devices, and keep electrical devices away from sinks or other sources of water. 6.4 A comprehensive fire safety plan must include fire prevention strategies, actions to take in the event of a fire, building evacuation routes and plans, fire drills, and local emergency contacts.

60 In Summary (cont.) 6.5 When using chemicals in the medical office, you should always wear protective gear, carry the container with both hands, work in a well-ventilated area, never combine chemicals unless it is specifically required in the test procedures, and properly clean up spills immediately. 6.6 In order to protect yourself from work-related musculoskeletal disorders at work, you must follow the principles of good body mechanics. Your physical safety at work depends on understanding and applying appropriate workplace safeguards. 6.5 When using chemicals in the medical office, you should always wear protective gear, carry the container with both hands, work in a well-ventilated area, never combine chemicals unless it is specifically required in the test procedures, always add acid to water if the procedure requires that you combine chemicals, and properly clean up spills immediately. 6.6 In order to protect yourself from work-related musculoskeletal disorders at work, you must follow the principles of good body mechanics. Your physical safety at work depends on understanding and applying appropriate workplace safeguards, including never running in an office, taking care when carrying objects through the facility, closing cabinets and drawers, and following appropriate safety procedures in the lab.

61 In Summary (cont.) 6.7 In order for an infection to occur, these five elements must be in place: a reservoir host, a means of exit, a means of transmission, a means of entrance, and a susceptible host. The most effective means of breaking the cycle of Infection is by using aseptic techniques. 6.8 Laws set forth in the OSHA Bloodborne Pathogens Standard of 1991 dictate how you must handle infectious or potentially infectious waste generated during medical or surgical procedures. 6.7 In order for an infection to occur, these five elements must be in place: a reservoir host, a means of exit, a means of transmission, a means of entrance, and a susceptible host. The most effective means of breaking the cycle of infection is by using aseptic techniques. These include maintaining strict housekeeping standards, adhering to government health guidelines, and educating patients in hygiene, health promotion, and disease 6.8 Laws set forth in the OSHA Bloodborne Pathogens Standard of 1991 dictate how you must handle infectious or potentially infectious waste generated during medical or surgical procedures. According to these rules, any potentially infectious waste materials must be discarded or held for processing in biohazardous waste containers.

62 In Summary (cont.) 6.9 The two basic methods of infection control are medical asepsis and surgical asepsis. OSHA recommends that healthcare workers who work with high-risk patients know their HIV and HBV status, participate in a HBV vaccination program, and avoid direct patient contact if they have a skin condition characterized by sores that secrete fluid The CDC requires reporting of certain diseases to the state or county department of health, who then reports the information to the National Notifiable Disease Surveillance System of the CDC. 6.9 The two basic methods of infection control are medical asepsis (clean technique) and surgical asepsis (sterile technique). OSHA recommends that healthcare workers who work with high-risk patients know their HIV and HBV status, participate in a HBV vaccination program, and avoid direct patient contact if they have a skin condition characterized by sores that secrete fluid. Any healthcare worker who is HIV- or HBV-positive should not perform procedures that might expose a patient without first consulting an expert review panel.

63 End of Chapter 6 Soap and education are not as sudden as a massacre, but they are more deadly in the long run. ~ Mark Twain


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