179 Healthcare: Introduction to Common Hospital Hazards

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Injuries in a hospital can often come from lifting and moving people.
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Hazard Types

Ergonomic Hazards

In healthcare and hospitals, injuries can often come from lifting and moving people or heavy objects, or a lot of bending, twisting or reaching. Examples of this kind of work are transferring a patient from bed to chair, helping a patient who has fallen, and handling trolleys and wheelchairs. Tasks like these may involve hazardous manual handling, which can lead to musculoskeletal disorders (MSDs) like sprains and strains to the back and shoulders.

Sometimes patients are totally dependent on staff members to provide activities, such as dressing, bathing, feeding, and toileting while they are in the hospital. Each of these activities involve multiple interactions with handling or transferring of patients/residents and could result in employee injuries. Employee injuries lead to increased injury costs, higher turnover rates, increased sick/injured days, and staffing shortages.

It is important to effectively identify and address employee exposure to work related MSDs from ergonomic stressors in a facilities safety and health program.

For more information on preventing ergonomic injuries in healthcare, see OSHAcademy course 623 Preventing Ergonomic Injuries.

1. An important prevention to ergonomic injuries in a healthcare setting is _____.

a. asking someone else to do it
b. telling a patient to try harder to move
c. having a valid and current safety and health program
d. getting a different job

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Slips, Trips, and Falls

Wet Floor
Hospital employees may be exposed to wet floors or spills that increase their risk of slipping or falling.
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Hospital employees may be exposed to wet floors or spills that increase their risk of slipping or falling. Hospitals are complex work environments often having medical equipment and clutter where employees are working, increasing the potential for tripping and falling.

You can reduce the chance of a slip, trip, or fall by implementing these best practices:

  • Keep floors clean and dry [29 CFR 1910.22(a)(2)].
  • Provide warning signs for wet floor areas [29 CFR 1910.145(c)(2)].
  • Where wet processes are used, maintain drainage and provide false floors, platforms, mats, or other dry standing places where practicable, or provide appropriate waterproof footgear [29 CFR 1910.141(a)(3)(ii)].
  • The Walking/Working Surfaces Standard requires keeping all places of employment clean and orderly and in a sanitary condition [29 CFR 1910.22(a)(1)].
  • Keep aisles and passageways clear and in good repair, with no obstruction across or in aisles that could create a hazard [29 CFR 1910.22(a)]. Provide floor plugs for equipment, so power cords need not run across pathways.
  • Keep exits free from obstruction. Access to exits must remain clear of obstructions at all times [29 CFR 1910.36(b)(4)].

For more information on this topic, see course 624 Healthcare: Slip, Trip, and Fall Prevention.

2. Access to exits must remain clear of obstructions _____.

a. only if it is in a high-traffic location
b. at all times
c. only in the nurses’ station
d. in patient rooms

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Hazardous Chemicals

Hazardous Chemicals
Hospital employees are at an increase risk of exposure to hazardous chemicals, such as hazardous drugs.
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Hospital employees are at an increased risk of exposure to hazardous chemicals, such as pesticides, disinfectants, and hazardous drugs.

OSHA requires employers implement a written program that meets the requirements of the Hazard Communication Standard (HCS) to provide for worker training, warning labels, and access to Safety Data Sheets (SDSs).

The Hazard Communication Standard ensures employee awareness of the hazardous chemicals they are exposed to in the workplace.

In addition to implementing a written program and providing training, employers are also required to provide appropriate personal protective equipment (PPE) when handling hazardous detergents or disinfectants. If an employee is exposed to a chemical hazard, hospitals must also provide suitable facilities for quick drenching or flushing of the eyes or body within the work area for emergency use.

Whenever possible, hospitals should substitute a non-hazardous product to eliminate the hazard.

For more information on this topic, see course 171 Healthcare: Hazardous Chemicals.

3. According to OSHA, who is required to provide appropriate personal protective equipment to workers?

a. Employer
b. State government
c. Employee
d. President

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Bloodborne Pathogens

Employers are required to identify employees who have occupational exposure to blood or other potentially infectious materials.
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Employers are required to identify employees who have occupational exposure to blood or other potentially infectious materials (OPIM) [29 CFR 1910.1030(b)]. Hospitals must implement a written Exposure Control Plan (ECP) designed to eliminate or minimize employee exposure to blood or OPIM [29 CFR 1910.1030(c)(1)].

Exposure Control Plan requirements:

  • Document an annual review and update of the written plan. The review process should evaluate new technology for safer medical devices that reduce or eliminate an employee’s exposure [29 CFR 1910.1030(c)(1)(iv)(A)]. Hospitals, as an employer, must also document their consideration and implementation of the safer medical devices annually [29 CFR 1910.1030(c)(1)(iv)(B)].
  • Hospitals are also required to get input for the safer medical devices from those directly responsible for patient care [29 CFR 1910.1030(c)(1)(v)]. The input provide by these employees must also be documented.
  • Employers are required to ensure the written ECP is accessible to all employees [29 CFR 1910.1030(c)(1)(iii)].

Employers should ensure employees with occupational exposure to bloodborne pathogens receive appropriate training, at no cost to employee and during working hours [29 CFR 1910.1030(g)(2)(i), 29 CFR 1910.1030(g)(2)(vii)].

For more information on this topic, see course 656 Bloodborne Pathogens in the Healthcare Setting.

4. An Exposure Control Plan must be ______.

a. recorded
b. hidden
c. unavailable
d. written

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Workplace Violence

The prevention of workplace violence has emerged as an important safety issue in and around hospitals and healthcare facilities. Workplace violence such as physical assaults, or threatening or violent behavior, are a growing problem in the workplace. The workplace may be any location either permanent or temporary where an employee performs any work-related duty.

From 2002 to 2013, incidents of serious workplace violence (those requiring days off for the injured worker to recuperate) were four times more common in healthcare than in private industry on average. In 2013, the broad "healthcare and social assistance" sector had 7.8 cases of serious workplace violence per 10,000 full-time employees. Other large sectors such as construction, manufacturing, and retail all had fewer than two cases per 10,000 full-time employees.

OSHA recommends that employers establish and maintain a violence prevention program as part of their facility's safety and health program. The prevention program should:

  • be available to all employees
  • ensure employees receive specific training on program content and implementation
Workplace Violence
There are important components that should be included in a facility's Violence Prevention Program.

The main components that should be included in a facility's Violence Prevention Program are:

  • management commitment and employee involvement
  • worksite analysis
  • hazard prevention and control
  • safety and health training
  • recordkeeping and evaluation of program

To prevent workplace violence a written program should incorporate the above areas and state clear goals and objectives suitable to the size and complexity of the given workplace. Although not every incident can be prevented, many can be, and the severity of injuries sustained by employees reduced by following a violence prevention plan.

For more information on this topic, see course 176 Healthcare: Workplace Stress and Violence.

5. Which of the following component should NOT be included in a facility’s Violence Prevention Program?

a. Management commitment
b. Education
c. Safety and health training
d. Consequences

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Burns and Cuts

Burns and Cuts
Employees can be exposed to burns or cuts when handling or sorting hot sterilized items or sharp instruments.

Employees can be exposed to burns or cuts when handling or sorting hot sterilized items or sharp instruments. Burns and cuts can also happen when employees are removing these items from autoclaves/sterilizers or from steam lines that service the autoclaves.

Work Practice Controls

To avoid burns or cuts, there are many things you can do. Here are some work practice controls to prevent hazards:

  • Do not remove items from sterilizers until cooled.
  • Avoid handling sharp ends of instruments.
  • Use forceps or other devices to remove sharp instruments from baskets and autoclaves.
  • Provide appropriate Personal Protective Equipment (PPE).
  • Employers must assess tasks to identify potential worksite hazards and provide and ensure that employees use appropriate personal protective equipment [29 CFR 1910.132].
  • Employers shall require employees to use appropriate hand protection when hands are exposed to hazards such as cuts or lacerations and thermal burns. Examples of PPE which may be selected include using oven mitts when handling hot items, and steel mesh or Kevlar gloves when handling or sorting sharp instruments [29 CFR 1910.138(a)].

6. When are healthcare employees most at risk for burns or scrapes?

a. Right after a training class
b. When they are working with someone else
c. When handling or sorting hot sterilized items or sharp instruments
d. Only at the end of their work shift

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Carbonless Paper

Potential Hazard

Carbonless paper is used every day for checks, credit-card receipts and medical forms. Tiny micro granules of dyes and resins are released when sheets are pressed together. The released chemicals can be absorbed through the skin or released into the air and inhaled resulting in mild to moderate symptoms of skin irritation and irritation of the mucosal membranes of the eyes and upper respiratory tract.

Carbonless Paper
Carbonless paper can cause moderate symptoms of skin irritation.

Symptoms include the following:

  • headaches
  • sinus infections
  • bronchitis
  • eye and skin irritations
  • shortness of breath
  • hives
  • allergic contact dermatitis (rare)

Possible Solutions

The National Institute for Occupational Safety and Health (NIOSH) recommends, in most cases, good industrial hygiene and work practices should be adequate to reduce or eliminate symptoms, including:

  • adequate ventilation, humidity, and temperature controls
  • proper housekeeping
  • minimal hand-to-mouth and hand-to-eye contact; and periodic cleansing of hands

7. Which of the following is a possible solution to reduce symptoms from carbonless paper?

a. Poor housekeeping
b. Proper housekeeping
c. Dirty hands
d. Inadequate ventilation

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