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FNA Health and Safety Program New Hire Orientation and Annual Training.

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1 FNA Health and Safety Program New Hire Orientation and Annual Training

2 Agenda Customer Service- “Give ‘em the Pickle” Health and Safety Committee Topics: Introduction to OSHA standards Note: Program specific standards…. Introduction to FNA H&S Policy and Procedure Manual Employee’s responsibilities under the H&S Program How to locate web based information Incident reporting procedures MSDS/ GHS Medication Management

3 Agenda Topics, continued: Ergonomics Proper lifting techniques Prevention of slips, trips, and falls Electrical safety Routes of egress from the work place Locating fire extinguishers and first aid equipment Common work place hazards Personal protective equipment Blood borne pathogens Workplace violence and prevention

4 Welcome! Open the door to safety: awareness is the key!

5 Administration In the event of an emergency… Restrooms Breaks Questions Contact information John Albers 452-1648 ext. 6236

6 Customer Service From Wikipedia: Customer service is the provision of service to customers before, during and after a purchase. According to Turban et al. (2002), [1] "Customer service is a series of activities designed to enhance the level of customer satisfaction – that is, the feeling that a product or service has met the customer expectation." servicecustomers [1] What does this mean for FNA? As noted above, service before, during, and after Program Services, involves: In-take process – whether it is Head Start, Early Head Start, Graf, Detox; initial contact with potential customers is important Performance of Service with consumers during participation Follow-up of service when a consumer accomplishes program completion! Give ’em the PICKLE Key Learning Points... Service Make serving others your #1 Priority. You work in a noble profession, be proud of what you do. Attitude Choose your Attitude. How you think about your customers, is how you will treat them. Consistency Set high standards, and stick to them. Customers return because they like what happened last time. Teamwork Look for ways to make each other look good. In the end, everything ends up in front of the customer!

7 Health and Safety Committee Just because you always did it that way, doesn't make it right.

8 H&S Committee- Function Established by FNA policy Scope of activities Recommend to management changes to procedures/programs/equipment to promote safety. Promote and publicize safety topics and activities. Monitor safety program effectiveness. Review job & training procedures and recommend improvements. Accept and evaluate employee safety suggestions/complaints. Review accident reports to determine means of reducing frequency or eliminating problems. Assist in accident investigation to uncover trends.

9 H&S Committee- Members Admin: William Abbott/ John Albers HS: Mary Willey/ ** EHS: Colleen Hasbrouck/ Emily Main RPC: Perry Ahsogeak/ Sharon Thronsen Detox: Catherine Jibben/ ** WCCIH: Danielle Nelson/ Louisa Hisamoto Graf: Shirley Moses/ Steven Powell CS: Freda Williams/ Esther Frykman FASAP: Twyla Cruger/ Felisha Cooper JOM: Linda Woods/ Kathy Halverson THV: Shirley Williams/ Chrislene French

10 Health and Safety: Mandatory Training Topics Safety is something you learn from the start - being accident free is doing your part.

11 Introduction to OSHA Working without safety is a dead-end job.

12 Why is OSHA Important to You? OSHA stands for the Occupational Safety and Health Administration, an agency of the U.S. Department of Labor OSHA’s responsibility is worker safety and health protection OSHA began because, until 1970, there were no national laws for safety and health hazards. On average, 15 workers die every day from job injuries Over 5,600 Americans die from workplace injuries annually Over 4 million non-fatal workplace injuries and illnesses are reported

13 OSHA’s Mission The mission of OSHA is to save lives, prevent injuries and protect the health of America’s workers. Some of the things OSHA does to carry out its mission are: developing job safety and health standards and enforcing them through worksite inspections, maintaining a reporting and recordkeeping system to keep track of job-related injuries and illnesses, and providing training programs to increase knowledge about occupational safety and health.

14 Your Rights Under OSHA You have the right to: A safe and healthful workplace Know about hazardous chemicals Information about injuries and illnesses in your workplace Complain or request hazard correction from employer Training Hazard exposure and medical records File a complaint with OSHA Participate in an OSHA inspection Be free from retaliation for exercising safety and health rights

15 Employer Responsibilities Under OSHA Provide a workplace free from recognized hazards and comply with OSHA standards Provide training required by OSHA standards Keep records of injuries and illnesses Provide medical exams when required by OSHA standards and provide workers access to their exposure and medical records Not discriminate against workers who exercise their rights under the Act (Section 11(c)) Post OSHA citations and abatement verification notices Provide and pay for PPE

16 OSHA Standards OSHA standards fall into four categories: General Industry, Construction, Maritime, and Agriculture. OSHA issues standards for a wide variety of workplace hazards. Where there are no specific OSHA standards, employers must comply with The General Duty Clause, Section 5(a)(1)

17 OSHA Inspections The OSH Act authorizes OSHA compliance safety and health officers (CSHOs) to conduct workplace inspections at reasonable times. OSHA conducts inspections without advance notice, except in rare circumstances (e.g. Imminent Danger) In fact, anyone who tells an employer about an OSHA inspection in advance can receive fines and a jail term.

18 OSHA Inspections OSHA Inspection Priority

19 OSHA Inspections Citations and Penalties

20 Where Can You Go For Help? Internally… Employer or supervisor, co-workers and union representatives Material Safety Data Sheet (MSDS) for information on chemicals Labels and warning signs Employee orientation manuals or other training materials Work tasks and procedures instruction

21 Where Can You Go For Help? Externally… OSHA website: and OSHA offices (you can call or write) Compliance Assistance Specialists in the area offices National Institute for Occupational Safety and Health (NIOSH) – OSHA’s sister agency OSHA Training Institute Education Centers Doctors, nurses, other health care providers Public libraries Other local, community-based resources

22 Filing An OSHA Complaint Workers can file a complaint or… A worker representative can file a complaint Telephone or visit local regional or area offices to discuss your concerns Download the OSHA-7 form from OSHA’s website or… File the complaint online Complete the form – be specific and include appropriate details OSHA determines if an inspection is necessary Workers do not have to reveal their name!

23 Introduction to FNA H&S Policy and Procedure Manual Know safety, no injury. No safety, know injury.

24 H&S Policy and Procedures Chapter 1, section 1-6: Divided into (8) sections… Health & Safety Committee Health & Safety Program Health & Safety Procedures Disaster Plan Hazard Communication Workplace Violence Bloodborne Pathogens Appendix

25 H&S Policy and Procedures Chapter 2, section 2-4: Roles and responsibilities… Program/ Project Directors: “Active participation in and support of the health & safety programs is essential. Supervisors must display their interest in health & safety matters at every opportunity. At least one program employee will participate in the Health & Safety Committee Meetings. The Health & Safety Committee, in conjunction with supervisors, will establish realistic goals…” “Goals and implementing instructions shall be within the framework established by this document. Incentives may be included as part of the implementing instructions.”

26 H&S Policy and Procedures Chapter 2, section 2-4: Roles and responsibilities… Supervisors: A primary responsibility of the Supervisor is ensuring the health & safety of the employees they work with and the consumers that utilize our services. To accomplish this obligation Supervisor’s will:

27 H&S Policy and Procedures Assure that all health & safety rules, regulations, policies & procedures, are understood and observed. Require the proper care and use of all required protective equipment. Receive and take initial action on employee suggestions, awards or disciplinary measures. Conduct periodic program and/or project safety meetings to discuss health & safety matters. Train employees during program orientation (New and experienced) in safe and efficient methods of accomplishing each job task as necessary. Attend program health & safety meetings and participate in the proceedings. Promote Employee participation in the health and safety program. Participate in the safety inspections of the facility and equipment. Assist the Health & Safety Committee in identifying and eliminating job hazards quickly through job safety analysis procedures. Inform and train employees on hazardous chemicals and/or procedures they may encounter under normal working conditions or during as emergency. Assist in review of accidents, identify trends and establish prevention measures. Actively follow the progress of injured workers and display an interest in their rapid recovery and return to duty.

28 H&S Policy and Procedures Chapter 2, section 2-4: Roles and responsibilities… Employees: “Observe and comply with the items of responsibility established in this document’s policies & procedures.” Safety is everyone’s responsibility!

29 Locating Web-Based Information Tomorrow – your reward for working safely today.

30 Useful Web Sites… U.S. Dept. of Labor OSHA AKOSH /lss/oshhome.htm /lss/oshhome.htm NIOSH National Fire Protection Association CARF SOA Childcare licensing dpa/Pages/ccare/defa ult.aspx dpa/Pages/ccare/defa ult.aspx

31 Incident Reporting Safety isn’t expensive, its priceless.

32 Accident Investigation and Reporting Report all work related accidents, injuries and illnesses as soon as possible!! Accidents, injuries, fatalities, illnesses, and exposures shall be investigated. FNA shall take whatever appropriate corrective action is necessary to avoid repetitive occurrences of accidents or injuries.

33 FNA Incident Report: Instructions Section 1: Description of the Incident Reporter’s responsibility Complete ALL areas!

34 FNA Incident Report: Instructions Section 1: Description of the Incident Reporter’s responsibility Complete ALL areas!

35 FNA Incident Report: Instructions Section 1: Description of the Incident Reporter’s responsibility Complete ALL areas!

36 FNA Incident Report: Instructions Section 1: Description of the Incident Reporter’s responsibility Complete ALL areas!

37 FNA Incident Report: Instructions Section 1: Description of the Incident Reporter’s responsibility Complete ALL areas!

38 FNA Incident Report: Instructions Section 1: Description of the Incident Reporter’s responsibility Complete ALL areas!

39 FNA Incident Report: Instructions Section 2: Department or Supervisor In Charge of Investigation Was the accident preventable? Did the employee take action after the incident? What action was taken to prevent future similar incidents? What follow up is needed? Who is responsible for follow up? Additional information Name, date, signature Date and time of Program Director review

40 FNA Incident Report: Instructions Section 3: Program H&S Representative Review/ Follow-up Complete ALL areas!

41 FNA Incident Report: Instructions Section 3: Program H&S Representative Review/ Follow-up Complete ALL areas!

42 FNA Incident Report: Instructions Section 3: Program H&S Representative Review/ Follow-up Complete ALL areas! Signatures H&S Representative Program Director Submit completed form by interoffice mail to Health and Safety Coordinator for review and final signatures

43 Most Common Hazards Injury to staff With or without workers comp form ~ 50% of total reports Slips, trips, falls Complications associated with known limitations/ previous injuries Consumer issues Nearly half illustrate behavioral issues and medical facility transfers

44 Staff Injuries- Worker’s Compensation In the event of an injury- suspected or otherwise- contact your H&S Rep or Supervisor and complete an “Employee Report of Occupational Health or Injury to Employer” Form You have 30 days to disclose a work-related injury to your employer; please report immediately! Once you have notified FNA you sustained a work-related injury, you have 5 calendar days to complete and submit your report for further processing

45 Hazardous Materials Communication (HAZCOM) Safety never takes a holiday.

46 HAZCOM… Mandated by OSHA Requirements: A written hazard communication program. An inventory of all hazardous substances. Employee training. All containers must be properly labeled. MSDS library for all hazardous substances in the workplace.

47 Training Employee Training: Training enables employees to perform their job according to the health, safety, first aid and emergency procedures necessary. Employees must be fully trained on the specific hazards in their work area. Employees that require training include: Those who might be exposed under normal conditions or in an emergency situation. Contractors and off-site employees. Transportation employees and emergency responders. Every employee must receive specific training before working with any hazardous chemical. Training is required at the time of the initial assignment. Additional training is required when a new chemical hazard is introduced to the workplace.

48 Inventory Hazardous Material Inventory… Safety information about all hazardous substances in the workplace. Information on chemical identification: The chemical’s full name from container labels. The chemical’s commonly used name. The product identifier: A unique name or number which can be cross-referenced to the correct MSDS so that anyone can easily obtain the chemical information they need. Information about where each hazardous material is used. Maintained in your MSDS book(s)

49 Labeling Container labeling… Labels must not be removed, defaced or altered in any way. All labels must be legible, in English and prominently displayed. Information in other languages may be added, as long as English is displayed as well. The information must be provided in a consistent manner. Chemicals not classified as hazardous do not have to be noted on the container. For solid materials, the label may be given along with the MSDS/ SDS during the initial shipment.

50 Secondary Containers Container labeling- secondary containers… The containers that hazardous materials are transferred into from their original containers must also be labeled with the contents and hazards. Alternative labels are acceptable as long as they include the product identifier and words, pictures or symbols that indicate general information about the product and the hazards involved. Labels for the National Fire Protection Association (NFPA) and Hazardous Materials Identification System (HMIS) are permitted, especially during the transition period. Supplementary hazard information may be included on labels as long as it provides further detail and does not conflict with the existing GHS-compliant label.

51 NFPA Label National Fire Protection Association

52 MSDS… Material Safety Data Sheets… Lists the characteristics of a particular substance. Understanding the hazards of the materials you are working with can help you protect yourself against them. An MSDS must be on file and readily available for each substance listed in the hazardous materials inventory section of the hazard communication program. Example: Clorox BleachClorox Bleach

53 MSDSs Contain… Identification Hazard(s) identification Composition and information on ingredients First-aid measures Fire-fighting measures Accidental release measures Handling and storage Exposure controls and personal protection Physical and chemical properties Stability and reactivity Toxicological information Ecological information Disposal considerations Transport information Regulatory information Other information including the date of preparation or last revision

54 MSDSs Sections… Section 1—Identification: The product identifier used on the label The recommended use and any restriction of use The contact information of the manufacturer, importer or responsible party An emergency phone number Section 2—Hazard identification: The classification of the chemical The signal word, hazard statements and symbols, including pictograms Special hazards, such as not using water in a fire situation

55 MSDSs Sections… Section 3—Composition and information on ingredients: The chemical name, common name and synonyms Hazardous ingredients with percentages of each For mixtures (as opposed to substances), the chemical name and exact percentage or concentration of all ingredients classified as health hazards Section 4—First-aid measures: The correct procedure, which is specific to the method of exposure Acute and delayed symptoms of overexposure The type of medical attention or treatment needed

56 MSDSs Sections… Section 5—Fire-fighting measures: Suitable extinguishing media Specific hazards arising from the chemical Section 6—Accidental release measures: Personal precautions and protective equipment Emergency procedures Containment methods Materials for cleanup Section 7—Handling and storage: Safe handling precautions

57 MSDSs Sections… Section 8—Exposure controls and personal protection: Permissible Exposure Limits (PEL) and other exposure limits Appropriate controls, including engineering controls and PPE Section 9—Physical and chemical properties: These include the following properties: appearance, odor, melting point, pH, vapor pressure, density and solubility. Section 10—Stability and reactivity: Pyrophoric substances: These spontaneously ignite in air. Oxidizers: These agents oxidize another substance, i.e., force it to give off oxygen, which can make it combustible or flammable. Explosives Polymerization: The substance will react and bond with itself, possibly generating heat. Reactivity: The substance readily reacts and bonds with other chemicals.

58 MSDSs Sections… Section 10—Stability and reactivity (continued): Conditions to avoid, such as static discharge, shock or vibration Hazardous decomposition products Section 11—Toxicological information: Description of health effects Routes of exposure Symptoms related to exposure Delayed and immediate effects Toxicity data The chemical’s status in the National Toxicology Program Suspected, presumed or known carcinogens

59 MSDSs Sections… Section 12- 15 not required on products in the U.S. Section 16—Other information: Date of preparation or last revision of SDS and related documents

60 HAZCOM and MSDS: By Program Your program Health and Safety Representative will orient you to the MSDSs at your location Read them! If you encounter a substance you are not familiar with DO NOT use it prior to consulting the MSDS If there is not an MSDS for that substance notify your supervisor and/or Health and Safety Representative immediately!

61 The New Standard: GHS- What and Why? To align with the Globally Harmonized System of Classification and Labeling of Chemicals (GHS) adopted by 67 nations To provide a common and coherent approach to classifying chemicals Reduce confusion and increase understanding of the hazards Facilitate training Help address literacy problems

62 GHS- Who is affected? Manufacturers, Distributors, Importers Change SDS information and format Change container labeling Employers Training employees on changes to: SDS (change from MSDS to SDS and 16-section format) Container Labels (including secondary containers) Employees Recognize and understand hazards based on: Information in new SDS format Pictograms on container labels Precautionary and hazard statements

63 GHS- Effective Dates/ Requirements

64 GHS- Labeling Effective June 1, 2015 There are several new label elements: Symbols called “Pictograms” Signal Words Hazard Statements Precautionary Statements Product Identification Supplier/Manufacturer Identification

65 GHS- Labeling- Pictograms Acute toxicity (Less Severe) Acute toxicity (Severe) Acute = short- term effect 1. Corrosive- Skin Carcinogen 2. Corrosive- Metal Compressed Gases ExplosivesFlammables Oxidizer

66 GHS- Labeling- Signal Words Signal Words These are words used to indicate the severity of the hazard and alert employees to the potential hazard. Only 2 signal words will appear: “DANGER” (more severe hazard) “WARNING” (less severe hazard) Not all labels will have a signal word. Some chemicals are not hazardous enough to require that a signal word appear on the label.

67 GHS- Labeling- Hazard Statements Hazard Statement There are specific hazard statements that must appear on the label based on the chemical hazard classification. Examples: Flammable liquid and vapor Causes skin irritation May cause cancer

68 GHS- Safety Data Sheets (SDS) MSDS= SDS Same information, just standardized SDS must be available for all chemicals in the workplace SDS must be readily available for review by all staff members at all times Secondary containers Still require adequate marking, ideally using NFPA or HMIS standard If you encounter a container that isn’t labeled notify someone immediately- DO NOT USE “IT”!

69 GHS- SDS content New 16-section standardized SDS format required (ANSI Z400.1) Section 1 – Identification Section 2 – Hazard(s) identification Section 3 – Composition / Information on Ingredients Section 4 – First-aid Measures Section 5 – Fire-fighting Measures Section 6 – Accidental Release Measures Section 7 – Handling and Storage Section 8 – Exposure Controls / Personal Protection Section 9 – Physical and Chemical Properties Section 10 – Stability and Reactivity Section 11 – Toxicological Information Section 12 – Ecological Information* Section 13 – Disposal Consideration* Section 14 – Transport Information* Section 15 – Regulatory Information* Section 16 – Other information including date of preparation of last revision *Sections outside of OSHA jurisdiction but inclusion of these sections is necessary for a GHS compliant SDS

70 Hazard Severity: GHS 1 11 1 1 11 1 Today….Tomorrow... Former standard: 0-4, 4 being most severe! GHS standard: 1-4, 1 being most severe!

71 GHS vs. “Old” Standard… Which is which?! The “old” (scale of 0-4) GHS (scale of 1-4)

72 Medication Management “Safety First” is “Safety Always.”

73 Medication Management FNA staff, when engaged in the administration, or observing self- administration, of consumer prescription medications must ensure these activities are done so in a manner that safeguards consumer health and safety.

74 Self Administration Unless you are a licensed health care provider you may ONLY observe and assist! Examples… Open the consumer’s medication container; Hand the consumer the medication container; Place the medication in the consumer’s hand; Transfer medication from one container to another for the purpose of an individual dose

75 Consumer Consent All new prescription medications or changes require consumer consent. Written consent for ongoing medication management may be obtained during consumer intake proceedings. FNA staff members are not decision-makers for the purposes of consent. If a consumer’s legal representative is unwilling to provide consent for a medication and FNA staff believes this decision is not in the consumer’s best interest, FNA staff should bring the matter to the attention of their respective director immediately.

76 Storage of Medications Safeguard medications: Keep a consumer's medications so they are not readily available to others. Store medications under proper conditions for sanitation, temperature, moisture and ventilation, and separate from food or toxic chemicals. Store medications in the original medication containers with pharmacist-prepared or manufacturer's label, or in medication organizers which are clearly labeled

77 Medication Disposal Properly dispose of all medications that are discontinued or superseded by another. Deliver medications to be disposed of to the Fairbanks’ Alaska State Troopers office with a list of the name of the medication(s), amount disposed, and date of disposal. Two people, the FNA staff member making the delivery for disposal and the law enforcement representative receiving it, will verify the disposal by signature. A record of this disposal will be maintained by the FNA Health and Safety Coordinator for a period of three (3) years.

78 Ergonomics Better a thousand times careful than once dead.

79 Ergonomics? Ergonomics is the science of fitting jobs to people: Ergonomics uses knowledge of physical abilities, limitations, and human characteristics that apply to job design, and “Anthropometrics,” or the study of human body measurement. Workstations and tasks are then designed around the knowledge of those physical abilities and characteristics.

80 Work Related Musculoskeletal Disorders (WMSDs) Work related musculoskeletal disorders or “WMSDs” can occur from ergonomically-related stressors. These are injuries to soft body tissues such as: Muscles Nerves Tendons Ligaments Joints Cartilage Bursa Spinal discs

81 Work Related Musculoskeletal Disorders (WMSDs) Causes and remedies: Continuous and repetitive motions: Use lightweight, balanced and sharpened tools to minimize force requirements. Static body positioning: Use things such as magnifiers and proper chair adjustments to eliminate the need for awkward body positioning. Grasping small instruments: Reduce force exertion and maintain the hand and wrist in a neutral position. Prolonged use of vibrating hand tools: Use vibration dampening devices to minimize exposure. Improper lifting techniques: Use proper lifting techniques.

82 Ergonomic Controls FNA can provide- individually or in combination… Engineering controls: Methods of controlling exposure by modifying the source of exposure. Administrative controls/ work practice controls: Controlling exposure by job rotation, work assignment and time periods. PPE Personal Protective Equipment

83 Ergonomic Assessment If you’re experiencing discomfort at your work station an ergonomic assessment can be conducted for recommended adjustments. Contact FNA H&S to schedule.

84 Ergonomic Strategies Strategies you can use in your day to day routine: Avoid static and/or awkward postures. Routinely alternate between standing and sitting. Alternate tasks. Take scheduled breaks. Micro breaks (stand up, walk around, move)

85 Lifting Don't be safety blinded, be safety minded.

86 Why Worry About Lifting? Back injuries are the number one workplace safety issue: Back injuries account for 20% of all injuries and illnesses in the workplace. Only colds and flu account for more time off. Cumulative trauma injuries which include back injuries account for 31% of all workplace injuries and 43% of the cost of claims. These injuries result in costs and aggravation for the injured person. They also create problems for the organization with lost time, productivity impacts and higher insurance costs.

87 Recognized Hazard The General Duty Clause of the federal workplace safety statute requires employers to provide employees with a workplace that is “free of recognized hazards.” Preventive training and awareness is in everyone’s best interests!

88 Back Injuries- Most Common Strains from overused or overstretched muscles. Sprains from torn ligaments as a result of sudden movement. Herniated disk from the loss of the spine’s cushioning ability. This is usually caused from strain and aging.

89 Contributing Factors Repetitive work, i.e., bending, twisting, pushing, pulling and lifting. Slipping, tripping and falling. Twisting while spine is supporting a heavy load. Heavy physical work. Poor physical condition. Being overweight. Loss of flexibility. Body mechanics and work habits. Stressful living.

90 Prevention Strategies Your health: Maintain good physical health. Be properly rested. Eat right. Reduce stress in your life. Stretching and strengthening: Stretching before exposure, both pre-shift and pre-task, will reduce the likelihood of an injury. Routine strengthening exercises and a physical fitness routine will also reduce the likelihood of an injury.

91 Prevention Shoes and back support: Shoes: Wear proper shoes for the job. They must include non-slip soles. Back support recommendations: Optional use of a lifting belt for additional back support may help if you are experiencing any back issues. The lifting belt helps by reminding you to use proper body positioning and to not lift more weight. Note: NIOSH studies indicate that back supports do not statistically reduce risk of injury.

92 Prevention Bending and lifting: Lifting doesn’t have to be dangerous. If you use proper techniques you can protect yourself from injury. The spine acts as a large spring to help reduce the muscle load. When we “unspring" our spines, we correctly force our muscles to do all the work. Ensure that the load is a safe weight. Ensure it is safe and not hazardous. Keep the feet apart and staggered. Squat to lift and lower. Minimize bending at the waist. Keep the back bowed in while bending. Get a good grip. Keep the weight close to the body. Keep load centered near the waist. Turn with the feet and not the body. Do not twist or jerk suddenly.

93 Prevention Check your surroundings: Is a clear path established? Remember the shortest way isn’t always the smartest way. Is the ground and pathway stable, level and not slick? Is lighting sufficient? Is area adjacent and above clear of obstructions? Is a clear set point established? Teamwork: Identify when and where two-person lifts are required. When you can’t handle it by yourself get help!

94 Prevention of Slips, Trips, and Falls A safer you is a safer me.

95 Slips, Trips, and Falls The leading hazard as indicated by our Incident Reports! Safety tips: Keep the floor clear. Remember to keep hoses and electrical cords out of walkways. Keep the floor clean. Clean up grease, water and other liquids immediately. Install non-skid mats in walkways and handrails in stairways. Climbing and reaching high places will increase your chance of falling. Use appropriate gear for tasks in these cases. For instance, use a sturdy step stool with hand rails when climbing and reaching high places is required. Use floor treatments where continual problems exist. Barricade the perimeter of areas being cleaned to prevent others from slipping.

96 Slips, Trips, and Falls Safety tips, continued: It is everyone’s responsibility to maintain good housekeeping. If you see a spill, clean it up. If the walkway needs shoveling, shovels are provided. Seasonally… Invest in shoes with appropriate traction for the season. Spiked shoes and shoe covers should be used when ice and snow present a hazard.

97 Electrical Safety Be alert, be aware, be alive.

98 Electrical Shock- What is it? Received when current passes through the body Severity of the shock depends on: Path of current through the body Amount of current flowing through the body Length of time the body is in the circuit LOW VOLTAGE DOES NOT MEAN LOW HAZARD Currents greater than 75 mA* can cause ventricular fibrillation (rapid, ineffective heartbeat) Will cause death in a few minutes unless a defibrillator is used 75 mA is not much current – a small power drill uses 30 times as much * mA = milliampere = 1/1,000 of an ampere

99 Electrical Shock- Injuries Burns Most common shock-related, nonfatal injury Occurs when you touch electrical wiring or equipment that is improperly used or maintained Typically occurs on the hands Very serious injury that needs immediate attention Falls Electric shock can also cause indirect or secondary injuries Workers in elevated locations who experience a shock can fall, resulting in serious injury or death

100 Electrical Shock- Causes Inadequate Wiring Hazard A hazard exists when a conductor is too small to safely carry the current Overload Hazard If too many devices are plugged into a circuit, the current will heat the wires to a very high temperature, which may cause a fire If the wire insulation melts, arcing may occur and cause a fire in the area where the overload exists, even inside a wall

101 Electrical Hazard- Signs Signs Indicating a Possible Electrical Hazard Tripped circuit breakers or blown fuses Warm tools, wires, cords, connections, or junction boxes GFCI that shuts off a circuit Worn or frayed insulation around wire or connection If you encounter any of these contact your supervisor and/ or Health and Safety Representative immediately!

102 Electrical Shock- Protection Devices Include fuses, circuit breakers, and ground-fault circuit- interrupters (GFCI’s), surge protectors Use the Appropriate Cord Extension cords for temporary use only Surge protectors rated for equipment for long term use Ideally- no extra cord at all. Plug directly into wall outlet.

103 Emergency Exits and Routes of Egress Safety- it's cheaper than a trip to the ER.

104 Emergency Exits All exits must be marked with appropriate signage. All doors which could be confused as exits must be marked “No Exit”. All exits must not be blocked! Inside Outside Fire doors must not be propped open or otherwise kept from closing

105 Routes of Egress Means “Your path to safety” Signage should be posted in all offices and at the junction of hallways FNA employs route maps which should look something like this… Always use the exit nearest you!

106 Fire Extinguishers and First Aid Kits Working without safety is a dead end job.

107 Fire Extinguishers Acquaint yourself with the location of fire extinguishers in your area during program orientation FNA conducts fire extinguisher training annually In areas other than your own look for signage indicating the location of fire extinguishers in those areas

108 Fire Extinguishers- Use Remember the acronym- PASS… P - Pull the safety pin A - Aim the nozzle at the base of the fire S - Squeeze the handle S - Sweep at the base of the fire

109 First Aid Kits Acquaint yourself with the location of first aid kits in your area during program orientation FNA provides first aid and CPR training for employees at no charge In areas other than your own look for signage indicating the location of fire extinguishers in those areas Should you need to use the first aid kit, notify your H&S Representative so it can be restocked Be sure to do an incident report!

110 Personal Protective Equipment Wear the right protective equipment for the job.

111 Protecting Employees from Workplace Hazards Employers must protect employees from workplace hazards such as machines, hazardous substances, and dangerous work procedures that can cause injury Employers must: Use all feasible engineering and work practice controls to eliminate and reduce hazards Then use appropriate personal protective equipment (PPE) if these controls do not eliminate the hazards. Remember, PPE is the last level of control!

112 Payment for PPE When PPE is required to protect employees, it must be provided by the employer at no cost to employees, except for specific items, such as: Safety-toe footwear, Prescription safety eyewear, Everyday clothing and weather-related gear

113 Examples of PPE Eye - safety glasses, goggles Face - face shields Head - hard hats Feet - safety shoes Hands and arms - gloves Bodies - vests Hearing - earplugs, earmuffs

114 Training Employees required to use PPE must be trained to know at least the following: When PPE is necessary What type of PPE is necessary How to properly put on, take off, adjust, and wear Limitations of the PPE Proper care, maintenance, useful life and disposal

115 Bloodborne Pathogens An ounce of prevention is worth a pound of cure.

116 Bloodborne Pathogens (BBP) Employees in many industries are at risk: Approximately 5.6 million employees in the health care, dentistry, hospitality and other industries can reasonably be expected to come into contact with blood or other potentially infectious materials (OPIM). They are at risk for bloodborne pathogen exposure. Regulations and standards have been set: The Occupational Safety and Health Administration (OSHA) has set a bloodborne pathogens standard which mandates safeguards to protect employees against the health hazards associated with the exposure to blood, needles, bodily fluids and OPIM.

117 BBP- Defined Bloodborne pathogens are pathogenic micro-organisms that may be present in human blood and other potentially infected material (OPIM) can cause disease in humans. Pathogens found in blood and OPIM include, but are not limited to the following: Human immunodeficiency virus (HIV), which causes AIDs Hepatitis B virus (HBV) Hepatitis C virus (HCV) Syphilis Malaria

118 BBP Transmission- Sources Other potentially infectious materials (OPIM) include: Semen. Vaginal secretions. Cerebrospinal fluid (brain spinal cord). Synovial fluid (joints). Pleural fluid (chest cavity). Peritoneal fluid (abdomen). Amniotic fluid (fluid around fetus). Saliva (if blood is present). Any unfixed tissue or organ from a human, living or dead, except intact skin. Any blood, cultures or animal tissue infected with or containing HIV, HBV or HCV.

119 At Risk Employees The Bloodborne Pathogens Standard Covers all employees who could be “reasonably anticipated” to face contact with blood and other potentially infectious materials as the result of performing their job duties. Does not cover those who engage in “Good Samaritan” acts, such as assisting a coworker with a nosebleed, because it is not considered an occupational exposure. However, if an employer allows trained employees to assist with first aid treatment on a “Good Samaritan” basis, it is considered best practice to implement the key elements of a bloodborne pathogen program.

120 At Risk Employees Who is at risk for exposure? Physicians, nurses and emergency room personnel Orderlies, housekeeping personnel and laundry employees Dentists and other dental employees Laboratory and blood bank technologists and technicians Medical examiners Morticians Law enforcement personnel Firefighters Paramedics and emergency medical technicians Anyone providing first-response medical care Medical waste treatment employees Home healthcare employees

121 Engineering Controls These controls reduce exposure by removing the hazard or isolating the employee. Examples of engineering controls include: Sharps disposal containers. Self-sheathing or retracting needles. Medical safety devices. Needleless systems, as shown here. Sharps with engineered injury protection.

122 Exposure Control Plan Is a written document that describes how the employer will comply with requirements and implement policies and procedures. Identifies the jobs and tasks where occupational exposure to blood or other potentially infectious material occurs. Describes how the employer will: Use engineering and work practice controls. Assure use of personal protective equipment. Provide training. Provide medical surveillance. Provide hepatitis B vaccinations. Use signs and labels. Must be accessible and communicated to employees.

123 Training Training must be: Provided at no cost to employees during working hours. Provided at the time of the initial assignment to a job with occupational exposure and at least annually thereafter. Provided additionally when existing tasks are modified or new tasks are required which affect an employee’s occupational exposure. Recorded and maintained for three years.

124 Work Practice Controls- Universal Precaution Using universal precautions involves: Treating all human blood or OPIM as contaminated with bloodborne pathogens. Treating all materials that have been contaminated with human blood or OPIM as potentially infectious with bloodborne pathogens. Minimizing handling and manipulation of materials contaminated with human blood or OPIM.

125 Work Practice Controls- General These are steps to take in order to complete job tasks safely by reducing the likelihood of exposure through choices. Recommended controls include: Covering any cuts or abrasions, especially those near your hands. Not touching the face or mouth when a potentially infectious material is present. Not eating, drinking, smoking or applying cosmetics, including lip balm when a potentially infectious material is present. Following universal precautions: employees should assume that all human blood is infectious.

126 Work Practice Controls- Sharps Sharps safety: Do not bend or break needles. Do not recap needles. Place needles in a sharps container as soon as possible. Use forceps or another device to pick-up sharps, such as broken glass or a loose needle.

127 Work Practice Controls- Working with Blood and OPIM When working directly with human blood or OPIM: Food and drinks must be stored in a separate refrigerator and work space from specimens. The storage location of the specimens must be labeled with the biohazard symbol. Procedures must minimize the creation of droplets, splash or spray. Mouth pipetting is prohibited. Secondary, leak-proof containers must be used for the storage and transportation of containers of human blood or OPIM. Equipment that may have come into contact with human blood or OPIM must be decontaminated prior to shipping or servicing.

128 Work Practice Controls- Biohazard Labels Biohazard warning labels must be placed on: Containers of regulated waste. Containers used to store, transport or ship blood or other potentially infectious materials. Refrigerators, freezers and other storage locations that contain blood and other potentially infectious materials. Laundry containers being sent for cleaning. Sharps containers. Red bags or containers may be substituted for labels.

129 Work Practice Controls- Housekeeping Housekeeping: A written schedule must be developed for cleaning and decontamination at the work site based on: The location within the facility. The type of surface to be cleaned. The type of soil present. The tasks or procedures being performed. Work surfaces must be decontaminated: After the completion of procedures. When surfaces are contaminated. At the end of the work shift. Follow instructions on the product label for dilution, contact time on the surface and required personal protective equipment (PPE). A diluted bleach solution, 1% household bleach, is considered to be an effective disinfecting agent.

130 Work Practice Controls- PPE The use of appropriate PPE is not optional! PPE is specialized clothing or equipment that is worn by an employee for protection against infectious materials. Always wear personal protective equipment (PPE) in potential exposure situations. Replace PPE that is torn, punctured or soiled. Reusable PPE must be properly cleaned, laundered, disinfected, repaired and disposed of at no cost to employees. Wash hands immediately after removing PPE.

131 Work Practice Controls- Hand Washing Hand washing Hand washing is one of the most important (and easiest) practices used to prevent the transmission of bloodborne pathogens. Wash hands or other exposed skin thoroughly as soon as possible following an exposure incident. Wash hands after removing gloves. Use antimicrobial soap. Do not use harsh or abrasive soap.

132 Work Practice Controls- Laundry Laundry: Remove clothing that is contaminated with blood as soon as possible. Use universal precautions when handling contaminated laundry by handling laundry as little as possible and protecting yourself with the proper PPE. Place clothing in approved and labeled bags or containers with the biohazard symbol. If the laundry will soak through the container, place in a secondary container and label with the biohazard symbol. Water soluble bags provide the greatest protection. They dissolve in laundry to minimize handling of contaminated items. Sorting or rinsing before transportation is not allowed.

133 Work Practice Controls- Regulated Waste Regulated waste items include: Blood or other potentially infectious materials (OPIM) in a liquid or semi-liquid form. Contaminated items that could release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed. Items with dried blood or other potentially infectious materials. Disposal Place items in closeable, leak-proof containers. These are: Built to contain all contents during handling, storing, transporting or shipping. Appropriately labeled or color-coded. Closed prior to transport, storage or handling. Placed inside a secondary container for shipping, transport or storage, if contamination occurs.

134 Work Practice Controls- HBV Vaccine Hepatitis B vaccinations: Employees who are routinely exposed to bloodborne pathogens, such as doctors, nurses or first aid responders, must be offered the hepatitis B virus (HBV) vaccine series. The vaccine series consist of three shots which build immunity to HBV. The three shot series is administered over a period of time. The HBV vaccine must be: Offered free of charge. Provided at a reasonable time and in an accessible location. Included for all employees at risk of exposure. Administered within 10 working days of initial assignment. Performed by a licensed professional.

135 Work Practice Controls- HBV Vaccine Employees do not have to be vaccinated if: They have already been vaccinated. An antibody testing reveals their immunity. They opt out after being offered the immunization. Opting out employees: Employees who decline the vaccination must sign a declination form. The vaccine must be made available if an employee initially declines and later decides to accept the vaccination. Employees are not required to participate in antibody prescreening programs to receive the vaccination series. Vaccination booster doses must be provided if recommended by the U.S. Public Health Service.

136 BBP- Emergency Response What to do if an exposure occurs: Wash the exposed area thoroughly with soap and running water. Use non-abrasive, antimicrobial soap. Flush the nose, mouth or skin with splashes of water. Irrigate eyes with water or saline. Report the exposure. Seek medical attention.

137 BBP- Post Exposure Follow Up Post-exposure follow-up: Routes of exposure and how the exposure occurred must be documented. Injuries from contaminated sharps must be recorded in a sharps injury log. Consent from the source individual and the exposed employee will be obtained and blood will be tested as soon as possible after the exposure incident. Risk counseling and post-exposure protective treatment for diseases will be provided when medically indicated. This is in accordance with current U.S. Public Health Service Guidelines. A written opinion of the findings will be provided to the employer with a copy to the employee within 15 days of the evaluation. Hepatitis B prophylaxis administration will also be available.

138 BBP- Medical Record Keeping For every incident, the following must be recorded: The name and social security number of the employee. The employee’s hepatitis B vaccination status. The results of examinations, medical testing and post-exposure evaluation. Follow-up procedures. Information provided to the health care professional. The health care professional’s written opinion. Employee medical records must be kept confidential and not disclosed or reported without the employee’s written consent (unless required by law). Medical records must be maintained for the employee’s duration of employment plus 30 years, according to OSHA’s rule governing access to employee exposure and medical records.

139 BBP- Medical Record Keeping Sharps injury log: Employers must maintain a sharps injury log for the recording of injuries from contaminated sharps. The log must be maintained in a way that assures employee privacy and must contain, at a minimum: The type and brand of device involved in the incident. The location of the incident. A description of the incident.

140 BBP- Summary Best practices: Always know what hazards you are working with. Use proper PPE in situations with bloodborne pathogens. Report all suspected exposures. Don't handle sharps or broken glass with your hands. Never fill a sharps containers more than two-thirds full. Read labels on the handling of decontaminants prior to use. Properly dispose of pathogen waste, PPE and sharps containers as regulated waste.

141 Workplace Violence and Prevention: Health Care and Social Service Accidents, and particularly street and highway accidents, do not happen - they are caused.

142 Workplace Violence Definition: Workplace violence is any physical assault, threatening behavior, or verbal abuse occurring in the work setting A workplace may be any location either permanent or temporary where an employee performs any work-related duty This includes, but is not limited to, the buildings and the surrounding perimeters, including the parking lots, field locations, clients’ homes and traveling to and from work assignments

143 Workplace Violence- Examples Verbal threats to inflict bodily harm; including vague or covert threats Attempting to cause physical harm; striking, pushing and other aggressive physical acts against another person Verbal harassment; abusive or offensive language, gestures or other discourteous conduct Disorderly conduct, such as shouting, throwing or pushing objects, punching walls, and slamming doors

144 Workplace Violence- Examples Making false, malicious or unfounded statements against coworkers, supervisors, or subordinates which tend to damage their reputations or undermine their authority Inappropriate remarks, such as making delusional statements Fascination with guns or other weapons, bringing weapons into the workplace

145 Workplace Violence- Types Violence by strangers Violence by customers or clients Violence by co-workers Violence by personal relations

146 Workplace Violence- Statistics Homicide is the second leading cause of death in the workplace In 1997, there were 856 homicides in America’s workplaces Assaults and threats of violence number almost 2 million a year Most common was simple assaults: 1.5 million a year Aggravated assaults: 396,000 Rapes and sexual assaults: 51,000 Robberies: 84,000 Homicides: nearly 1,000

147 Workplace Violence- Economic Impact Cost 500,000 employees 1,175,100 lost work days each year Lost wages: $55 million annually Lost productivity, legal expenses, property damage, diminished public image, increased security: $ billions $

148 Workplace Violence- Risk Factors Prevalence of handguns and other weapons among patients, their families, or friends Increasing use of hospitals by the criminal justice system for criminal holds and the care of acutely disturbed, violent individuals Increasing number of acute and chronically mentally ill patients being released from hospitals without follow- up care, who now have the right to refuse medicine and who can no longer be hospitalized involuntarily unless they pose a threat to themselves or others

149 Workplace Violence- Risk Factors Availability of drugs and money at hospitals, clinics and pharmacies, making them likely robbery targets Unrestricted movement of the public in clinics and hospitals Presence of gang members, drug/alcohol abusers, trauma patients, distraught family members Low staffing levels during times of increased activity such as meal and visiting times, transporting of patients

150 Workplace Violence- Risk Factors Isolated work with clients during exams or treatment Solo work, often in remote locations, high crime settings with no back-up or means of obtaining assistance such as communication devices or alarm systems Lack of training in recognizing and managing escalating hostile and aggressive behavior Poorly-lighted parking areas

151 Employer Responsibilities Under OSHA OSHA GENERAL DUTY CLAUSE, SECTION 5(a)(1) Each employer shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or likely to cause death or serious physical harm This includes the prevention and control of the hazard of workplace violence

152 Workplace Violence- Prevention Program Management Commitment and Employee Involvement Worksite Analysis Hazard Prevention and Control Training and Education Recordkeeping and Evaluation of Program

153 Employee Involvement Understand and comply with the workplace violence prevention program and other safety and security measures Participate in employee complaints or suggestion procedures covering safety and security concerns Prompt and accurate reporting of violent incidents

154 Administrative and Work Practice Controls State clearly to patients, clients, and employees that violence will not be tolerated or permitted Establish liaison with local police and state prosecutors Require employees to report all assaults and threats Set up trained response teams to respond to emergencies

155 Post-Incident Response Trauma-crisis counseling Critical incident stress debriefing Employee assistance programs to assist victims

156 Training and Education Employees should understand concept of “Universal Precautions for Violence”, i.e., that violence should be expected but can be avoided or mitigated through preparation Employees should be instructed to limit physical interventions in workplace altercations unless designated emergency response team or security personnel are available

157 Sources of Assistance OSHA Consultation Program OSHA Internet Site NIOSH Public Safety Officials Trade Associations Unions and Insurers Human Resource and Employee Assistance Professionals

158 This Concludes Today’s Training… Questions? Your safety gears are between your ears.

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