OSHA AND V ETERINARY M EDICINE Office Management

I NTRODUCTION OSHA stands for Occupational Safety and Health Administration and was founded in 1970 to ensure employee safety. Employer is responsible for providing a safe working environment for all team members and will be penalized if they do not. Up to $70,000 per violation OSHA oversees workplace hazards, including safe use and disposal of chemicals. Must have MSDS (Material Safety Data Sheets) sheets on hand for quick reference.

W HY DO WE NEED OSHA IN V ETERINARY M EDICINE ? Essential to prevent transmission of zoonotic disease. Safety plans are needed in case of fire or natural disaster. Normal day to day potential hazards should be addressed. Proper protection should be utilized when handling chemicals, or other dangerous situations.

Z OONOTIC D ISEASES Zoonoses- diseases that may be directly or indirectly transmitted to humans from wild or domesticated animals. More than 1400 diseases are currently known to be zoonotic. 60% are caused by pathogens known to cross species lines. Veterinary team members may be held liable if not properly educating the public and are vital in the public health role of control of zoonotic diseases. All employees should sign statement that they have received prevention training.

D ISEASE T RANSMISSION Mode of disease transmission is important to understand when trying to prevent the spread of a disease. Reservoir- place where infectious organism survives and replicates (within animal or soil) Host- living organism that offers an environment for maintenance for the organism but that may not be required for the organism’s survival. Depending on disease, organism may be transmitted to more than one host or reservoir. Control methods are generally aimed at reservoirs and hosts.

T YPE OF T RANSMISSION Direct Requires close contact between the reservoir of the disease and the susceptible host Indirect Intermediaries carry the agent of disease from one source to another Vector- living organism that transports infectious agents Ex: fleas, ticks, mosquitos Vehicle- mode of transmission of an infectious agent from the reservoir to the host. Ex: food, water

C ONTROL OF Z OONOTIC D ISEASES Is important as a technician to recognize early symptoms of zoonotic diseases and know how to treat. Those at risk are immune compromised, the old, and the young. Prevention may be aided by good hygiene, vaccination, and water filtration.

A NIMAL H ANDLING AND H USBANDRY Animal related injury number one injury in a vet clinics Potential of zoonotic diseases Training is a must with new employees!! When bitten, employee should wash area for at least 5 minutes and seek medical attention.

P ERSONAL H YGIENE Regular Hand washing is strongly encouraged Before eating, drinking Before smoking Before leaving Before and after using restroom After handling specimens After handling animals

H OW TO PERFORM A THOROUGH H AND W ASHING Wet both forearms with warm water Apply a generous amount of disinfecting soap in the palm of one hand Using a vigorous motion, scrub each side of the hand, between the fingers and at least halfway up the arm If there is debris under the fingernails, use a hard pick or stiff brush to remove matierial while soap is still on the hands Rinse both hands thoroughly with warm or tepid water Dry both hands and arms with a towel or air dryer

S AFETY H AZARDS IN THE V ETERINARY P RACTICE Moving Equipment/Lifting Multiple employees should be involved if over 40 lbs. Lift with legs. NOT BACK!

Wet Floors Signs should be posted to indicate a wet floor hazard. May need to dry the floor sometimes Running Team members should not be allowed to run through the practice.

Toxicities Chemicals Radiology chemicals Cleaning supplies Should not mix certain chemicals together Chemotherapy agents Sometimes are expelled in urine and feces of pets Medications Excess drug powder and residue can collect on the hands Repeated ingestion may not be safe Washing hands is essential after handling medication

Radiation Must be taken seriously Excess can cause birth defects, sterility and even cancer Must wear proper PPE OSHA states that employees must provide and demonstrate proper use of PPE in veterinary clinics Collimation also important when it comes to radiation as well A dosimeter badge is worn on collar to measure radiation exposure Allowed.05 Sv/year as occupationally exposed (5 rem/year) Appropriate signs must be posted to indicate radiology sites

A NESTHETIC G ASES Practices are expected to properly store, label and use chemicals safely. Should help to keep employee exposure under allowed limits. Should: Have periodic monitoring of equipment and exposure levels. Have proper ventilation. Have proper scavenging systems. Train staff appropriately.

M ASKING AND T ANK I NDUCTION Make sure masks and tanks have tight-fitting seals and are connected to scavenging systems. Use proper fitting masks for patients Only use masking procedures when medically indicated Remember to turn on oxygen, place mask, then turn on gas, reverse order to remove mask.

S IMPLE A NESTHETIC E XPOSURE B ADGES Used to help test exposure to anesthetic gases. Can be obtained from several labs. Should be worn by a typical employee on typical workload day. OSHA recommends testing every 6-12 months.

W ASTE A NESTHETIC G AS S CAVENGERS Active Scavengers Fan in a box that creates vacuum Cost from $400-$1000 Will need maintenance and replacement Manual activation, must be turned on Passive Exhaust Channels gases through a tube from patients diaphragm Limited distance Adsorption Charcoal absorption canisters Should be monitored and changed

B IOHAZARDS Sharps containers Biological bags

F ORMALIN /F ORMALDEHYDE Make sure properly identified and stored. Keep least amount on hand as possible. Wear Appropriate PPE.

E THYLENE O XIDE Form of sterilization procedure. Not used as commonly today. MUST be used with a ventilation system. Link with cancer. Fines associated with trying to shortcut the process. OSHA requires monitoring to take place. Will use bade devices to detect exposure levels. Detailed written plan also required. Make sure to follow manufacturer instructions. Make sure to follow proper storage and training recommendations.

E THYLENE O XIDE C ONTINUED Emergency Plans If exposed, adequate fresh air is the treatment of choice. If irritation persists, consult physician. If in contact with liquid form, removal all contaminated clothing and wash skin surfaces for 15 minutes. If in contact with eyes, use eyewash for at least 15 minutes and consult an ophthalmologist.

C HEMICALS Five Specific requirements that veterinary clinic must follow: 1. Practice must have a written chemical plan. 2. A complete list of all hazardous chemicals must be maintained. 3. The practice must maintain a library of material safety data sheets. 4. All containers of hazardous chemicals must be properly labeled. 5. The practice must train all staff members on the dangers and safety aspects of the chemicals.

B ULK C HEMICALS If more than 20 gallons, should consult with fire department about storage. Should make sure areas with large amount of chemicals are properly identified. Should have plans in place if emergency occurs for avoiding areas with bulk chemicals.

C HEMICAL S AFETY T RAINING Conduct training as soon after the person is hired as possible. Prepare workbook or handout for training. Include worker’s rights. Provide hospital policy copies. Stress importance of PPE. All chemicals must be stored in tightly sealed containers and be placed below eye level in case they are spilled. If have to store on higher shelves, use step stool to retrieve.

D ETERMINING C HEMICAL ’ S H AZARD Health Hazard: chemical for which there is evidence that acute or chronic health effects may occur in exposed employees. Falls into following categories: Carcinogen Toxic Irritant Sensitizer Any agent which damages the lungs, skin, eyes or mucous membranes. Physical Hazard: chemical that is: Combustible liquid Compressed gas Explosive Flammable Organic peroxide Oxidizer Pyrophoric Unstable Water-reactive

H AZARDOUS CHEMICAL L ABELS All chemicals should be properly labeled Should always label secondary containers No special labels are required, but should be uniform throughout practice. If can’t physically label, use a color code system. If is a prescription, no additional information is needed than is what is found on a customary prescription label.

D IAMOND L ABELING S YSTEM National Fire Protection Association uses colored diamond labels to indicate the risks associated with health, fire, reactivity, and special hazards of specific chemicals. Diamond stickers are placed at entry point of the practice, along with the room the hazard is located in. Good for any emergency personnel that may be responding to a situation. Also should be placed on chemicals that are transferred from their original bottle.

E XEMPTIONS Hazardous waste- by EPA not OSHA Tobacco products Wood or wood products Articles (what is product of hazardous materials) Food, drugs, cosmetics or alcoholic beverages that are packaged to be sold to consumers and that are not opened in the hospital. Foods, drugs, cosmetics intended for personal consumption by the employee while in the workplace. Any common cleaner that is is used in way as is used by average consumer. Any drug sold in final solid form to client for immediate consumption by patient.

W RITTEN C HEMICAL P LAN Should be reviewed and revised often. Should include hazardous material and what PPE is recommended for use while using this chemical. Should describe training offered to employees on a chemical. Should outline MSDS system.

C HEMICAL S PILLS Spill kit should be developed and maintained in a location that is easy to access. Should include Cat litter Dustpan Broom Nitrate gloves Eye protection Copy of cleanup procedures

C HEMICAL S PILL C LEANUP P ROCEDURES Remove all unnecessary people and pets from area to prevent spreading and exposure to chemical. Increase ventilation to area. Open windows and turn on exhaust fans and vents. Put on protective gloves. Put on gown if needed. Cover spill with absorbable material, either cat litter or paper towels. Clean up saturated absorbent material. Place chemicals in a trash bag and dispose of it properly. Wash hands Replace materials used in spill kit.

M ATERIAL S AFETY D ATA S HEETS Produced by the chemical manufacturer. Should be kept together in one location. Should be indexed in a systematic way. Call distributor or manufacturer if need a MSDS. Should be current within 3 years

C ONTENTS OF MSDS SHEETS Each MSDS sheet should contain: The identity of the chemical Physical and chemical characteristics Health hazards Permissible exposure limits Whether the product is a carcinogen Emergency first aid procedures Specific hazards

E YE WASH DEVICES Mounted and eyewash bottles. Mounted stations should not be on faucet used for bathing animals because of exposure to other chemicals. Device should not be locked. Hand held bottles are designed for foreign bodies and not chemicals. Employees should be trained as to location and operation. Flushing is recommended for minutes, refer to MSDS sheet.

F OOD AND B EVERAGES Consumption of food and beverages must be limited to areas free of toxic and biologically harmful substances. Staff lunches, drinks, condiments and snacks must be stored in an area free from biological or chemical hazards.

E LECTRICITY Outlets should not be overloaded with excessive plugs and extension cords Symptoms of electrical problems include frequent tripping of circuits and lights that dim when large pieces of equipment are used. Extension cords should not be used on a permanent basis If used, use with a 3 way conductor for better protection and should never be run through doorways or windows.

E XITS Should never be blocked Use caution where storing supplies Signs must indicate where the exit is located. If door looks like exit but is not must be marked as “NOT an EXIT” Emergency lights are required and must be tested on a yearly basis. Lights must be installed in locations that lead to the exits

A UTOCLAVES Generate a high amount of heat and steam Should be properly ventilated before opening door. Face and hands should be kept away from both the vent and door when venting and opening the autoclave.

L ARGE ANIMALS Never be in chute with large animal Make sure stalls are locked Make sure approach slowly and use common sense.

B ATHING, G ROOMING AND I NSECTICIDES Wear appropriate PPE. Make sure that wet areas or dangerous areas are identified. All chemicals should be stored and labeled properly. Anything changed from one container to another should be properly labeled.

Compressed air cylinders Should be stored in a dry, cool place, away from potential heat sources. Must be secured in an upright position by holder, bracket, chain or strap. Sign should identify where these cylinders are kept. v=ejEJGNLTo84 v=ejEJGNLTo84

D RESS Must dress appropriately for job. No open toed shoes Jewelry should be kept to a minimum

N OISE H AZARDS Generally the kennel area. If prolonged exposure, may be harmful. Should be identified by a sign and ear protection should be provided. Sound Panels may be used to help reduce noise.

E RGONOMICS Repetitive movements. Have computers and office equipment comfortable and able to prevent injury.

OSHA R EQUIRED T RAINING T OPICS Animal handling Chemicals Ethylene oxide Emergency and fire prevention plan Formaldehyde Ionizing radiation Medical services and first aid Noise exposure Medical waste and sharps Personal safety, violence prevention Portable fire exit Personal Protective Equipment Signs and tags Worker’s Rights and Responsibilities

D EVELOPING S AFETY P ROTOCOLS Should be developed in each practice to ensure employee safety. Must be instituted regarding how employees will be notified in case of emergency. Where to meet in case of emergency, and how safety plan will take effect. Role playing may be needed

I MPLEMENTING S AFETY P LANS AND P ROTOCOLS 4 steps: 1. Gather information Designate a safety officer Make sure all registrations are current 2. Delegation and Preparation Hazards can be placed in different sections 3. Training Training on the different sections 4. Implementation Following previous three sections

D EVELOPING A H OSPITAL S AFETY M ANUAL Should include an overview of all materials covered so far. Include hazards communication plan, MSDS filing system, and explanation of secondary labeling system.

H AZARD C OMMUNICATION : E MPLOYEES R IGHT TO K NOW To establish compliance, a practice must have: A designated safety manager. This employee is responsible for training all team members and ensuring the safety program meets standard requirements. A written plan A summary of all hazardous chemicals available, including injectable medications, pesticides, antiseptics. Disinfectants, and laboratory agents. MSDS’s available at all times. If any chemicals are transmitted to another container, the new container must be accurately labeled with descriptions that are transferred to a spray a bottle to clean exam room tables. An explanation of the labeling system. A protocol for emergency evacuation. A training program implementing the use of PPE and monitoring devices as well as hazards of the practice. Required for all practices with 11 or more employees.

S TAFF R ESPONSIBILITIES Read the OSHA poster Comply with standards Follow rules and regulations Wear PPE while working Report hazardous conditions Report any job-related injury or illness to employer and seek treatment Cooperate with OSHA compliance officers

E MPLOYER ’ S R ESPONSIBILITIES Responsibilities Provide a hazard free workplace Set and enforce safety rules Provide Personal Protective Equipment (PPE) with proper instructions Provide training on any potential workplace hazards

E MPLOYER ’ S R IGHTS Rights: Enforce workplace rules Be present during an inspection or investigation. Require a warrant for inspection. Request postponement of inspection. Expect that no trade secrets will be divulged Consult an attorney See any complaints Have employees interviewed at a time that does not interfere with staff member’s job Right to appeal findings

A CCIDENT R EPORTING AND I NVESTIGATION Every accident must be reported to the safety manager and/or practice manager and owner. If medical treatment is needed, appropriate paperwork should be available for employee to take to hospital or doctor. Paperwork may include First Notice of Accident or Injury and Illness Accident Report as well as Workers’ Compensation Insurance Claim form. Paperwork should be sent to appropriate authorities upon employee’s return. Documentation of the safety program must exist.

F IRE P REVENTION Most common causes of fire are overloaded electrical circuits and items stored too close to heat sources. Practices with 10 or more employees must have a written OSHA plan that includes fire prevention and response. Fire codes vary by location and inspection is conducted by the fire department. Before using fire extinguisher, make sure alarm has sounded.

F IRE E XTINGUISHERS Must be located no more than 75 feet from any distance within the clinic and placed 32 to48 inches above the ground surface. Should be placed near the exit doors of the practice. All employees must be trained in the use of the fire extinguisher PASS P= pull the pin A= Aim low. Point the extinguisher to the bottom of the fire S= Squeeze the handle S= Sweep from side to side at the base of the fire until it appears to be out.

F IRE E XTINGUISHERS CONTINUED Made of carbon dioxide, dry chemicals, halon or water. Carbon dioxide is most effective on class B and C fires (liquid and electrical) but is only effective for 3 to 8 feet because carbon dioxide disperses quickly. Dry chemical fire extinguishers are used for a variety of fires and contain and extinguishing agent and compressed gas a propellant. Halon extinguishers contain a gas that interrupts the chemical reaction taking place when fuel burns Water extinguishers are used for combustible (Class A) fires only,

S MOKE D ETECTORS / F IRE S PRINKLERS Batteries in smoke detectors should be replaced on a yearly basis. Monthly testing is recommended. New buildings are required to have sprinklers and should be evaluated to ensure they are working order.

E SCAPING A NIMALS Windows should never be left open. Doors should never be left open. Should use slip leash when removing dogs from kennels (double leash in opposite directions is ideal). Feral animals should be handled with caution.

V ETERINARY P RACTICE AND THE L AW Clients that are injured on the premises may be tempted to sue. Prevention is the key. Team members must report any injury and be aware of all potential hazards in the clinic.

OSHA I NSPECTIONS Know who is allowed to admit inspectors. On-site inspection must be triggered by at least one of the following: Written complaint and OSHA must believe that a safety or health danger exists. Complaint must allege that physical harm has occurred and that hazards still exists. Must allege imminent danger Employer failed to provide adequate response to a compliant Business has history of failure-to-abate citations during last 3 years. Discrimination issues for filing complaints about OSHA standards

H OW TO S URVIVE I NSPECTION Be polite and cooperative Verify credentials Request that inspection take place at a more convenient time Make time for inspection Take notes and pay attention during inspection Have employees “stand-by” during inspection Show officer only what he or she asks to see Have copies of hospital policies readily available Correct any violations immediately

W HAT SHOULD YOU DO ? Mr. Yazzi, a long term client, has come into your practice with Taco, his Pomeranian. Upon walking to the counter to check out, Mr. Yazzi trips on the scale, which was recently moved into the hallway between the exam rooms. He is able to catch himself but twists his back, sending it into muscle spasms. He states he is fine and it was his fault for not looking down. You offer him a chair to sit down and rest and let his back relax but he refuses and pays his bill and leaves practice. What should you do?