Section F Flashcards
Three class of control measures to reduce exposure to hazards
engineering controls - most effective. The most effective way to control a hazard is to eliminate it
adminstrative controls
personal controls
Major elements of WHMIS 2015 are
safety data sheets
labels
training
Universal Precaution applies to
semen vaginal secretions synovial fluid , amniotic fluid cerebrospinal fluid pleural fluid peritoneal fluid pericardial fluid
Body Substance isolations includes
Included urine, joint fluid, semen, saliva, etc.
Focused on the use of barrier protection
STANDARD PRECAUTION or ROUTINE PRACTICE
It is a Combination of Universal and Body Substance Isolation precautions.
minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where healthcare is delivered.
2000’s –New Addition to Routine Practice:
Applies to any patient with sign of coughing, congestion, rhinorrhea, or increased production of respiratory secretion
Education of health care workers, patient and visitors
Posted signs and instructions in language appropriate to the population served
Covering sneezes with tissue paper or mask
Cough or sneeze into your upper sleeve , not hand
Hand Hygiene
Five Components of Routine Practice
Component 1: Risk Assessment
Before any task is performed, evaluate the risk of disease transmission.
The risk assessment should take into account the following:
the time it takes to complete the task
the type of body fluids that the worker may come into contact with
the presence of microorganisms in the bodily fluids
the route of potential exposure to these microorganisms
the susceptibility of the worker to these microorganisms
the environment in which the task is carried out
Five Components of Routine Practice
Component 2: Hand Hygiene: Wash hands with soap and water frequently.
Before and after direct contact with a patient, blood , body fluid or medial equipment
After removing gloves.
Any type of plain soap may be used.
Bar soap should be kept in a self draining holder that is cleaned thoroughly before new bars are put out. However should not be used in Health care facilities
Liquid soap containers.
What are alcohol rubs/gels/rinses?
Alcohol rubs/gels/rinses are excellent hand antiseptics, provided they contain more than 60% alcohol.
They are widely used in the health care settings, or in situations where running water is not available.
How do I use alcohol based hand rubs?
Alcohol-based hand rubs should only be used if no visible dirt is present on the hand
Five Components of Routine Practice
Component 3: PPE-Protective Barriers
PPE refers to a variety of barriers and respirators used alone or in combination to protect mucous membranes, airways, skin, and clothing from contact with infectious agents.
Should be worn at all times when working with blood or blood products or body fluids or waste that may contain blood.
Gloves should be worn by laboratory personnel when handling biomedical specimens and infectious materials.
Most health care facility have a NON-Latex policy
All gloves are permeable to some extent and the longer they are worn, the more likely they are to develop small holes or tears.
To prevent loss of protection, gloves should be changed after 30 minutes of work or sooner if they are soiled.
Hands should be thoroughly washed after glove use and between glove changes to remove any microorganisms that may have penetrated through the gloves.
KNOW THE ORDER OF DONNING AND DOFFING
Five Components of Routine Practice
Component 4: Environmental Controls
Environmental control refers to controlling and minimizing the level of microorganisms in the environment.
Environmental control measures include:
Equipment and work area cleaning
Proper disposal of waste such as sharps, biomedical, and pathological waste
Appropriate ventilation and other engineering controls
Installation of easily accessible and clearly identified waste containers, hand hygiene product dispensers, and dedicated hand wash sinks
Effective placement and segregation of sources of contamination - using single patient room or using a “blood work only” biological cabinet for laboratory work associated with blood samples
Five Components of Routine Practice
Component 5: Administrative Controls
Administrative controls are critical to ensure that the principles of routine practices are effectively and properly executed in the workplace
how to cough, immunizations
Routine Practice - Engineer control :
t is the responsibility of the employer to ensure safe practices in the workplace and hence to remove or isolate a hazard in the workplace.
Examples:
Provide Sharp disposal containers
Use Needles with built in safety mechanism
NOSOCOMIAL infections
The term nosocomial refer only to infections acquired in hospitals.
Transient microorganisms found on the hands of health care personnel are more frequently implicated as the source of nosocomial infections. The most common transient flora includes Staphylococcus aureus
PORTS OF ENTRY
Skin or eye
Inhalation
Ingestion
Injection
Labeling Biomedical Waste
Biohazardous waste should be identified as:
Human Infectious or Non-infectious Anatomical or Non-anatomical (blood/blood products, clinical equipment or sharps) Must have biological hazard symbol Facility name and address Date
Packaging of Biomedical Waste
Hazardous waste must be separated at the point of generation from regular waste.
Human and infectious non-anatomical waste: Biohazard Autoclave Bags- gowns, masks and gloves, culture plates, plastic pipettes and media, blood –May be dispose regular garbage
Biohazard Sharps Containers- needles in non- penetrable (rigid) container .This waste is transported off site by a licensed bio-medical waste transportation and disposal company.
Disinfectant (hypo chlorite solution)-liquids
Off and On–Site Movement of Waste
Packaged, labelled and transported according to TDGR and WHMIS
Colour coded –Orange
Biohazard label
Risk Group 1
Low individual risk and low community risk
Risk Group 2
moderate individual risk and low community risk
Risk Group 3
high individual risk and low community risk
Risk Group 4
high individual risk and high community risk
Containment Level 1 (CL1)
basic laboratory
Any biological agent unlikely to cause disease in healthy health care workers.
Biological safety cabinets (BSCs) are not required.
Work may be done on an open bench top
Containment is achieved through the use of practices normally employed in a basic microbiology laboratory.
Containment Level 2 (CL2)
Any pathogen that can cause human disease under normal circumstances
The primary exposure hazards associated with organisms requiring CL2 are through the ingestion, inoculation and mucous membrane route.
BSCs and centrifuges with sealed rotors or safety cups
PPE - appropriate personal protective equipment (i.e., gloves, laboratory coats, protective eyewear).
Environmental contamination must be minimized by the use of handwashing sinks and decontamination facilities (autoclaves).
Containment Level 3 (CL3)
Any pathogen that can cause serious human disease
HEPA filtration of exhausted laboratory air and strictly controlled laboratory access.
Containment Level 4 (CL4)
Any pathogen that usually produce very serious human disease, often untreatable
CLASS 1 BIOSAFETY CABINETS (1a and 1b)
Provides partial personal protection, no product protection and are suitable for handling low –moderate biohazard aerosol. Connected to the building exhaust system HEPA filter in the duct outside No flammables or toxic chemical Air is drawn through the front
CLASS 2 TYPE A1- BIOSAFETY CABINETS (A1, A2, B1 &B2 )
Provide product and partial personal protection, and are suitable for handling
low –moderate biohazard aerosol.
Class A’s –recirculation back into the lab.
Class B’s no air recirculation within the cabinet
100% HEPA filter exhaust
May be used with toxic, volatile or radio- active material
CLASS 3 BIOSAFETY CABINETS-or GLOVE - BOX
Totally closed front and gas tight
Protect worker and product
Impermeable rubber gloves attached to the cabinet front opening
Two HEPA filter that moves contaminated air into an exhaust system
Negative pressure compared to the lab
Provide the highest personal protection and clean work environment
Use with highly bio-hazard agents
Level 4 pathogens
HEPA FILTER- High Efficiency Particulate Air
They are designed to remove microbes, chemical and radiation airborne particles of 0.3 um (micro meter).
They do not remove chemical vapours from the air
Filtration occur by: interception, inertial impaction and diffusion
Start-up procedures when preparing for work in the BSC
- Turn off UV lights if in use and ensure that the sash is in the appropriate position.
- Turn on fluorescent light and cabinet blower, if off.
- Check the air intake and exhaust grilles for obstructions.
- If the cabinet is equipped with an alarm, test the alarm and switch it to the “on” position.
- Confirm inward airflow by holding a tissue at the middle of the edge of the viewing panel and ensuring that it is drawn in.
- Disinfect the interior surfaces with a suitable, noncorrosive disinfectant.
- Assemble all materials required for the procedure and load them into the cabinet; do not obstruct the air grilles; the working surface may be lined with absorbent paper with plastic backing; segregate “clean” items from “contaminated” items.
- Wait 5 minutes to purge airborne contaminants from
Do not work with open flames inside the BSCs. the work area.
Work 10-15 cm from the opening of the cabinet.
Procedures upon completion of the work
- Allow the cabinet to run for 5 minutes with no activity.
- Close or cover open containers before removing them from the cabinet.
- Surface disinfect objects in contact with contaminated material before removal from the cabinet.
- Remove contaminated gloves and dispose of them as appropriate; wash hands.
- Don clean gloves, and ensure that all materials are placed into biohazard bags within the cabinet.
- Using a suitable non-corrosive disinfectant (e.g., 70% ethanol), disinfect interior surfaces of cabinet; periodically remove the work surface and disinfect the area beneath it (including the catch pan) and wipe the surface of the UV light with disinfectant.
- Turn off the fluorescent light and cabinet blower when appropriate (some cabinets must be left on at all times; if you are unsure, check with your cabinet certifier, safety officer or building maintenance personnel).
- Turn on the UV light if appropriate (do not turn on when people are working close by); UV must be tested to ensure that it is emitting a germicidal wavelength (ask your cabinet certifier to perform this test).
Thermal burns
burns due to external heat sources which raise the temperature of the skin and tissues and cause tissue cell death or charring.
Example:Hot metals, scalding liquids, steam, and flames, when coming in contact with the skin, can cause thermal burns.
Radiation burns
urns due to prolonged exposure to ultraviolet rays of the sun, or to other sources of radiation such as x-ray, gamma rays
Chemical burns
burns due to strong acids, bases, detergents, or solvents coming into contact with the skin and/or eyes.
Electrical burns
burns from electrical current, either alternating current (AC) or direct current (DC)
Spills and splashes on the skin
Prevention and First Aid
Wear lab coat and gloves
Remove contaminated clothing
Run with cold water for 15 min or till it stops hurting
Strong acid
Prevention and First Aid
Wear rubberized apron and gloves
Remove contaminated clothing
Run with cold water for 15 min or till it stops hurting
Splashes in the eyes
Prevention and First Aid
Use safety glasses or face shield Proceed to nearest eye wash station Rinse open eye for 15 min Remove contact lens and wash for 15 min Seek medical treatment
Heat Burn
Prevention and First Aid
Keep hair tied back and be aware of open flames.
Do NOT reach over open flame.
Run with cold water for 15 min or till it stops hurting
Cover the area with moist bandage to keep it moist
Cloth/Body Fire
STOP where you are
DROP to the floor and
ROLL to smother the flames .
Proceed to the safety shower and cool burned area with plenty of water.
Chemical Burn
Prevention and First Aid
Wear protective gloves and lab coat
Remove clothing or jewellery from around the burnt area
Immerse the burnt surface in cold water for 15 min
Cover the area with moist bandage to keep it moist
Electrical shock
Prevention and First Aid
Unplug equipment after use
Place person on their back
Cover with blanket to maintain body temperature and seek medical assistance
Chemical Poisoning
Prevention and First Aid
Use chemical fume hood
Wear appropriate mask when exposed to poisonous gasses or vapour
Move victim from the contaminated area
Place victim on back with head slightly tilted back to facilitate breathing
Cover victim to maintain body temperature
Identify the poison
Retrieve MSDS sheet
Call 911
Call Poison Control Center at Sick Children’s Hospital for advice
Cuts
Prevention and First Aid
Keep working area free of clutter.
Use the proper equipment to clean up broken glass.
Apply pressure to the wound with a sterile dressing
If the object protrudes from the wound- apply pressure around the wound
Keep cut area above the elevation of the heart if possible
Needle Sticks
Always use safety closure device
Identify source of specimen (name of patient)
Squeeze finger under water (encourage bleeding)
Clean the puncture site with alcohol
Apply sterile bandage
Report to supervisor
Code Yellow
Missing person
Orange
disaster
red
fire
purple
hostage
silver
person with weapon
black
bomb
blue
MI
PINK
child MI
The Fire Triangle
Fuel - Any combustible of flammable solid liquid or gas
Oxygen- From the air, 16% or more is needed for the fire to be sustained
Heat - is needed both to initially ignite the fire, and also to sustain it
Class A fires
Extinguishing Method
Type of Extinguisher
fuelled by materials that, when they burn, leave residue in the form of ash, such as paper, wood, cloth, cardboard, rubber, and certain plastics.
- Cooling Effect
Water Foam multipurpose ABC Dry chemical Wet Chemical
Class B fires
Extinguishing Method
Type of Extinguisher
fires involve flammable liquids and gasses, such as gasoline, paint thinner, kitchen grease, propane oil, solvents and acetylene.
Oxygen removal
Foam
Multipurpose ABC
Dry chemical powder
Carbon Dioxide
Class C fires
Extinguishing Method
Type of Extinguisher
involve energized electrical wiring or equipment, such as motors, computers, switch boxes
Non-conducting agent Never use water!
Carbon dioxide
Multipurpose ABC
Dry chemical powder must be used.
Class D fires
Extinguishing Method
Type of Extinguisher
certain metals and compounds, such as magnesium, sodium, titanium, and phosphorous.
Designed for Class D fires only. Combustible metals burn at high temperature and reacts violently with water and air.
Dry Chemical extinguishers designed for combustible metals.
fire extinguishers operate according to
PASS - How to use a fire extinguisher. Pull the pin in the handle, Aim the nozzle at the base of the fire, Squeeze the lever slowly, and Sweep from side to side.
Fire drills are conducted for three reasons:
Fire drills allow personnel to practice fire response training
Reinforce fire safety (education) and allow for evaluation of staff knowledge.
To ensure that drills provide the maximum benefit, personnel should respond to each drill as if there were an actual fire.
WHO recommendations for cleaning up spills of blood or body fluids
1:10 dilutions of 5.25% household bleach for 10 minutes
A chemical is defined as a hazard if
It causes harmful biological effects
It is flammable , explosive or highly reactive
If it has potential harmful vapours or dust
Symptoms of Chemical Exposure
ACUTE
Headache or dizziness
Sudden nausea or vomiting
Eye, nose and throat irritation
Toxic chemicals accumulates in the body and causes damage over time.
ACUTE: It is considered acute if the exposure is 14 days or less
Symptoms of Chemical Exposure
CHRONIC
Persistent dermatitis
Discoloured urine or skin
Numbness or tremors
repeated exposures over a period of time
NFPA label is designated by four diamonds
RED – fire hazard
BLUE – Health Hazard
YELLOW – Reactivity
WHITE- Special Hazards
BLUE – Health Hazard -
0- Exposure under fire conditions would offer no hazard beyond that of ordinary combustible materials.
No chemical is without some degree of toxicity
1- Irritation
2-Needs immediate medical attention
3-short exposure- animal carcinogen
4-Very short exposure could cause death or serious residual injury even though prompt medical attention was given.A known or suspected human carcinogen, mutagen or teratogen.
Red - Flammability
0-Materials that will not burn. NO Flash Point
1-Must be preheated before ignition can occur.
2-Must be moderately heated or exposed to relatively high temperature before ignition can occur.
3-Liquids and solids that can be ignited under almost all ambient conditions.
4-Will rapidly or completely vaporize at normal pressure and temperature, or is readily dispersed in air and will burn readily
Yellow - Reactivity
0-not reactive with water.
1-unstable at elevated temperatures
2- undergo violent decomposition but do not detonate
3-Capable of detonation or explosive reaction,
4-Readily capable of detonation
OX- Special hazard
oxidizer, a chemical which can greatly increase the rate of combustion/fire.
W with a bar
Unusual reactivity with water. This indicates a potential hazard using water to fight a fire involving this material.
MINOR SPILL
lways Notify supervisor or professor and others in the area
Identify the name of the chemical
Wear protective equipment
Medical care- appropriate
Use appropriate neutralizer for inorganic acids and bases.(Spill Kits-This will be covered in the labs)
Clean spill area with detergent and water where ever applicable
MAJOR SPILL
Attend to the injured person
Evacuate the area
Notify campus security, supervisor or 911
Close door to affected area
Government Legislation and Licensing for All radioactive nuclear substances
Canadian Nuclear Safety Commission (CNSC)
The CNSC operates under the authority of the Nuclear Safety and Control Act (1997) and recommends dose limits for those working with radiation.
Electromagnetic Radiation
Produced by vibrating electric charges that give off tiny packets of energy called photons.
Electromagnetic waves transfer energy through electric and magnetic fields, not through matter (water or air).
Light is a form of electromagnetic radiation
amplitude, a,
wave is the distance from the centre line (or the still position) to the top of a crest or to the bottom of a trough
Amplitude is measured in metres (m).
The greater the amplitude of a wave then the more energy it is carrying.
wavelength, λ,
distance from any point on one wave to the same point on the next wave along. (The symbol is a Greek letter, ‘lambda’.)
measure wavelength from the top of a crest to the top of the next crest, or from the bottom of a trough to the bottom of the next trough. Wavelength is also measured in metres (m) - it is a length after all.
frequency, f,
ave is the number of waves passing a point in a certain time. We normally use a time of one second, so this gives frequency the unit hertz (Hz), since one hertz is equal to one wave per second.
Ionized Radiation:
higher frequency but shorter wavelength- and the relation between wavelength and frequency is more clearer.
Properties of Ionizing Radiation
Has enough energy to penetrate deeply and break strands of DNA
Shorter wavelength
X-rays and Gamma rays – “Penetrating”
Kills microorganism
The International System of Units (SI) for radiation measurement is now the official system of measurement and uses the “gray” (Gy) and “sievert” (Sv) for absorbed dose and equivalent dose respectively.
The Fetus is also highly sensitive to radiation
Gamma rays
Highly penetrating
Cause cell damage
Dense material need to shield
Clothing does not provide protection
Alpha rays - block by paper
Does not penetrate the skin
Harmful if swallowed, inhaled or absorbed in the skin
Beta - blocked by aluminum
Can penetrate the skin
Can affect new skin cells development
NON- IONIZATION RADIATION examples and organs at risk
Ultraviolet radiation Visible Light Infra red Lasers Microwave
Organs Bone marrow Female breast Thyroid Lungs Digestive system
Radiowaves examples and risk
Broadcasting, TV transmission Cellular phones Cordless telephones Computers Wireless Internet access Baby monitors, Garage door openers.
No hazards
Microwaves examples and risk
Micro wave ovens
Radar-used to detect range and speed
Blue Tooth
Enough intensity causes molecule vibration=friction=heat
Can cause heart pacemaker interference
Can cause cataracts-denatures protein in the lens of the eye
Infrared
seeing
no hazards
UV light examples and risk
Sun,
Fluorescent bulbs & lamps
welding equipment
Penetrates <1mm
Stimulates production of melanin
UV-A-tans - not readily absorbed
UV-B-causes sunburn, Wrinkles skin/ Aged skin, Epidermal skin cancer. Most lethal
UV-C- absorbed by the atmosphere , does not reach the earth
Laser Light- (“Light Amplification by Stimulated Emission of Radiation)
A form of non-ionizing radiation
Monochromatic. Contains one specific wavelength of light (one specific color).
Directional. Strong , concentrated beam
Laser radiation can be generated in different parts of the spectrum - ultraviolet (UV), visible light, and infrared (IR).
Instant injury to the corneal, retinal and skin burn
UV RADIATION AS A STERILIZING AGENT-
220-300
Used to sterilize and decontaminating hospital operating rooms, food processing areas, infected waste stations.
Cause modification or break in DNA which causes death of the organism
Low energy- as a result have very low penetration power,can penetrate not more than 1 cm.It also cannot penetrate through opaque surfaces,hence mostly used for surface treatment
Use to sterilize work area of bio safety cabinet
Used to treat various skin conditions, and is necessary for the formation of vitamin D3 in our bodies.
Internal exposure to radiation
when radioactive dust or gases get inside the body and irradiate it from within. Radioactive particles can be inhaled, ingested or absorbed through the skin.
External exposure to radiation
occurs when a person has been physically close to a source of radiation. The penetrating radiation emitted by the source travels through the air and irradiates the person.
Prevention and Protective Equipment -UV RADIATION
UV light may be reflected by some surfaces e.g. stainless steel
Avoid direct contact to the eyes, skin- goggles , Plexi glass shield, face shield are to be used
Cover exposed body parts- Lead shield, Lead gloves
Dosimeter
EFFECTS OF RADIATION OVEREXPOSURE
Acute:
Skin- sunburns
Bone marrow- aplastic anemia
Digestive system
Neuromuscular system
Chronic: After years of exposure
EFFECTS OF RADIATION OVEREXPOSURE
Leukemia Other malignancies Premature skin aging Skin cancer Weakening of the immune system. Eye problems
Reducing Radiation Exposure:
ime of exposure-refers to the time an individual spends actually handling radioactive material or being exposed to radiation. The shorter the exposure period near radioactive materials, the lower the radiation dose.
Distance from the source-refers to the physical distance between you and the radioactive material. The farther one is from a source of radiation, the lower the exposure.
Presence of shielding- is a barrier placed between an individual and a source of radiation. Shielding absorbs radiation, allowing a person to remain relatively close to a radiation source while minimizing the radiation exposure.
Administrative Controls are rules used to reduce radiation exposure.
Use gloves, safety glasses, lab coats when handling radioactive materials.
Label all radioactive use areas.
Properly store and dispose of materials.
Never store food or beverages in refrigerators, freezers or anywhere in laboratories that contain radioactive materials.
Keep a contamination log book
Equipment used to monitor personnel exposure
Dosimeters monitor the:
whole body
upper extremities: hands, fingers,writs, forearms
lower extremities: feet, ankles, lower legs
Thermoluminescent Dosimeter (TLD) Badge/ Rings- lithium fluoride or aluminum oxide in powder solid form-chip) that retain deposited energy from radiation exposure. Measure radiation exposure to your extremities due to x-ray, beta, and gamma radiation with an encased lithium fluoride chip.
Minor radioactive spills
Notify all in the immediate area and limit access to those cleaning up the spill
Cover spill with absorbent paper
Survey staff with radiation monitor before they leave the area
Remove contaminated clothing and footwear and wash affected area with soap and water
Dispose of clean-up material in a labelled container according to institutions policy and procedure
Notify radiation safety officer
Major radioactive spills
Notify all in the immediate area and limit access to those cleaning up the spill
Turn off any ignition source
Vacate room, close door and post warning sign
Contact radiation safety officer
Qualified personnel will select the appropriate PPE, refer to MSDS and all reference and supplies
Survey staff with radiation monitor before they leave the area
Remove contaminated clothing and footwear and wash affected area with soap and water
If contamination persists, use diluted potassium permanganate or 3-5% EDTA.
Dispose of clean-up material in a labelled container with the radioactive symbol and according to institutions policy and procedure
