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Patient Safety > Exam 1 - PPE > Flashcards

Exam 1 - PPE Flashcards

1
Q

What is PPE?

A

Personal protective equipment

Equipment worn to minimize exposure to serious workplace hazards

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2
Q

Why do we wear PPE?

A

Illness/injury can result from the following hazards:
- chemical
- radiological
- physical
- electrical
- mechanical

(PRE CM)

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3
Q

Examples of PPE (longer list)

A

Safety glasses
Full bodysuits
Respirators
Earplugs/earmuffs
Shoes/shoe covers
Hard hats
Coveralls
Gloves
Vests

(Selling FRESH Cut Green Vegetables)

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4
Q

Who can mandate the use of PPE?

A

OSHA and employers

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5
Q

Does PPE protect the wearer or the patient?

A

BOTH

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6
Q

When MUST employers provide proper PPE?

A

When engineering, work practices, and administrative controls are not feasible or not providing enough protection to the employee

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7
Q

Employers MUST ensure proper use of PPE. What is included in “proper use?”

A

Correct fit
Comfortability
PPE stores & maintained correctly

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8
Q

Why must PPE fit correctly?

A

Improper fit can cause dangerous exposures

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9
Q

Why is comfortability included in proper use of PPE?

A

Encourages employee use

(Think about how many people refuse to wear masks right because it’s uncomfortable)

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10
Q

Employer requirements regarding PPE

A

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

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11
Q

What should employees who are required to use PPE be trained on?

A

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)

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12
Q

What should PPE programs address?

A

Potential hazards
Selection/maintenance/use of PPE
Training of employees
Monitoring

(Meet Some People Today)

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13
Q

Types of PPE (shorter list)

A

Face shields
Respirators
Gloves
Gowns/aprons
Goggles
Masks

(Feeling Really Great + Getting Good Money)

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14
Q

What do respirators protect?

A

Protect respiratory tract from airborne infectious agents

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15
Q

Key points about PPE

A

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

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16
Q

When should hand hygiene be performed (in relation to PPE)?

A

Immediately after removing PPE

If hands are visibly contaminated during PPE removal, wash hands BEFORE removing any other PPE

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17
Q

Hand hygiene after PPE is removed

A

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

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18
Q

What are standard precautions?

A

Recommends the use of PPE & other infection control practices to prevent tranmission

Previously called “universal precautions”

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19
Q

What do standard precautions assume could be infectious?

A

Blood and bodily fluids of ANY patient

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20
Q

How is the type of PPE to be used determined?

A

By the clinical interaction w/ the patient

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21
Q

Standard precaution recommendations

A

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)

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22
Q

What type of PPE would you wear when transporting a pt in a wheelchair?

A

Generally none

(You aren’t even touching them so it’s fine)

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23
Q

What type of PPE would you wear when responding to an emergency situation w/ bloody injuries?

A

Fluid resistant gloves
Mask/goggles or face shield

(Gloves for obvious reasons and mask/goggles in case of splashing)

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24
Q

What type of PPE would you wear when cleaning an incontinent pt w/ diarrhea?

A

Gloves

(Realistically, it should only touch your hands)

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25
Q

What type of PPE would you wear when irrigating a wound?

A

Gloves
Gown
Mask/face shield

(Because of splash risk)

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26
Q

Contact precautions

A

Gown and gloves w/ pt or environment of care

Medical equipment or sometime when entering pt environment

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27
Q

Droplet precautions

A

Surgical masks within 3 ft of pt

(Think about how much people talked about droplets during covid)

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27
Q

What type of PPE would you wear when taking vital signs?

A

Generally none

(Makes sense because wearing any would be stupid)

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28
Q

What are expanded precautions? Categories?

A

Transmission based precautions

Include:
- contact precautions
- droplet precautions
- airborne infection isolation

(CAD)

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29
Q

Airborne infection isolation

A

Particulate respirator

NEGATIVE pressure isolation room required

(NEGATIVE pressure because you want others to be NEGATIVE for the infection)

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30
Q

What is PPE used when handling HDs considered?

A

CONTAMINATED

Must be disposed of properly

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30
Q

Hand hygiene for expanded precautions

A

Immediately after removing PPE

Between pt contacts

Either w/ soap and water or alcohol-based hand rub

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31
Q

Can you wash PPE?

A

NO (other than a few exceptions)

Disposable PPE is designed to be used ONCE by ONLY ONE PERSON

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31
Q

Hazardous medications have ____ for the use and disposal of PPE

A

Varying requirements

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32
Q

What PPE can be washed? (The exceptions)

A

Some types of respirators and eye goggles

IF correct decontamination procedures are followed

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33
Q

Why can you not wash PPE?

A

It can change the protective/barrier capabilities

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34
Q

What is the main purpose of OSHA?

A

To maintain a safe work environment

Includes mandated employee trainings

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34
Q

What else does OSHA do?

A

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)

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35
Q

OHSA bagging and labeling

A

Bags w/ contaminated materials with HDs but be labeled accordingly

Hazard communication standard (section F)

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36
Q

Labeling of waste containers

A

“Hazardous Drug Waste Only”

Must be properly labeled, sealed, and covered containers

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37
Q

HD waste should be disposed of according to what?

A

EPA, state, and local regulations

Commercial waste should be performed by a licensed company

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38
Q

While waiting for removal, where should waste be kept?

A

In a secure area in covered and labeled drums w/ plastic liners

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39
Q

What groups oversee pharmaceutical waste management?

A

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)

40
Q

What is the issue w/ the groups that oversee pharmaceutical waste management?

A

May of the rules contradict each other, making it hard to find clear rules

41
Q

What are red bins for? Examples?

A

Biohazards

Anything dealing w/ body fluids like:
- tubing
- syringes
- needles

42
Q

What are yellow bins for? Examples?

A

Chemotherapy/radioactive

Examples:
- trace/residual chemo drugs
- contain < 3% of chemical (empty containers)
- packaging and tubing if emptied
- gowns/gloves worn when compounding

43
Q

Where do tubing for admin of chemo/radioactive drugs have to be primed? How do they have to be labeled?

A

Primed in the hood (NOT on the floor)

Must be placed in bag labeled “chemotherapy”

43
Q

What can change regarding disposal of chemo/radioactive depending on state laws?

A

Unused chemo can go in the black bin or its own box labeled “chemotherapy waste”

Disposal requirements

44
Q

What are blue bins for?

A

Non-RCRA drugs

Drug waste, non-hazardous materials

44
Q

Bins for non-hazardous materials can be blue or ____ and are _____ in every state

A

White
Not required

45
Q

What are black bins for?

A

HDs (P and U list)
RCRA container

45
Q

Black bins MUST be managed by a _____

A

Hazardous waste disposal company

46
Q

What are the labeling requirements for hazardous waste?

A

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

46
Q

Hospital pharmacy help for disposal of HDs

A

ASHP
Publishing info on HDs since 1983

47
Q

Who governs the management of hazardous waste?

A

Resource Conservation and Recovery Act

(Originally passed in 1970s but not enforced until 2007)

47
Q

What is hazardous waste?

A

Waste that has the potential of having a harmful impact on human or environmental health

48
Q

What are the hazardous waste lists? Which ones are for pharmaceutical waste?

A

4 lists: F, U, P, K

Lists U and P are pharmaceutical

(Remember FUPK UP)

49
Q

What is the P list?

A

Acute hazardous waste

(Said she’d probably ask about this one over the U list)

50
Q

What is the U list?

A

Toxic wastes that cause harm long term

51
Q

What counts as hazardous waste?

A

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)

52
Q

Where should P-listed waste be disposed of?

A

In black bins

53
Q

Which chemicals on the P-list are pharmaceutic agents?

A

Nicotine
Warfarin
Arsenic trioxide
Phentermine
Physostigmine
Physostigmine salicylate
Nitroglycerin
Epinephrin base

(Never Wanted A Pretty Pink Pony - Not Ever)

53
Q

P listed waste has an LD50 of ___ or less

A

50 mg/kg

53
Q

Pharmaceuticals are ____ first and ____ second

A

Chemicals
Therapeutic agents

54
Q

Which pharmaceutic agent on the P list are chemo therapy agents? Why does this matter?

A

Arsenic trioxide

Must be discarded separately as chemo waste

54
Q

What are the P-listed waste exclusions?

A

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

54
Q

Empty containers of P-listed waste is NOT considered to be “RCRA empty” (no longer considered hazardous material) UNLESS they have been:

A

Triple rinsed AND the rinsate is managed as hazardous waste

This is usually not viable in healthcare settings (so handle as hazardous anyway)

54
Q

What two requirements must be met for a substance to be treated as hazardous waste?

A

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)

55
Q

What can vary from state to state regarding empty containers from P-listed waste?

A

Some states are less strict about sold dosage forms — may not regulate things like:
- warfarin stock bottles
- unit dose packaging

55
Q

Where should U-listed waste be disposed of?

A

Black bins

56
Q

U-listed drug waste must be managed as hazardous waste if:

A

Discarded drug waste contains sole AI from U-list

Not used for intended purpose

57
Q

What is the concentration limit for disposal of U-listed waste? What is the dilute exclusion?

A

NONE

58
Q

What are the U-list pharmaceutics?

A

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)

59
Q

What U-listed pharmaceutics are chemo drugs?

A

Daunomycin
Diethylstilbestrol
Chlorambucil
Melphalan

Streptozotocin
Cyclophosphamide
Uracil mustard
Mitomycin

(Don’t Date Crazy Men — SCUM)

60
Q

What 2 conditions must be met for an empty container of U-listed waste to be considered RCRA empty?

A

All contents removed using normal methods

No more than 3% my weight remains

61
Q

What is the universal waste rule?

A

Regulations set to allow individuals and companies to handle, transport, and recycle certain hazardous wastes in a different way from other hazardous wastes

62
Q

What does the universal waste rule mainly cover?

A

Non-pharmaceutical products (ie mercury batteries)

63
Q

Where must universal waste be disposed of?

A

At an RCRA treatment, storage, and disposal facility — the most expensive mode of incineration

Very unlikely for hospital to pay this

64
Q

__% of all pharmaceutical waste remains unregulated at the federal level

A

95%

65
Q

Hospitals tend to use companies that regulate _____. Examples of companies?

A

Drug disposal

Stericycle
Sharps Compliance Ince
Biomedical Waste Services

66
Q

What was the 2019 update for disposal of medications?

A

All states adopted regulation prohibiting dumping into sewage treatment waste

(Why we don’t tell pts to flush leftover meds anymore)

67
Q

ALWAYS follow your company’s ___ for drug disposal. It is the responsibility of ____ to evaluate and update policies accordingly.

A

Policy
Management

68
Q

How should contaminated PPE be managed?

A

As hazardous waste under best management practices

69
Q

What is considered contaminated PPE?

A
  • 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)

70
Q

Trace contaminated chemo materials should be ____ as regulated

A

Incinerated

71
Q

A variety of ___ are used to dispose of controlled substances across institutions

A

Devices

72
Q

How should disposal of CS be documented?

A

According to state law AND company policy

73
Q

What do many states (including WV) require regarding disposal of CS?

A

Require destruction of CS to be witnessed by a licensed medical professional and sign off on the disposal

74
Q

When dispensing HDs, designated ___ should be used

A

Trays, spatulas, and gloves

75
Q

After dispensing HDs, what must be done with designated trays, spatulas, and gloves?

A

Trays and spatulas must be cleaned immediately

Gloves must be changes

76
Q

Where are HDs dispensed and stored?

A

It depends on the facility

Some have dedicated dispensing and storage areas

State laws differ on requirements

77
Q

If you are dispensing HDs, you must have a HD ______

A

Spill plan (liquid or powder)

78
Q

What are the 5 models for managing pharmaceutical wastes?

A
  1. Automated barcode driven sorting device
  2. Electronic labeling in the nursing units
  3. Manual labeling in the nursing units
  4. Segregating waste at the central storage accumulation area
  5. Managing all drug waste as hazardous waste

(An Evil Man Steals Meds)

79
Q

All 5 models for managing pharmaceutical waste involve ___

A

Satellite accumulation (designated areas)

80
Q

Models 1, 2, and 3

A

Segregation at the point of generation

Waste disposal containers (usually black) are required

81
Q

Model 4

A

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)

82
Q

Model 5

A

Managing all drug waste as hazardous

Can be beneficial for smaller facilities

In larger systems, it can have an excess cost of > $1M

83
Q

Acronyms for handling spills of HDs (just the letters, not what they mean)

A

EAR
CLEAN

84
Q

Handling spills of HDs: EAR

A

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

85
Q

Handling spills of HDs: CLEAN

A

Contain the spill
Leave the area
Emergency medical treatment
Access material safety data sheet (MSDS)
Notify administration

86
Q

What is the common problem w/ disinfection of healthcare equipment?

A

Many HCPs are non-compliant due to:
- inconvenience
- time pressures
- skin damage from constant washing

87
Q

___ is effective in reducing contamination of stethoscopes and other medical equipment

A

70% isopropyl alcohol scrub

88
Q

When should medical equipment be disinfected?

A

Between patients
Before/after shift
As needed during visits

89
Q

What should you NOT do when disinfecting medical equipment?

A

DO NOT soak
NEVER sterilize
DO NOT expose to heat

(Soak, sterile, heat)

90
Q

Why should you not soak equipment?

A

Washing w/ running water or leaving the item in a basin/water/disinfectant will cause microorganism growth

91
Q

Why should you never sterilize equipment?

A

It can alter components of the medical advice

92
Q

Why should equipment not be exposed to heat?

A

It can damage/alter components of the device

Leave to air dry instead

Patient Safety (7 decks)

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