Do your staff know how to keep safe?
OSHA expects you to make sure they learn
You hold an inservice on safety and infection control each year, but are you certain it covers everything your staff need to know? The Occupa tional Safety and Health Administration (OSHA) in Washington, DC, is concerned about home health care staff safety in the office, on the road, and in patients' homes. OSHA regulations require safety measures that cover everything from preventing latex glove allergies to protecting staff from a deranged, gun-wielding family member.
Several education managers interviewed by Homecare Education Management have developed comprehensive staff safety and OSHA inservices. They offer these guidelines for what a home health agency should cover:
1. Start with OSHA's toxic substances regulations.
Optima Health Visiting Nurse Services in Manchester, NH, begins its general OSHA inservice with a discussion about toxic substances and what information is printed on a material safety data sheet (MSDS) that manufacturers send the agency, says Susan Garside, RN. Garside is inservice coordinator for the full-service agency that is affiliated with the Optima Health System in Manchester.
She hands out a packet of information that includes a sample MSDS and an explanation of the information contained on the sheets. Each MSDS includes:
o manufacturer's identity;
o product's hazardous ingredients;
o product's physical and chemical characteristics;
o fire and explosion data;
o reactivity and stability of substance;
o health hazards due to exposure;
o precautions for safe handling and use;
o control measures.
Garside also explains to staff how important labeling is on hazardous substances. "If you remove anything from its original container and put it in another container for use, you need to label that second container with the product name and any health hazards listed on the original label," she says.
2. Cover infection control and universal precautions.
Optima Health Visiting Nurse Services divides its OSHA inservice into two parts. The first part is for the entire staff and includes hazardous chemicals and infection control, says Linda Grass, RN, education coordinator for the agency.
"After an hour, the office staff take part of their exams and leave, and then we continue with the clinical aspects of OSHA safety and infection control," she says. The basic infection control section covers hand washing and what to do if the employee is exposed to any type of communicable disease.
Explain transmission of TB
The education managers discuss tuberculosis (TB) and its airborne transmission. All employees are told they must have an annual TB test. Then Garside explains what a positive test means and how further testing might need to be done. For nurses and other clinical staff, education managers go into more detail about disease transmission and review causative agents, she says.
Using TB as an example, the causative agent is the tubercle bacillus, also called Mycobac ter i um tuberculosis. Then they explain how the organism lives in a reservoir, and with TB that reservoir would be the respiratory system. The portal of exit, how the organism leaves its home, is through coughing, Garside explains. "The mode of transmission in TB would be air because the organism is airborne," she adds. Finally, the susceptible host is the person who contracts the organism.
The clinical infection control review also covers universal precautions. "We explain what `universal precautions' means. Basically, it means that all clients are considered potentially infectious, so we treat everyone the same way," she says. "We always wear gloves if there is contact with a wound. Just because a client lives in a beautiful home in a nice section of town doesn't mean you don't have to wear gloves."
Clinical staff are told to carry personal protection equipment in their bags at all times, so they'll always have a barrier if they come into contact with a spill or bleeding, Garside says. That equipment includes two pairs of gloves, a paper mask, a gown, disposable goggles, alcohol wipes, a shower cap, and booties, all sealed within a plastic bag. "We give a quick review of correct bag technique," she adds. "Inside the clinical carrying bag, everything is considered clean, so you must wash your hands and get everything out you need and don't re-enter until your hands are clean again."
Likewise, home health aides should make sure the items they use, such as nail clippers, blood pressure cuffs, stethoscopes, and thermometers, are wiped with alcohol and cleaned before being returned to a clean plastic bag or container. "And we review the fact that if their sharps containers are three-quarters full, they should bring them back for disposal," Garside says.
"We encourage clients who do self-injections to dispose of their syringes in puncture-proof containers, such as heavy detergent bottles or metal coffee cans, before throwing them away," Grass says.
3. Go over violence prevention.
OSHA's requirement that agencies provide a workplace free of recognized hazards includes the patient's home, says Kristie Brandenburg, RN, personnel and education manager for Ridgeview Home Care Community Services in Waconia, MN. Brandenburg spoke in April about workplace violence at the 13th National Home Care Aide Service Conference in Washington, DC.
"OSHA identifies the risk factors, like poorly-lit parking areas and a lack of staff training on how to manage assaultive behavior," she says. "Another risk factor is solo work in remote locations where there is high crime."
She says some statistics show the prevalence of guns in the homes of patients and caregivers is as high as 25%. For those reasons, she suggests home care agencies develop programs to prevent workplace violence, including conducting a worksite analysis, annual safety training, home safety assessments, and detailed security measures. (See story on violence prevention and worksite safety, p. 111.)
4. Review fire, electrical, and general safety.
Electrical safety has become a greater concern in the home health setting, Grass says. Optima Health Visiting Nurse Services provides employees with a brief guideline on how to prevent electrical shocks and with a booklet on home safety. Basically, home care staff are instructed to report immediately any shocks they receive from medical equipment and to report to a manager if any medical equipment is plugged into an outlet that has a three-pronged adapter. Such adapters may not be grounded and could cause electrical shock.
Garside says the agency's fire safety portion uses the acronym RACE:
R: Rescue yourself and others; remove yourself from harm.
A: Pull the nearest alarm.
C: Contain the fire by closing doors and windows on the way out, or if the fire is small enough, try to put it out with a fire extinguisher.
E: Exit the building.
"Then we briefly cover how to use a fire extinguisher," she says. "They must pull the pin, aim at the base of the fire, and squeeze the extinguisher using a sweeping motion to put out a small flame."
Education managers also remind staff they're required to wear seatbelts. "And we go over basic common sense things, such as if there's bad weather, they should have proper footwear and make sure their car is in good condition," she says.
Also, field staff should carry emergency items in their trunks, including jumper cables, flares, sand or kitty litter for ice, a small shovel, and a blanket. "We recommend that if there are any unsafe driving conditions, or if staff members come across a disaster anywhere in the city, then they should call and alert us so we can put out a general page to alert other employees in that area," she says.
5. Explain how to write an incident report.
Optima Health Visiting Nurse Services has several types of incident reports, and the inservice covers why and how each is used. The forms include:
o incident reports for staff accidents or injuries;
o reports for medication errors made by employees;
o reports for suspected client reactions to drugs;
o reports for any serious injury or death of clients or employees potentially caused by a faulty medical device;
o reports for all other incidents.
The agency's education managers tell staff they must report any incident inconsistent with the routine care of a patient, the routine service of a department, or the routine operation of a facility, Garside says. They must report all incidents that have occurred as well any potential hazards. "Also, we stress that all information going onto an incident report should be objective. That is not the time to guess at something."
6. Briefly touch on latex allergy and back safety.
Optima Health Visiting Nurse Services gives employees two pages of questions and answers about latex allergy, Garside says. The agency's health system even has a latex allergy committee dedicated to protecting employees and patients from unnecessary exposure to latex.
The two-page sheet explains that latex is a milky sap harvested from a rubber tree and is found in more than 40,000 products, including surgical gloves, condoms, balloons, and chewing gum. It also includes:
o what latex sensitivity or allergy is;
o what to do if you think you have a latex allergy;
o what to do if you have problems with gloves;
o how to find out if patient care products contain latex;
o where to find the agency's latex-free carts;
o how to obtain replacement materials for the latex-free carts;
o whom to call with questions.
The agency has a separate inservice on back safety, but it also briefly covers this topic during the OSHA seminar, Grass says. "I had gone to a seminar on ergonomics and back injuries, and a speaker said the home care industry has the highest rate of back injury when compared with long-term care and hospitals," she relates. "Working in an environment that is not conducive to medical equipment has really put us at risk, and we have to be aware of body mechanics."
The education managers give employees a handout that explains how most back injuries are caused by an accumulation of long-term bad habits, not by one specific injury.
"Most back injuries result from improper lifting, bending the back when reaching too far, reaching to one side, twisting, off-balance lifting, or just attempting to lift too much," Garside says. "We go over what is the correct way to lift, such as squatting close to the object; keeping your back straight; grasping the object firmly and holding it close to your body, and lifting with your legs."
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