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Employee Development

This self-directed learning module contains information you are expected to know to protect yourself, our patients, and our guests.

Target Audience: Temporary Staff,Students, Student Interns,& Volunteers

Contents

Instructions........................................................ 2

Learning Objectives .......................................... 2

Module Content................................................. 3

Posttest ............................................................. 35

© 2005 Carolinas HealthCare System

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Instructions:

This module is an introduction to important information and procedures for your safety and security at work. After completing this module, contact your supervisor if you have any questions about the material or to obtain additional information specific to the department where you will be working.

• Read the module.• Complete the posttest at the end of the module and give it or a copy of your

online transcript to your supervisor.

Learning Objectives:

When you finish this module, you will be able to:

• Describe ways to protect yourself from exposure to bloodborne pathogens.

• Describe the steps to follow in an emergency (i.e., internal disaster).

• Describe the steps to follow in the event of a fire.

• Describe ways to help reduce the risk of accidents and injuries at CHS (i.e., general safety).

• Define the Right-to-Know/Hazard Communication standard.

• Identify ways to prevent infant abduction.

• Describe ways to prevent the spread of infection.

• Describe your role in the Medical Equipment Management Program.

• Describe the utility systems at CHS and steps to take if these systems fail.

• List three situations when CHS Security must be contacted.

• Describe ways to arrange the work environment to reduce stress (i.e., ergonomics).

• Identify the CHS mission and Performance Improvement model.

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Remember:

--YOU play the biggest part in the Carolinas HealthCare System (CHS) safety program by following current policies and procedures.

Bloodborne Pathogens

Bloodborne Pathogens are disease-producing organisms in the blood and other body fluids causing illness and sometimes death. The three

most common bloodborne diseases you may be exposed to in a healthcare setting are:

• Human immunodeficiency virus (HIV-the virus that causes AIDS)• The hepatitis B virus (HBV)• The Hepatitis C virus (HCV)

All body fluids may transmit bloodborne pathogens. Some examples of body fluids are:

• Blood• Semen• Vaginal secretions• Amniotic fluid• Cerebrospinal fluid• Breast milk• Any body fluid visibly contaminated with blood.

The most common bloodborne pathogen exposures in a healthcare setting are:

• Needle-sticks during a procedure or clean up.• Cuts from other contaminated object(s) that may penetrate the skin (scalpels,

broken glass, etc.).• Splashes to your eyes, nose, or mouth. • Dry, cracked, or broken skin that comes in contact with contaminated blood

and other potentially infectious materials.• You may also be exposed to bloodborne pathogens away from work if you

have direct contact with blood or body fluids, or have unprotected sex.

Individuals may also be exposed to bloodborne pathogens away from work if they have direct contact with blood or body fluids, or have unprotected sex.

The Hepatitis B vaccine is available through Employee Health to employees who are at risk of exposure to blood or body fluids.

� Contact your supervisor for more information.

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Personal Protective Equipment

Personal Protective Equipment (PPE) is equipment or specialized clothing that protects you from contact with blood or other potentially infectious materials. Examples of PPE include:

• Gloves• Masks• Gowns• Headcovers• Eye wear (goggles)• Face shields• Shoe covers• Disposable mouth pieces and resuscitation devices

If you do not use your PPE correctly, then it will not protect you like it is intended.

• Use appropriate PPE each time you perform a task, where it is reasonable to anticipate exposure to blood or OPIM (e.g. contact with contaminated laundry).

• Be trained to use the equipment properly and do not wear anything that is damaged (e.g. gloves torn or punctured)

• Gloves and other PPE must fit properly.• If, when wearing equipment, it is penetrated by blood or other potentially

infectious materials, remove it as soon as possible.• Before leaving the work area, remove all protective equipment and place it in the

designated area or container for washing, decontamination, or disposal.

Standard Precautions

Many people carry bloodborne infections without even knowing it, so it is difficult to identify patients who may transmit infection.

Standard Precautions requires you to treat all human blood and body fluids as if they were infected with a bloodborne pathogen.

Use Standard Precautions to Protect Yourself from Exposureto Blood and Body Fluids.

Adopt these practices to protect yourself from exposure to potentially harmful blood or body fluids:

1. Take care of yourself with good personal hygiene at work.

• Check your hands for any cuts, scrapes, or broken skin and cover, if possible.

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• DO NOT store food, eat, drink, apply cosmetics or lip balm, or handle your contact lenses in work areas where you could be exposed to blood or body fluids.

• DO NOT store your food or drinks in refrigerators or freezers used for blood or body fluids.

• DO NOT touch your nose, eyes, or mouth when you are in a contaminated work area.

• Use tongs, forceps, broom, and dust pan to clean up broken glass. NEVER use your hands.

• Remove all PPE as soon as the procedure is completed.• Always wash your hands after you remove PPE. • Always minimize splashing, spraying, spattering, and generation of droplets.

2. Clean blood or body fluid spills correctly.

• Wear gloves and/or other personal protective equipment.• Remove the visible material and then clean the surface with a 1:10 solution

of household bleach and water (one part bleach to nine parts water) or an EPA/hospital approved disinfectant such as Sanimaster 4.

3. Dispose of Regulated Medical Waste (Biohazard Waste) items correctly.

• Place contaminated items in red trash containers or the small cans labeled "biohazard." Contaminated items refers to having the presence of liquid, semi-liquid, or caked/dried blood or OPIM on an item or surface. Refer to CHS Waste Disposal Guide for appropriate disposal of various medical waste items.

4. Use and dispose of needles and sharps correctly.

• Do not bend, recap, or remove contaminated needles.• NOTE: exceptions only apply to circumstances were the action is required

for a specific medical procedure. These specific actions require written justification and recapping must be accomplished through a recapping device or a one-handed technique (hand-to-hand recapping is prohibited).

• Place sharps and needles in appropriate sharps containers or needleboxes as soon as possible after use.

• Discard glass vials, medicine containers, and blood tubes in sharps container. NOTE: Do not dispose of broken mercury thermometers in the sharps container. Follow your facility's mercury spill clean-up procedure.

• Do not overfill needle boxes. When the box is two-thirds full, use a new box.• Do not pass individual instruments by hand. Instead pass trays of surgical

instruments implementing a hands-free zone or a neutral zone.

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5. Safety Devices MUST be used

Based on the OSHA Bloodborne Pathogens standard and the CHS Exposure Control Plan the use and activation of engineering controls is MANDATORYwhen it will reduce the employee exposure either by removing, eliminating, or isolating the hazard. Engineering controls used within CHS include, and are not limited to the following:

• Retractable fingerstick devices• Retractable IV start needles• Self-sheathing syringes• Blunt suture needles• Blood Tubes• Safety scalpels• A needleless IV System• Sharps disposal containers• And other Sharps with Engineered Sharps Injury Protections (SESIP) or non-

needle sharps specific to a department – “Non-needle sharp or a needle with a built-in safety feature or mechanism effectively reduceing the risk of an exposure incident”.

WHEN using SESIP remember the acronym “SAFER”

S is for Select the correct device

A is for Ask (if you do not know how to use a device).

F is for Focus and think through the procedure before you do it.

E is for Execute the procedure; remember to trigger the safety characteristics

R is for Remove the device after activating the safety feature

CHS uses a systematic process which entails management and non-managerial employees to identify and select appropriate and effective engineering controls. As new engineering control technologies become available, CHS will continue to evaluate and select appropriate engineering controls to further reduce exposure incidents.

1. Be careful with contaminated linen.

• Handle contaminated linen as little as possible.• DO NOT rinse soiled linen before bagging.• If linen is very soiled and wet, place it in a leak-proof bag and take it to the

linen holding area or linen chute immediately.

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2. Watch for bloodborne pathogens warning labels which are orange or orange-red with the biohazard symbol.

• Bags or containers labeled with the biohazard warning label contain blood or OPIM.

• The label may also be on contaminated equipment, or on doors leading to contaminated areas such as a biohazard storage room.

• Warning labels must be posted on refrigerators and freezers containing blood and OPIM and other containers used to store, transport, or ship blood or OPIM.

• Remember to wear gloves if you need to open a contaminated container or if you have to handle contaminated equipment.

If you are exposed to blood or body fluids…

What to do if you are exposed to blood or body fluids:

• Wash the area with soap and water.• If your nose or mouth have been splashed, flush these areas with water. For

eye splashes flush eyes immediately with at least 500cc sterile saline.• Notify the area supervisor immediately.• Complete the Report of Occupational Injury and Illness Form (ROII).• Take this completed form (signed by a supervisor) to or call Employee Health

as soon as possible.• If you have been exposed to blood or body fluids of a known HIV positive or

highly suspected patient, report your exposure immediately (within twohours) to Employee Health. Any other exposures to blood and body fluids must be reported (within 24 hours).

• Employee Health will provide you a confidential medical evaluation, and with your consent, blood tests, post exposure preventive treatment, and follow-up counseling.

REPORT ALL EXPOSURES! THIS IS VERY IMPORTANT FOR YOUR HEALTH!

If you have any questions about Standard Precautions or Bloodborne Pathogens, call the Infection Control office or Employee Health at your facility.

Emergency Management

Emergency Management is the ability of an organization to prepare to respond to an emergency or disaster outside the facility, in the community, or inside the facility.

The community looks to facilities such as those of CHS for assistance to provide healthcare services to Charlotte and the surrounding areas, with

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minimal disruption, in the event of a disaster.

All CHS employees must know their assigned roles and perform them efficiently and without any errors. A carefully planned and flawlessly implemented disaster plan is the key to saving lives.

Emergency Management and Disaster Plans

The CHS Safety Management Program Manual (SMPM) is now available on-line via Synapse. The on-line manual contains CHS-level (system-wide plans) and some of the major acute care facility-level plans. Additional plans may exist at the facility and department level. Be sure to check which plans apply to your specific departmental operations.

NOTE: Section 10 of the manual is available on-line via Synapse. In addition to the electronic documents, hard copies of “Section 10” should be maintained and available at the facility and department level.

The following are types of plans for addressing emergency situations:

1. External Disaster Plan,2. Internal Disaster Plan, and3. Department-Specific Disaster Plans.

Types of Disasters

Disasters are usually described as either external or internal.

External Disasters are events which cause serious injury to multiple persons at one time. Examples include:

• Earthquake• Flood• Severe weather or other natural disasters• Multiple car accident • Large-scale power outage • Train collision or derailment• Off-site hazardous chemical spill results in

mass casualties• Nuclear, biological, or chemical incidents

arising as acts of terror

These events may have devastating effects on the community, as well as on the ability of healthcare facilities responding to them. CHS has emergency management and disaster-planning programs to manage the consequences of

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naturally-occurring disasters or other external emergencies which could potentially disrupt the facility’s delivery of patient care services.

Internal Disasters

In addition to natural disasters and external emergencies, internal disasters can be very disruptive. Examples of internal disasters are:

• Utility failure (electricity, loss of natural gas, water, etc.)• Bomb threat• Facility fire• Computer, telephone, or wireless paging system, failure

Ambulatory or Business Setting

If you are in an ambulatory or a business setting such as a doctor’s clinic/office or business office, in the event of fire or other disaster, staff, patients, and/or visitors must immediately evacuate to a safe area outside the building. For more information refer to your departmental fire policy and procedures.

Emergency Codes and Conferences

Note: The North Carolina Hospital Association has asked its members to adopt a uniform Disaster Code Scheme. Adopting a uniform system required a change to several existing code and conference names.

It is recommended facilities establish paging and response procedures for the following codes and conferences prior to changing voice paging procedures.

Code Black - Utility Outage (power, water, natural gas, steam, etc.)

Code Brown (Note color change) - Medical gas failure (Oxygen, vacuum, air)

Code Red - Fire, odor of smoke, visible smoke

Code Orange (Note color change) - Chemical Spills or Releases beyond the training of staff in the area

CCCooodddeee YYYeeellllllooowww (Note color change) - Suspicious Object/ Package – Bomb Threat

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Code Green - Severe Weather/Natural Disaster

Code Pink - Infant and/or minor patient abduction

Code Gray (Note color change) – Workplace Violence

Code Blue/Pediatric Code Blue - Medical Emergency – Adult(Note name change)

Code Triage (Note name change) - Mass Casualty Event– Multiple victims/ influx of patients

Telephone Conference - Telephone service has been disrupted

Paging Conference - The numeric and/or alpha-numeric paging systemis disrupted

Computer Conference - An internal computer network or system has been disrupted

Nurses Conference – Missing patient

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Code Levels

Outside agencies (Fire, police, ALERT, Emergency Management, etc.) have developed multi-county response plans describing eventsby a Level. The levels allow employees to speak in the same terms as emergency responders in the community. As the level number goes down, the situation becomes more serious.

• Alert At this level, facilities are in a heightened state of readiness and initial preparations are made for an event. Infra-facility communication is activated to facilitate readiness communication and outreach to others in the community, as needed.

• Level 3 Minor disruption of normal operations with no affect on patient care. No Internal Disaster is called. (Group text paging. No overhead page.)

• Level 2 Disruption of patient care and the appropriate code or conference may be paged accordingly. The administrative personnel referenced in the CHS Disaster Management Team are contacted to assess the resource needs in anticipation of Incident Command Center (ICC) activation.

• Level 1 Major event scenario with significant disruption in services and/or patient care. ICC is established.

Overhead Paging

Voice pages are announced by the paging operator (communications) on the overhead paging system. They will be repeated three (3) times as will the “All Clear” page that will follow once the event ends.

Procedures at the Corporate and Facility levels address each of the Codes and Conferences listed on the following pages.

Please note not all events will be voice paged. Voice paging will take place to notify employees to implement departmental procedures in response to the event.

If there is no overhead paging system for your facility, check with your manager to find out how emergency alerts will be made.

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Fire Safety

The leading causes of fires in healthcare facilities are:

1) the use of smoking materials, including matches and lighters2) combustible and suspicious fires.

The Carolinas HealthCare System has adopted a strict Smoking Management Policy to establish a smoke-free environment throughout CHS and to reduce the possibility of a hospital fire.

CHS is committed to protecting the public’s health, comfort, and safety by providing a smoke-free environment for the following reasons:

• Smoking is a major contributing factor in many deadly diseases, including heart disease and lung cancer.

• The passive smoke inhaled by non-smokers includes high concentrations of the same toxins that cause disease in smokers.

• SAFETY! Among the most common causes of hospital fires are smoking materials, including matches and lighters. Ignited clothing, mattresses, and bedding materials produce large quantities of smoke and toxins that may quickly make a patient, visitor, or employee unconscious.

• It is the responsibility of all faculty and staff to follow the Smoking Management Policy. Adherence to this policy is a condition of continued employment for all employees.

Elements of Fire Safety

1. Fire Prevention

The best way to deal with fire is to prevent it. To help prevent fires at CHS:

• Take the time to recognize and eliminate potential fire hazards in your area, as well as in other areas throughout CHS.

• Report hazards beyond your immediate control to your supervisor and/or the appropriate department in your facility (e.g., the Support Center, Facility Safety Officer, or Plant Operations and Maintenance).

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• Be sure to keep your work area clean. Pay particular attention to halls and stairways—keeping them clear ensures a faster evacuation in the event of fire.

• Always observe the Smoking Management Policy by smoking only in designated areas.

• Know your department’s Fire Plan, which is to include:

1. fire alarm procedures;

2. fire escape routes;

3. patient/staff evacuation procedures;

4. the location of fire extinguishers in your immediate area.

2. Fire Detection

The fire detection systems at CHS—visual and audible alarms, smoke detectors, and sprinkler system— are designed with one goal in mind: to detect smoke and fires as rapidly as possible. Accomplishing this goal helps ensure the safety of patients, visitors, and staff at CHS by providing fire safety professionals the time they need to put out the fire. In many of our smaller Business Occupancy locations, such systems are not present. Such outpatient facilities employ a fire plan based around evacuation of the building.

Fire Alarm Signals at CHS

• CHS’s fire alarm system will sound an alarm ONLY in the building in which the fire is located.

• All hospital buildings served by the fire alarm system will receive the following announcement on the hospital’s overhead paging system as a matter of information:

o “Attention please, Code RED,” [this is repeated three times, along with the location of the fire. Chimes and strobe lights will also be activated where located.]

• The fire alarm may continue to sound until it is determined it is safe to return to “business as usual.” Note: Some fire alarms will not sound continuously; however, strobe lights will flash until the building is safe. Check your facility’s Fire Safety Plan for more details.

• All staff within a building “in alarm” must follow the respective department’s Fire Plans.

Never enter a building if the fire alarm is sounding or the strobe lights are flashing. It is safe to enter the building ONLY after the termination of all audible and visual alarm signals or notification from a designated hospital representative. The only exception to this rule is staff members performing duties critical to patient care.

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What to do in Case of FIRE …

In the RACE for safety, the first three minutes are critical.

Because fire is so fast, investigate suspicious odors or smoke at once. If you think you smell smoke coming from behind a door, be sure to feel the door with the back of your hand before grabbing the door handle. If the door feels too hot to the back of your hand, do not open it.

RESCUE - (Rescue) Remove anyone who is in immediate danger to the nearest safe location. Use horizontal (i.e., sideways) exits first, stairs second. DO NOT use the elevator unless told to do so by the Fire Department.

ALARM/ALERT - (Alarm/Alert) Pull the fire alarm nearest you to alert others, AND call the appropriate telephone extension (or 911) as appropriate to report the fire and the location of the fire.

CONTAIN - (Contain the fire) by closing all doors and windows tightly. Fire doors will close automatically.

EXTINGUISH/EVACUATE - (Extinguish) Use the proper fire extinguisher only after the alarm has been sounded, only if you have been trained to use an extinguisher, and only if it is safe to do so. Or Evacuate.

Before You Use a Fire Extinguisher…

BEFORE you attempt to fight a small fire:

• PULL the fire alarm.• CALL the appropriate telephone extension (or 911) as appropriate.

NEVER attempt to fight a fire, if even one of the following statements is true:

• The fire is spreading beyond the immediate area where it started, or is already a large fire.

• The fire could potentially spread and block your escape.• You are not trained to operate the fire extinguisher.• You are in doubt about whether the extinguisher is designed for the type of fire at

hand or if it is large enough to fight the fire.

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It is reckless to fight a fire with an extinguisher if any of the above statements are true for you. Instead, leave immediately, sound the fire alarm, close the doors, and warn others.

How to Use a Fire Extinguisher…

Pull the Pin - This will release the lock latch.

Aim Low - Point the extinguisher nozzle (horn or nose) at the base of the fire.

Squeeze the Handle - This action releases the extinguishing agent.

Sweep from Side-to-Side - Keep the extinguisher aimed at the base of the fire until the fire appears to be out. If fire breaks out again, repeat the process.

3. Fire Containment

The hospital building is designed to limit the spread of fire by providing a series of physical barriers between patients and the fire and smoke and by maintaining a smoke-free way to escape if evacuation becomes necessary.

Closing doors and windows helps form a sealed compartment that prevents the spread of smoke and other gases into patient rooms.

4. Evacuation

Inpatient Setting –

• In the event of a fire, remove patients in immediate danger first across relatively short distances into unaffected smoke compartments on the same floor (i.e., horizontal movement). Check all rooms for patients who may need assistance.

• Vertical or downward movement to a safe area will be ordered after horizontal movement is judged unsafe. Patients will be moved to a lower floor - two floors below the fire is recommended, if time permits.

• Basement, ground, and first floors will evacuate by the nearest exit to the outside. Once outside, keep clear of the building and wait for further instructions.

Outpatient/Ambulatory Setting/Business Occupancy –

In the event of a fire or other disaster, evacuate to a safe area outside the building. Using such a “safe area” or assembly area is important so that your superiors and fire fighting personnel can quickly account for all persons from the building. This assembly area should be addressed in your specific facility Emergency Evacuation Plan.

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Review the fire plan for your department.Locate the fire alarm pull stations and fire extinguishers when you arrive in

your department. � Check with your supervisor for details.

Interim Life Safety

Interim Life Safety Measures (ILSM) are a series of administrative actions taken to compensate temporarily for hazards posed by existing Life Safety Code deficiencies or ongoing construction activities. These measures apply to all personnel, including construction workers. ILSM must be implemented during project development and continuously enforced through project completion to provide CHS personnel, their patients and visitors, and other workers with a safe environment. Interim Life Safety Measures consist of the actions listed below.

Ergonomics

Ergonomics is the science of fitting the work environment to the people doing the job, rather than the people to the work environment. Ergonomicsinvolves workplace design and arrangement of work activities to help prevent injury from occurring at work.

Why Should I be Concerned about Ergonomics?

The three goals of ergonomics are to prevent musculoskeletal disorders (MSDs), increase comfort and safety, and increase productivity and job satisfaction.Ergonomics interventions allow employees to work safely and reduce the risks of MSDs. Ergonomics can also help reduce the high costs of work-related injuries by improving the work or the job before injuries occur. Ergonomics benefits employees, supervisors, and managers.

What are Musculoskeletal Disorders (MSD)?

Musculoskeletal disorders (MSDs) are injuries that involve the muscles, tendons, or nerves. They occur over time and can take a long time to heal. MSDs most commonly occur in the neck, shoulder, elbow, hand, wrist, or back.

Signs and Symptoms of MSDs• Pain • Stiffness• Numbness • Decreased range of motion• Aching or tingling • Deformity• Burning • Decreased grip strength• Cramping • Loss of muscle function

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Preventing MSDs

One of the basic principles of ergonomics is to use good body positions that keep you working in neutral. This means keeping your joints in their strongest, most stable and least stressful positions while you work. These are some general ways we can use ergonomics to prevent MSDs by applying ergonomic principles to the tasks you perform every day:

• Review work methods and procedures on an ongoing basis to identify musculoskeletal disorders (MSD).

• Look for ways to improve ergonomics and reduce MSDs by changing:o work area organization and layout;o work environment (i.e. lighting);o work procedures;o work methods;o tools and equipment;o reduce or avoid repetitive motions;o reduce the amount of force needed to perform a task;o reduce awkward or difficult movements, reaches, or stretches by

reorganizing the work area- move parts closer to the worker, change the work surface height, etc.;

Basic Rules of Good Body Mechanics

These are the principles of good body mechanics. Remember these principles apply at home as well as at work. If you keep these principles in mind, you will not only have less chance of injury, your job will be easier and less tiring.

Remember – “Maintain Your Curves"

The muscles in the back are unlike many other muscles in your body— they are almost always in use. They hold your torso in an upright position throughout your day. They assist you every time you pick something up, whether it's a pen or a concrete block. They support posture while you sit in your chair, and they even work at night when you sleep.

In order for you to understand what is good posture and what is bad posture— let's take a look at how your back is designed:

Three Curves of Your Back:

Your back is composed of three natural curves forming an S-shape. When your three natural curves are properly aligned, your ears, shoulders, and hips

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are in a straight line. Without support from strong, flexible muscles, your back loses its three natural curves. Poor posture can lead to pain and serious injury.

When you use good posture, your back is aligned in three natural curves supported by strong, flexible muscles. Good posture helps prevent back strain and pain.

Tips for Keeping Your Back Safe• Keep your low back in the normal curved or arched position.• Replace twisting motions with pivoting or sidestepping.• Plan the transfer or lift ahead of time.• Make sure you have all the necessary equipment; use mechanical means

to assist as much as possible.• Keep your stomach muscles tight when lifting.• Place your feet in a position that gives you a wide, solid base of support.• Keep your head and shoulders upright.• Bend at the knees, not at the waist; lift with your legs, not your back. • Get as close to what you are picking up as you can.• Use your body weight and momentum to move the object, rather than just

using muscle strength.• Never lift anything you consider heavy, even if it is for a short distance.• Sit back against the chair, with your feet on the floor.• Stretch frequently especially when sitting for long periods of time.• Make sure all work heights are at the level which require the least amount

of lifting and do not force you to bend over at the waist. • Set up your work area to limit the amount of reaching you must do.• Use a ladder or secure step stool to reach for something overhead.• Stand with one foot in front of the other and your knees slightly bent, or

with one foot on a footrest such as a box, or bottom shelf.• Exercise for a stronger back, heart, improved strength, fitness, flexibility,

stamina, endurance, posture, and to control weight.

Questions or concerns regarding Ergonomics are to be directed to Corporate Safety (704-697-7283).

General Safety

Slips, Trips, and Falls

Employees frequently suffer injuries when they slip on wet floors or icy surfaces, trip over objects such as electrical cords and hospital carts, or fall because they are carrying heavy or bulky items.

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Sharps Injuries

Sharps injuries are punctures or cuts to the skin caused by sharp objects, including needles, syringes (with or without an attached needle), scalpel blades, surgical wire, utility or razor blades, blood tubes, slides and cover slips, glass and rigid plastic pipettes, or broken glass.

NOTE:• Notify your supervisor immediately if you encounter blood or other OPIM

contaminated sharp objects which have not been disposed of in designated containers. Only employees appropriately trained in Bloodborne Pathogens specified practices and procedures are to dispose of the equipment and/or article.

Strains

The term “strain” is typically used to describe overexertion injuries, such as certain types of back injuries, carpal tunnel syndrome, and ankle sprains. Repetitive tasks and improper lifting techniques cause many of these injuries, which may lead to musculoskeletal disorders (MSDs). Musculoskeletal disorders (MSDs) are disorders of the muscles, nerves, tendons, ligaments, joints, cartilage, blood vessels or spinal disks. MSDs often involve overuse of muscles, repeated strains of joints, or inflammation of tendons or tendon sheaths. Cumulative Trauma Disorders (CTD) are disorders of the musculoskeletal and nervous system due to motion, strong exertion, vibration, and mechanical pressure.

Injury Prevention Tips

To help prevent Slips, Trips, and Falls…

Some of the best ways to prevent slips, trips, and falls may include the following:

• Maintain a clean work area.• Look before you walk and make sure your pathway is clear of debris.• Close drawers after every use.• Avoid bending, twisting, and leaning backwards while seated.• Secure electrical cords and wires away from walkways.• Always use an appropriate stepladder for overhead reaching.• If you see objects on the floor, even a pen or a paper clip, pick them up!• Clean up spills immediately. If the contents of the spill are unknown or hazardous

do not attempt to clean the spill yourself. Contain the spill and notify your supervisor immediately.

• Report loose carpeting or damaged flooring to your supervisor.

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Back Strain Injury Prevention Tips

Most instances of back injury may be prevented by learning how strain on the lower back leads to injury and implementing techniques to reduce or eliminate back strain. Lower back strain and injury are typically the result of one or more of the following factors:

• Improper lifting techniques• Excessive bending• Excessive twisting• Improper posture• Failing to get help • Failing to use lifting aids• Rushing or being in a hurry

While the first factors may seem obvious, the final factor, rushing or being in a hurry, may not. Employees involved in direct patient care frequently find themselves in situations in which patients need immediate assistance. Do not allow rushing or being in a hurry to compromise your personal safety or the safety of your coworkers. Follow proper procedures when lifting patients or heavy objects.

The Safe Way to Lift

Always Remember: If the load is not manageable, get help

If the load is manageable, follow these tips for safe lifting:

• Brace the Lower Back

By tightening your stomach muscles, you can brace your pelvis; this will help your back remain stable while you lift.

• Bend the Knees

Bend at your knees, instead of at your waist. This helps you keep your balance and lets the strong muscles in your legs do the lifting.

• “Hug” the Load

As you gradually straighten your legs to a standing position, try to hold the object you are lifting as close to your body as possible.

• Avoid Twisting

Twisting can overload your spine and lead to serious injury. Make sure your feet, knees, and torso are pointed in the same direction when lifting.

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In addition to these techniques, make sure your footing is firm when lifting, and your path is clear. Use the same safe techniques when you set your load down. It takes no more time to do a safe lift than it does to do an unsafe lift.

Finally, research shows healthy people are less likely to suffer back pain from an on-the-job injury. So, eat well, exercise regularly, limit caffeine intake, and avoid smoking. Staying physically fit will give you the strength and flexibility you need to perform your job safely.

Overhead Lifts

Overhead loads may be particularly dangerous to lift. If you have to lift an object that is above shoulder-level, use a stepstool or ladder to avoid over-reaching. Test the weight of the load before removing it from its shelf. If the load is less than 25 pounds or so, slide it toward you, and hug it close to your body as you descend. If possible, hand it down to a waiting coworker.

What to do if you are involved in an accident or injury…

If you, or a CHS employee, are involved in an accident or injury:• Tell your supervisor.• Complete a "Report of Occupational Injury and Illness Form," according to the

instructions, fax it to Workers’ Compensation, and give the report form to your supervisor, so they may complete their section.

• If medical treatment is needed, take the "Report of Occupational Injury and Illness Form" with you to the treatment area assigned to your facility.

• If the injury occurred because of a broken piece of equipment or a hazard in the workplace, take the hazard/equipment out of service, label it “DO NOT USE”, and remove from the work area. Do not throw any of the pieces away. Save all the parts, and hold for Risk Management or Clinical Engineering to pick up.

If the safety problem involved a patient or visitor:1) Notify a supervisor and complete an Incident Report.2) If the injury is caused by a hazard in the workplace, including an equipment

malfunction, remove the hazard.

To reduce the risk of accidents and injuries:• Report unsafe conditions to your supervisor.• You may contact the Safety Hotline to anonymously report any safety

problems (704-355-SAFE).• Take immediate actions to prevent injury such as removing broken equipment

from service or notifying your supervisor immediately.• Follow correct policies and procedures at all times.

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Hazard Communication

HazCom (also known as Right-to-Know) is an informational system that alerts employees to any hazardous materials they may come in contact with

in the workplace. Your health and safety depend on knowing the correct way to handle and dispose of chemicals with which you work. A list of all hazardous materials in your department is located in the Safety Management Program Manual. Included in this manual is a section on disposal of materials harmful to the environment or to people.

Your responsibilities, as an employee, begin with familiarizing yourself with specific chemicals which will be used in your work area. Next, you must carefully read the important information on all chemical labels, MSDS, and training materials provided during both new employee orientation and subsequent annual refresher training sessions, including this module.

� If you do not understand a feature of CHS’s Right-to-Know program, ask your supervisor.

The most dangerous chemical is one without a label. Never handle a chemical until you know what it is. If a label is missing, immediately tell your supervisor.

If a spill occurs, notify your supervisor. Materials must be cleaned up properly to ensure no harm occurs to people or the environment. The best source for information on a chemical spill is the MSDS, usually located in the Safety Management Program Manual in your department.

Infant Abduction

Infant abduction is the unlawful taking of an infant from its parents, guardians, or other persons to whom the infant’s care had been entrusted.

An individual who abducts a newborn tends to use one of two methods. The abductor may:

1) pretend to be a healthcare worker, enter the mother’s room, and give a medical reason for taking the baby to the nursery, or

2) take the baby from the nursery when nursery staff is not in the immediate area.

Most abductors fit this profile:

• Female, age 15-45, often overweight.• Usually live in the community where the abduction takes place.• Often tell others they have lost a baby or are not able to have children.

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• Often married or in a relationship. • Frequently visit the facility before the abduction. May ask staff members about

hospital procedures and floor layout. • May be dressed in scrubs, lab coat, or oversized coat. • May be carrying a large bag such as a gym bag, shopping bag, or large bundle of

linen.

CHS employees will be notified of an infant abduction by the facility hospital paging operator, who will use the term “Code Pink” to announce that an abduction had occurred. If an abduction occurs, rapid response is critical.

• Staff must go to the nearest elevator(s) and push the button to call the elevator to the floor in order to observe who is in it and to prevent an abductor from using the elevator. Let the elevator go after checking.

• Staff must remain at the elevator until the Code Pink is cancelled.• Respond, then, according to the specific duties listed in the Infant Abduction

Plan.• If you see an unidentified individual in scrubs, a white lab coat, or an oversized

coat, and/or the individual is carrying a large bag, ask to see his/her CHSidentification badge (including temporary staff and construction workers, etc.).→ If he/she refuses, do not try to detain the individual.→Direct the person to leave through the main lobby or employee entrance.→Call CHS Security immediately on 704-355-3333.→Give a complete description of the person.

If you do not feel the person should be approached, call Security immediately and give a physical description.

Prevention is the most important point of this module!

Infection Control

Who Should Be Concerned about Infection?

Everyday people are exposed to germs that may make them sick. People who work in healthcare, such as nurses, laboratory technologists, and environmental service workers, have a greater risk of exposure in the workplace.

Patients may also be exposed to germs found in healthcare facilities. When a patient gets an infection while in a healthcare facility, it is called a nosocomial or hospital-acquired/associated infection.

People working in healthcare facilities frequently have questions about preventing the spread of infection between staff and patients. Many of these questions will be answered in this module.

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What does Infection Control mean?

Infection Control means preventing nosocomial infections and reducing the likelihood employees, patients, or visitors will be exposed to germs in a healthcare facility.

Where can I learn more?If you have questions about specific departmental or area infection control measures, or

high-risk patients or procedures, be sure to ask your supervisor about these issues before beginning work.

Your role:

• Stay healthy. If you become sick with an infectious illness such as a bad cold or pink eye, stay home.

• Handwashing is the most effective way to prevent the spread of infection. Wash your hands frequently: → after using the restroom, blowing your nose, or sneezing,→ before preparing/serving food,Use an alcohol based hand rub:→ Before and after having direct patient contact.→ After removing gloves.→ Before leaving the job site.

• Use Standard Precautions, see page 3 of this module for more information.

Standard Precautions away from Work

You should always practice Standard Precautions as a way to protect yourself and others. If you are exposed to blood or other body fluids when you are away from work, you need to assume there is a possibility of contact with a bloodborne pathogen.

Protect yourself by:• Using barriers. If an unexpected or emergency situation occurs, use whatever

protection you can find to create a barrier between yourself and the possible source of infection. Examples of barriers include a towel, clothing, plastic bag, or newspapers.

• Washing your hands according to the previously described guidelines.• If you are exposed to human blood or body fluids outside of work, call your personal

doctor for follow-up instructions.

Should I come to work if I am sick?

Some infections may be readily transmitted to patients, family members, and others. If you suspect you have an infection or have been exposed to an infection or infectious illness, call Employee Health before coming to work.

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The following are examples of infectious illnesses or exposures to report to Employee Health:

• Conjunctivitis (pink eye)• Viral Hepatitis• Herpes Whitlow (herpes of the fingers)• HIV• Meningococcal meningitis• Varicella (chicken pox)• Pertussis (whooping cough)• Tuberculosis (TB)• Salmonella• Shigella

Health Screening

Employee Health will assess your health to make sure you are not infectious to others. Your supervisor may also help if you are ill. Remember! you may do more harm than good if you do not have your own illness checked or treated. You may place patients, co-workers, and family members at risk of catching your illness.

To avoid becoming ill, take the following precautions:• keep immunizations up-to-date• maintain a healthy lifestyle• exercise• eat fruits and vegetables• practice good personal hygiene

Special Precautions

*Policies governing volunteer activities exempt volunteers from entering isolation rooms. Therefore, this section on Special Precautions does not apply to volunteers.

A sign on the patient’s door requiring Special Precautions means the patient has an illness that may not be contained with Standard Precautions alone. If you need to enter a room where a patient is on additional precautions (e.g., Transmission Based Precautions), ask for assistance from the nurse.

Tuberculosis (TB) germs are spread through the air and may be inhaled. You cannot get TB from bed linens or dishes. To avoid catching the disease, follow “Airborne Precautions – NIOSH-Approved Respirator Required” precautions, including wearing a NIOSH-Approved respirator and putting patients in a negative-pressure room.

�Contact your supervisor for more information.

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When using equipment, products, and supplies for patient care:• Make sure the package has no holes, tears, or small openings.• Check for an expiration date (if applicable). Do not use expired products.• Do not use an item if it is damaged, wet, or soiled, or if the packaging is

damaged, wet, or soiled.• Keep clean equipment and supplies separate from used equipment and supplies.• Do not use one patient's supplies or equipment for another patient; this action

may transfer germs and cause infection.• Discuss the proper cleaning of equipment in unit meetings to make sure

everyone follows policy/procedures.

Compressed Medical Gas

Gases such as oxygen and nitrous oxide are stored under pressure. If accidentally damaged, the cylinder may act as a projectile and cause serious injury or damage. Cylinder tanks must remain in an upright position and be secured at all times. They must be placed in the corner of a storage area with a chain securing them to the wall or in a special carrier or holder. They must never be placed on the floor, propped against items, or placed on a patient stretcher. Always identify contents of a cylinder prior to use.

Medical Equipment and Utilities Management

Medical Equipment Management

The Medical Equipment Management program promotes safe and effective use of medical equipment. The program ensures all medical equipment is properly selected, inventoried, maintained, and replaced and users are trained to safely operate equipment and properly report equipment failures/incidents.

The primary purpose of the Medical Equipment Management Program is to:

1. ensure all equipment has been properly inspected;2. provide information and instruction regarding the proper use of equipment,

equipment maintenance requirements, and the risks associated with the use of various medical devices to contribute to patient and staff safety.

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Steps to Take if a Person Has Been Injured or in an Accident Involving Medical Equipment

If a person is injured or involved in an incident involving medical equipment:

1. Offer to get treatment for the injury (i.e., visitors will go to the Emergency Department; physicians will be notified for in-patients).

2. If a person is badly injured or dies, inform your supervisor immediately.3. Document the problem.

• If the injured person is an employee: Fill out the Report of Occupational Injury and Illness Form.

• If the injured person is a patient or visitor: Fill out an Incident Report. Be sure to fill out Section V.

4. If the injury is serious call Risk Management immediately at 704-355-3238. If the injury happens after hours, tell your supervisor, who will then call the Administrator On-Call.

5. If the injury possibly happened because the equipment did not work properly, save all the parts, including disposable ones. Do not change the control settings on the equipment. Tag the equipment as “defective,” remove it from service, and hold it for Risk Management or Clinical Engineering to pick up. Be sure to let Clinical Engineering know the equipment is involved in an incident. Be prepared to provide additional details to assist in the evaluation of the potential device malfunction.

Electrical Equipment Prohibited from Use at CHS Facilities

Some types of electrical equipment may not be used in CHS facilities. A complete listing of electrical equipment prohibited from use at CHS facilities may be found in the Safety Management Program Manual.

Some examples of equipment not to be used are:

• Coffee pots (non-commercial grade)• Heating pads• Clothes irons• Electric blankets• Hotplates• Popcorn poppers• Radiant heaters

Potential Hazards

In modern healthcare facilities, the use of electrical equipment is essential to perform most aspects of our work, however, it may be dangerous if not used properly or correctly. According to the National Safety Council, approximately six percent of work-related deaths result from electric shock. Learning about the hazards associated with

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the use of electricity, maintaining electrical equipment in good working order, and following safe work practices will help prevent most electric shock injuries.

Fire

An overlooked hazard associated with the use of electrical equipment is fire. Since heat is generated from the passage of electric current, an overloaded circuit or a spliced or frayed wire may generate enough heat to cause a fire.

Electrical Safety Tips

• When unplugging an electrical device, pull the plug, not the cord. Over time, pulling the cord may result in damage to both the cord and plug, leading to exposed wires.

• Inspect all electrical equipment prior to use. Report any frayed cords, broken adapters, or equipment without proper labels immediately to your supervisor, safety officer, or the Corporate Safety Department.

• Never use an adapter to plug more than two electrical devices into an outlet. Doing so may overload the circuit, which may result in a fire. “Cheater plugs” or adapters allowing three-pronged (grounded) plugs to be used in two-pronged outlets are never to be used.

• Always follow manufacturers' directions for proper and safe use of equipment.• A surge protector outlet strip must only be plugged directly into an electrical wall

receptacle. Strips in patient care use must be hospital grade and UL (or other agency) listed. These outlet strips are prohibited in certain high risk areas (wet areas) such as the OR.

• Extension cords may only be used temporarily, must be plugged directly into an electrical wall receptacle (not into another extension cord), and must never be used for refrigerators, microwaves, heaters, or coffee pots, or in designated high risk areas.

Utilities Management

The primary function of the Utilities Management Program is to ensure all elements of the utilities system (i.e., electrical system, heat and air conditioning, plumbing, communications system, etc.) are maintained and properly operated.

Two Types of Electrical Systems

Under normal conditions, Duke Power supplies electricity to all electrical outlets. “Normal” outlets are brown, ivory, or gray. In the event of a power failure, "normal" outlets may be without electricity, and electricity is supplied to the red outlets by emergency generators.

Emergency outlets are red.

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Equipment to always be plugged into emergency, or red outlets, include the following: ventilators, suction machines, specialty beds, defibrillators, and communications systems.

Steps to Take if the Electrical System in Your Area Fails:

1. Notify the CHS Support Line on 704-446-6161 or 866-446-6161. Note: All facilities managed by Lincoln Harris are to notify the Lincoln Harris Response Center on 1-800-933-4357.

2. Notify the clinical supervisor of the area.3. Verify life-support equipment is on emergency power or staff is providing interim life

support.

Elevator Safety

Vertical transports or elevators are used to move people and equipment vertically in the building. Follow these tips if an elevator stops between floors while you are in it:

1. Remain calm.2. Use the emergency phone in the elevator. Tell the operator what elevator you are

on, if there is a medical emergency, how many people are on the elevator, and the floor closest to you.

3. Activate the alarm, usually a red button or switch.4. Stay on the elevator. Do Not try to exit an elevator stuck between floors.

Pneumatic Tube System

The pneumatic tube system transports a variety of materials including pharmaceuticals, laboratory specimens, and other critical patient care items. When maintained and used properly, this system allows staff members to concentrate on the patient without having to walk floor to floor to obtain the information or medical supplies required for the patient.

Every employee using the pneumatic tube system has the responsibility of keeping the pneumatic tube system running. The number one cause for the tube system stopping is user error. User error includes overstuffed carriers, improper packaging of carriers, and sending broken carriers throughout the system. These conditions can cause blockages or spills in the system.

The Plant Operation and Maintenance Department maintains the tube system. Users should contact the maintenance department at 446-6161 to report any spills or blockages as soon as possible, and to report any broken carriers.

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Heating Ventilation Air Conditioning (HVAC)

A variety of air-handling systems (HVAC) help to maintain a safe and comfortable environment for patients, visitors, and staff.

The thermostats are to set at a comfortable setting, usually between 72-75 degrees. If a situation requires the temperature be outside the 72-75 degree range, reset the thermostat within the normal range as soon as the situation has been corrected. Do not adjust locked thermostats. If the HVAC system fails or is not working correctly, notify the CHS Support Line on 704-446-6161or 866-446-6161, or, where applicable, contact the Lincoln Harris Response Center on 1-800-933-4357.

Security

The CHS Security Department’s goal is to provide a safe and secure environment for patients, visitors, employees, and staff. Security Officers work

each shift to assist visitors, guests, and employees with:

• Routine patrols,• Information and directions,• Motorist assists (e.g., battery boosts, flat tire assists, door unlocks),• Personal escorts,• Traffic direction, and• Investigating and reporting security related incidents.

You play a very important role in keeping our facilities safe and secure. Report any suspicious activity or potential security problems immediately.

Types of situations to report to Security:

• Disruptive behavior of any type,• Any suspicious activity,• Destruction or damage to property,• Any type of theft or attempted theft,• Bomb threats, or any suspicious packages or letters,• Assaults,• Attempted suicide.

Everyone at CHS is responsible for security.

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Security Tips

Tips to keep us safe:

• Be aware of your surroundings. • Wear your Carolinas HealthCare System identification badge at all times while on

CHS property. Anyone observed in restricted areas (particularly in patient care areas) without proper identification will be asked, “May I help you?”

• Do not wait for a problem to develop. Immediately contact Security (704-355-3333) whenever you have any problem or concern about safety issues.

• Report all incidents.• Keep personal items and System equipment in a secure area. Bring to work only

the items you need.• Take the time to assist our patients and guests. They are in a strange

environment and often feel vulnerable. If visitors or guests are experiencing difficulties, contact Security for assistance.

• Politely, and firmly, challenge individuals in and around your work area if they seem suspicious or do not have proper identification. Simply by asking, “May I help you?”, you may determine what business the individual has in your area. If the person refuses to cooperate or seems agitated, contact Security immediately.

Suspicious Letters or Packages

• When delivery personnel bring packages, check for an identification badge or ask to see identification.

• Check the name and address on packages before accepting delivery.• If a delivery is left outside the door or department, check the address

and vendor before opening it. • Do not open unexpected packages or ones without a correct address. • Call Security if you have any doubts. Some common indicators of a suspicious

letter or package include the following:→ No return address/excessive postage→ Excessive packing materials, such as paper wrappings, large amounts of tape

or string→ Rigid sides or lopsided package→ Package’s weight is particularly heavy for its size→ Any strange odors coming from the package→ Any unusual sounds coming from the item, such as beeping, ticking, etc.→ Oily stains on the outside of package or signs of any crystallized or powdery

substances→ Wires / aluminum foil showing through the outside of package→ Restrictive markings on package such as “Attention to___” or “Confidential:

Do Not Open”

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→ Package is addressed to a title, rather than an individual (such as “Director of Security”)

→ The package/letter was found or delivered in an unconventional manner (not US Postal, FedEx, regular courier, etc.)

If You Discover a Suspicious Letter or Package:

• Treat the letter or package with care. DO NOT SHAKE OR BUMP UNNECESSARILY!

• DO NOT tear open, smell, taste, or touch the item unnecessarily.• Isolate the item and look for any additional signs (see indicators above).• If additional signs are present, or the package seems suspicious, treat the letter

or package as suspect and immediately call Security for assistance.

Bomb Threats

If a bomb threat is called in to your area:• Remain calm.• Write a note and give it to another staff member to notify your manager

immediately.• Keep the caller on the line and obtain as much information as possible. Ask for

information in this order:→ When is the bomb going to explode?→ Where is it right now?→ What does it look like?→ What type of bomb is it?→ What will cause it to explode?→ Did you place the bomb?→ Why did you place the bomb?→ What is your address?→ What are your name, sex, age, and race?

• Write down anything you notice about background noises and the caller’s voice or language, etc.

• Give all information to Security.

Workplace Violence Awareness & Prevention

Carolinas HealthCare System has a policy of zero tolerance for workplace violence, verbal and non-verbal threats, and related actions (CHS Policy 2.10).

Some factors increasing the risk of workplace violence are:• Lay-off or termination• Unresolved conflicts with coworkers• Organizational changes• Disciplinary actions

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• Poor performance reviews• Psychological issues• Family/personal problems• Financial difficulties• Being passed over for promotion• Discrimination (real or perceived)• Alcohol or drug dependency• Ignored grievances

Your role

Employees’ responsibility for preventing workplace violence is to notify the supervisor, Human Resources, and Security of any violent or potentially violent situations. Employees who withhold information relating to violence, threats, or harassment will be subject to discipline up to and including termination.An important part of avoiding violence in the workplace is the establishment of a healthy work environment. This includes, and is not limited to,

• Open communication with employees• Following complaint/grievance procedures• Using the Employee Assistance Program (EAP)• Maintaining a drug and alcohol free workplace• Enforcing policies and procedures consistently• Respecting your coworkers

Presence of a Weapon or Hostage Situation

In the event a weapon is involved during a Workplace Violence incident, or a hostage situation occurs staff are to always retreat to safety (when possible) and contact Security and/or the local Police Department and give them the following information:

• Location of the incident, including exact area where the armed subject was last seen

• Description of the subject, including their relative position in the area • Information on what type of weapon they are armed with (knife, handgun, rifle,

etc.) • Your name, telephone number, and how many people (if any) are involved

The affected area is to be immediately be evacuated and bear in mind the armed subject is in control of the situation. Do not attempt to intimidate, threaten, or challenge theindividual’s authority. Give plenty of room, and do not block the route if he/she isattempting to leave the area. Note their last direction of travel, and contact Security and /or the local Police with this information. In the event you cannot leave the area remember the following:

• Try to talk to the subject, convincing him/her a non-violent solution is the best alternative. Show a commitment to assist in any way to reach a peaceful

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settlement; however do not stop communicating with the individual no matter what the outcome.

• Never take a surrendered weapon from a subject, even if it is offered to you. Instead, have is placed in a neutral location, and back away from it. This will decrease the chances of an accidental injury or sudden “second thoughts” on the part of the subject.

• When a surrendered or confiscated weapon is present, always use extreme caution and contact Carolinas HealthCare System Security immediately. Do not leave a weapon unattended until security and/or local police arrive to secure the area.

Workplace violence is traumatic and affects everyone. By preparing strategies and heightening employee awareness of potential danger signs, we may prevent workplace violence from occurring.

�If you are scheduled to work in an area identified as a security sensitive area (e.g., pharmacy, emergency department, nursery, pediatrics), be sure to obtain

further information on security issues from your supervisor.

Performance Improvement

Performance Improvement (PI) is vital to the CHS mission statement.

The mission of Carolinas HealthCare System shall be to create and operate a comprehensive system to provide healthcare and related services, including education and research opportunities, for the benefit of the people it serves.

Quality is an important component to us, as reflected by our vision and goals. The ultimate purpose of Performance Improvement (PI) is to improve the care provided to our patients. We provide quality services by (a) planning quality activities and (b) monitoring those activities. Results are reported through a committee structure to the Board of Commissioners, who oversees the quality program. Monitoring occurs through routine monitors by hospital departments, peer review, and the use of PI teams. Each facility has a Performance Improvement Plan. You will see it as part of your hospital or department orientation. It contains the topics monitored through the year and the PI priorities for your organization.

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Carolinas HealthCare System’s Method of Performance Improvement: PDCA

PLAN – This step includes questioning of the current process, developing theories of how to improve the process, creating an action plan for process improvement, and predicting the outcome.

DO – Implementing the action plan on a small scale by conducting a trial run or pilot study.

CHECK – Observing the effects and noting whether or not the process achieved the desired results.

ACT – Implementing the improved process on a system-wide basis and incorporating improvements into daily practices.

Sentinel Event

A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Examples include:

• Suicide of a patient in a setting where the patient receives around-the-clock care• Infant abduction or discharge to the wrong family• Rape• Hemolytic transfusions reaction involving administration of blood or blood

products having major blood group incompatibilities• Surgery on the wrong patient or wrong body part

Your role

If a sentinel event occurs in your area, immediately report it to your supervisor or manager.

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PosttestName: _____________________________________________

Date: ______________________________________________

Circle the correct answer.

1. Examples of fluids that may spread bloodborne pathogens are:

a. Bloodb. Semenc. Breast Milkd. All of the above

2. If you are exposed to blood or other body fluids, you must:

a. Complete an Incident Reportb. Complete a Report of Occupational Injury or Illness Form (ROII) c. Go to or call Employee Health as soon as possibled. Wash the area with soap and watere. a ,c, df. b, c, d

3. While working in your department one day, you notice heavy smoke coming from an area at the far end of the hallway. What must you do?

a. Remove all patients/staff from the areab. Alarm/Alert othersc. Move patients horizontally (sideways) through the next set of fire doorsd. Wait for the fire department to come to move the patientse. Use the elevators to evacuate to the lobbyf. a, b, and cg. c and d

4. Define R-A-C-E.

a. Run And Catch the Elevatorb. Rescue; Alert/Alarm; Contain; Extinguish/Evacuatec. Run; Alert, Catch; Evacuated. Rescue; Alarm; Catch the Elevator

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5. How do you prevent a possible fire in your department?

a. Recognize, eliminate, and/or report hazardsb. Keep your work area and exits cleanc. Observe the Smoking Management Policyd. Know your department’s fire plane. All of the above

6. The ______________ standard gives you the right to know about hazardous chemicals in your work area.

a. HazComb. Important-to-Knowc. Right-to-Knowd. Both a and c

7. What are you to do if you see a suspicious person with large bundle in infant nursery or pediatric areas?

a. Ask to see the person’s identification badgeb. Direct the person to exit through the main lobby or employee entrancec. Call Security on 704-355-3333 immediately with a description of the persond. All of the above

8. You must always wash your hands:

a. After touching a patientb. When your hands are soiled with blood or body fluidsc. After using the restroomd. All of the above

9. True or False (Circle One)

The number one cause of downtime associated with the tube system is user error.

10.If the power goes out in your department, you must:a. Notify the clinical supervisorb. Ensure all life support equipment is on emergency powerc. Call the CHS Support Line on 704-446-6161 or 866-446-6161d. All of the above

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11.What are the three components of the System’s mission statement?

a. Healthcare and related services, education, and researchb. Quality, education, and researchc. Improvement, healthcare, and researchd. None of the above

12.Standard Precautions must be used:

a. With every patient regardless of illness/injuryb. Only with patients with respiratory problemsc. Only when you suspect a patient has an infectiond. Only when ordered by the physician

13.The words used to announce a fire situation are:

a. Code Yellowb. Code Redc. Code Greend. Code Alpha

14.If you have questions about how to clean up a hazardous material spill, you should ask your supervisor and:

a. Refer to the MSDS for the hazardous materialb. Call Corporate Safetyc. Call Environmental Services for assistanced. A and B

15.“Ergonomics” means:

a. Improving the speed at which the job is done.b. Science of fitting the work environment to the people doing the job.c. Monitoring telephone conversations made by employees.

16.All patient equipment must be:

a. Inspected by Clinical Engineering prior to useb. Inspected for an intact cord and plug prior to each usec. A and Bd. Neither of the above

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17.True or False (Circle One)

Gas cylinders may be stored on a stretcher or on the floor.

Score: __________

Manager’s Initials: _________ 2005 Carolinas HealthCare System