Exam 1 - PPE Flashcards
What is PPE?
Personal protective equipment
Equipment worn to minimize exposure to serious workplace hazards
Why do we wear PPE?
Illness/injury can result from the following hazards:
- chemical
- radiological
- physical
- electrical
- mechanical
(PRE CM)
Examples of PPE (longer list)
Safety glasses
Full bodysuits
Respirators
Earplugs/earmuffs
Shoes/shoe covers
Hard hats
Coveralls
Gloves
Vests
(Selling FRESH Cut Green Vegetables)
Who can mandate the use of PPE?
OSHA and employers
Does PPE protect the wearer or the patient?
BOTH
When MUST employers provide proper PPE?
When engineering, work practices, and administrative controls are not feasible or not providing enough protection to the employee
Employers MUST ensure proper use of PPE. What is included in “proper use?”
Correct fit
Comfortability
PPE stores & maintained correctly
Why must PPE fit correctly?
Improper fit can cause dangerous exposures
Why is comfortability included in proper use of PPE?
Encourages employee use
(Think about how many people refuse to wear masks right because it’s uncomfortable)
Employer requirements regarding PPE
Train employees who are required to use PPE
Training should be done on an annual basis (usually part of OSHA training)
PPE programs should be used to address certain points
What should employees who are required to use PPE be trained on?
When to use
What type of PPE is needed
How to properly don/doff PPE
Correct storage and disposal of PPE
Limitations of the equipment
(Look What Happens With Coke)
What should PPE programs address?
Potential hazards
Selection/maintenance/use of PPE
Training of employees
Monitoring
(Meet Some People Today)
Types of PPE (shorter list)
Face shields
Respirators
Gloves
Gowns/aprons
Goggles
Masks
(Feeling Really Great + Getting Good Money)
What do respirators protect?
Protect respiratory tract from airborne infectious agents
Key points about PPE
Don PPE before contact w/ patient — preferably before entering the pt room
Use carefully & don’t spread contamination
Remove & discard carefully at room doorway or immediately outside the room — remove respiratory outside the room
HAND HYGIENE
When should hand hygiene be performed (in relation to PPE)?
Immediately after removing PPE
If hands are visibly contaminated during PPE removal, wash hands BEFORE removing any other PPE
Hand hygiene after PPE is removed
Wash hands w/ soap and water or use alcohol-based hand rub
Important to ensure hand hygiene facilities are readily available at the locations needed
What are standard precautions?
Recommends the use of PPE & other infection control practices to prevent tranmission
Previously called “universal precautions”
What do standard precautions assume could be infectious?
Blood and bodily fluids of ANY patient
How is the type of PPE to be used determined?
By the clinical interaction w/ the patient
Standard precaution recommendations
Perform hand hygiene
Use PPE whenever there is the expectation of possible exposure to infectious material
Follow respiratory hygiene/cough etiquette guidelines
Ensure proper pt placement (ie isolation precautions)
Properly handle, clean, and disinfect pt care devices/instruments
Handle textiles and laundry carefully
Follow safe injection practices
(He’s Feeling Pretty Fucking Ugly, Putrid Even)
What type of PPE would you wear when transporting a pt in a wheelchair?
Generally none
(You aren’t even touching them so it’s fine)
What type of PPE would you wear when responding to an emergency situation w/ bloody injuries?
Fluid resistant gloves
Mask/goggles or face shield
(Gloves for obvious reasons and mask/goggles in case of splashing)
What type of PPE would you wear when cleaning an incontinent pt w/ diarrhea?
Gloves
(Realistically, it should only touch your hands)
What type of PPE would you wear when irrigating a wound?
Gloves
Gown
Mask/face shield
(Because of splash risk)
Contact precautions
Gown and gloves w/ pt or environment of care
Medical equipment or sometime when entering pt environment
Droplet precautions
Surgical masks within 3 ft of pt
(Think about how much people talked about droplets during covid)
What type of PPE would you wear when taking vital signs?
Generally none
(Makes sense because wearing any would be stupid)
What are expanded precautions? Categories?
Transmission based precautions
Include:
- contact precautions
- droplet precautions
- airborne infection isolation
(CAD)
Airborne infection isolation
Particulate respirator
NEGATIVE pressure isolation room required
(NEGATIVE pressure because you want others to be NEGATIVE for the infection)
What is PPE used when handling HDs considered?
CONTAMINATED
Must be disposed of properly
Hand hygiene for expanded precautions
Immediately after removing PPE
Between pt contacts
Either w/ soap and water or alcohol-based hand rub
Can you wash PPE?
NO (other than a few exceptions)
Disposable PPE is designed to be used ONCE by ONLY ONE PERSON
Hazardous medications have ____ for the use and disposal of PPE
Varying requirements
What PPE can be washed? (The exceptions)
Some types of respirators and eye goggles
IF correct decontamination procedures are followed
Why can you not wash PPE?
It can change the protective/barrier capabilities
What is the main purpose of OSHA?
To maintain a safe work environment
Includes mandated employee trainings
What else does OSHA do?
Recommends structure for providing safe work procedures
Can mandate PPE use and safe work procedures
Reduction of potential hazards including the handling, storage, admin, and disposal of hazardous drugs/chemicals
Potential hazards also include exposure to workplace violence, ergonomics, and latex allergy prevention
(CRRP)
OHSA bagging and labeling
Bags w/ contaminated materials with HDs but be labeled accordingly
Hazard communication standard (section F)
Labeling of waste containers
“Hazardous Drug Waste Only”
Must be properly labeled, sealed, and covered containers
HD waste should be disposed of according to what?
EPA, state, and local regulations
Commercial waste should be performed by a licensed company
While waiting for removal, where should waste be kept?
In a secure area in covered and labeled drums w/ plastic liners
What groups oversee pharmaceutical waste management?
Environmental Protection Agency (EPA)
Dept of Transportation (DOT)
Drug Enforcement Administration (DEA)
Occupational Safety and Health Administration (OSHA)
State EPAs
State Pharmacy Boards
Local Publicly Owned Treatment Works (POTW)
(LOSSEDD)
What is the issue w/ the groups that oversee pharmaceutical waste management?
May of the rules contradict each other, making it hard to find clear rules
What are red bins for? Examples?
Biohazards
Anything dealing w/ body fluids like:
- tubing
- syringes
- needles
What are yellow bins for? Examples?
Chemotherapy/radioactive
Examples:
- trace/residual chemo drugs
- contain < 3% of chemical (empty containers)
- packaging and tubing if emptied
- gowns/gloves worn when compounding
Where do tubing for admin of chemo/radioactive drugs have to be primed? How do they have to be labeled?
Primed in the hood (NOT on the floor)
Must be placed in bag labeled “chemotherapy”
What can change regarding disposal of chemo/radioactive depending on state laws?
Unused chemo can go in the black bin or its own box labeled “chemotherapy waste”
Disposal requirements
What are blue bins for?
Non-RCRA drugs
Drug waste, non-hazardous materials
Bins for non-hazardous materials can be blue or ____ and are _____ in every state
White
Not required
What are black bins for?
HDs (P and U list)
RCRA container
Black bins MUST be managed by a _____
Hazardous waste disposal company
What are the labeling requirements for hazardous waste?
Facility:
- name
- full address
- specific EPA ID #
Start date of waste accumulation (date you started using it)
Must be labeled “pharmaceutical hazardous waste”
HANDLE WITH CARE
Toxic sticker should be 5 inches from the bottom of the container on the same side as the hazardous waste label
Hospital pharmacy help for disposal of HDs
ASHP
Publishing info on HDs since 1983
Who governs the management of hazardous waste?
Resource Conservation and Recovery Act
(Originally passed in 1970s but not enforced until 2007)
What is hazardous waste?
Waste that has the potential of having a harmful impact on human or environmental health
What are the hazardous waste lists? Which ones are for pharmaceutical waste?
4 lists: F, U, P, K
Lists U and P are pharmaceutical
(Remember FUPK UP)
What is the P list?
Acute hazardous waste
(Said she’d probably ask about this one over the U list)
What is the U list?
Toxic wastes that cause harm long term
What counts as hazardous waste?
Formulations w/ a listed AI, even if it isn’t the sole AI:
- ALL chemo
- drugs in appendix VI of OSHA technical manual
- U list
- P list
- carcinogenic drugs
- combination vitamin/mineral preparations w/ heavy metals
- endocrine disruptors
(Very Convincing Chanel DUPE)
(Used for mnemonic: Vitamins, Carcinogen, Chemo, Drugs, U, P, Endocrine)
Where should P-listed waste be disposed of?
In black bins
Which chemicals on the P-list are pharmaceutic agents?
Nicotine
Warfarin
Arsenic trioxide
Phentermine
Physostigmine
Physostigmine salicylate
Nitroglycerin
Epinephrin base
(Never Wanted A Pretty Pink Pony - Not Ever)
P listed waste has an LD50 of ___ or less
50 mg/kg
Pharmaceuticals are ____ first and ____ second
Chemicals
Therapeutic agents
Which pharmaceutic agent on the P list are chemo therapy agents? Why does this matter?
Arsenic trioxide
Must be discarded separately as chemo waste
What are the P-listed waste exclusions?
2 most common in healthcare facilities are epinephrine and nitroglycerin — US EPA have exclusions for these agents
Epi salts (only) as well as weak medicinal nitroglycerin
NOT all states have accepted these so it is crucial to check w/ state agencies
Empty containers of P-listed waste is NOT considered to be “RCRA empty” (no longer considered hazardous material) UNLESS they have been:
Triple rinsed AND the rinsate is managed as hazardous waste
This is usually not viable in healthcare settings (so handle as hazardous anyway)
What two requirements must be met for a substance to be treated as hazardous waste?
Discarded drug waste contains a sole AI (saline & dextrose NOT considered AIs)
Has not been used for its intended purpose — referring to drugs & associated containers/dispensing instruments that have been given to a pt and now need to be discarded (like leftover IV med in bag)
What can vary from state to state regarding empty containers from P-listed waste?
Some states are less strict about sold dosage forms — may not regulate things like:
- warfarin stock bottles
- unit dose packaging
Where should U-listed waste be disposed of?
Black bins
U-listed drug waste must be managed as hazardous waste if:
Discarded drug waste contains sole AI from U-list
Not used for intended purpose
What is the concentration limit for disposal of U-listed waste? What is the dilute exclusion?
NONE
What are the U-list pharmaceutics?
Lindane
Streptozotocin
Chlorambucin
Saccharin
Trichloromonofluoromethane
Hexachlorophene
Uracil mustard
Melphalan
Paraldehyde
Selenium sulfide
Warfarin
Daunomycin
Mitomycin C
Phenol
Reserpine
Diethylstilbestrol
Cyclophosphamide
Dichlorodifluoromethane
Mercury
Resorcinol
Chloral hydrate
(Loud, Scary, Creaky Sounding THUMPS Will Drive Many People Really Damn Crazy — Don’t Make Rach Cry)
What U-listed pharmaceutics are chemo drugs?
Daunomycin
Diethylstilbestrol
Chlorambucil
Melphalan
Streptozotocin
Cyclophosphamide
Uracil mustard
Mitomycin
(Don’t Date Crazy Men — SCUM)
What 2 conditions must be met for an empty container of U-listed waste to be considered RCRA empty?
All contents removed using normal methods
No more than 3% my weight remains
What is the universal waste rule?
Regulations set to allow individuals and companies to handle, transport, and recycle certain hazardous wastes in a different way from other hazardous wastes
What does the universal waste rule mainly cover?
Non-pharmaceutical products (ie mercury batteries)
Where must universal waste be disposed of?
At an RCRA treatment, storage, and disposal facility — the most expensive mode of incineration
Very unlikely for hospital to pay this
__% of all pharmaceutical waste remains unregulated at the federal level
95%
Hospitals tend to use companies that regulate _____. Examples of companies?
Drug disposal
Stericycle
Sharps Compliance Ince
Biomedical Waste Services
What was the 2019 update for disposal of medications?
All states adopted regulation prohibiting dumping into sewage treatment waste
(Why we don’t tell pts to flush leftover meds anymore)
ALWAYS follow your company’s ___ for drug disposal. It is the responsibility of ____ to evaluate and update policies accordingly.
Policy
Management
How should contaminated PPE be managed?
As hazardous waste under best management practices
What is considered contaminated PPE?
- Gloves/gowns
- Drip pads
- Other materials overtly contaminated in the preparation or admin of chemo
- Other hazardous materials know or suspected of having been overtly contaminated
(O GOD)
Trace contaminated chemo materials should be ____ as regulated
Incinerated
A variety of ___ are used to dispose of controlled substances across institutions
Devices
How should disposal of CS be documented?
According to state law AND company policy
What do many states (including WV) require regarding disposal of CS?
Require destruction of CS to be witnessed by a licensed medical professional and sign off on the disposal
When dispensing HDs, designated ___ should be used
Trays, spatulas, and gloves
After dispensing HDs, what must be done with designated trays, spatulas, and gloves?
Trays and spatulas must be cleaned immediately
Gloves must be changes
Where are HDs dispensed and stored?
It depends on the facility
Some have dedicated dispensing and storage areas
State laws differ on requirements
If you are dispensing HDs, you must have a HD ______
Spill plan (liquid or powder)
What are the 5 models for managing pharmaceutical wastes?
- Automated barcode driven sorting device
- Electronic labeling in the nursing units
- Manual labeling in the nursing units
- Segregating waste at the central storage accumulation area
- Managing all drug waste as hazardous waste
(An Evil Man Steals Meds)
All 5 models for managing pharmaceutical waste involve ___
Satellite accumulation (designated areas)
Models 1, 2, and 3
Segregation at the point of generation
Waste disposal containers (usually black) are required
Model 4
Centralized segregation
All drug waste discarded in hazardous waste containers at the point of generation
(ie nursing places all waste in centralized area and pharmacy returns waste to pharmacy to be properly sorted)
Model 5
Managing all drug waste as hazardous
Can be beneficial for smaller facilities
In larger systems, it can have an excess cost of > $1M
Acronyms for handling spills of HDs (just the letters, not what they mean)
EAR
CLEAN
Handling spills of HDs: EAR
Evacuate the immediate area
Alert the spill response team and dial the emergency #
Remain by the phone outside the affected area — keep people from going in the area — communicate w/ spill team
Handling spills of HDs: CLEAN
Contain the spill
Leave the area
Emergency medical treatment
Access material safety data sheet (MSDS)
Notify administration
What is the common problem w/ disinfection of healthcare equipment?
Many HCPs are non-compliant due to:
- inconvenience
- time pressures
- skin damage from constant washing
___ is effective in reducing contamination of stethoscopes and other medical equipment
70% isopropyl alcohol scrub
When should medical equipment be disinfected?
Between patients
Before/after shift
As needed during visits
What should you NOT do when disinfecting medical equipment?
DO NOT soak
NEVER sterilize
DO NOT expose to heat
(Soak, sterile, heat)
Why should you not soak equipment?
Washing w/ running water or leaving the item in a basin/water/disinfectant will cause microorganism growth
Why should you never sterilize equipment?
It can alter components of the medical device
Why should equipment not be exposed to heat?
It can damage/alter components of the device
Leave to air dry instead
