First aid in the era of biohazards

by Lisa J. Burns, Q.S.S.P.

10 best practices to keep responders safe

Everyone sees the need for trained responders, first-aid kits and automated external defibrillators at the workplace. But what about the simple cut that bleeds enough to require a gauze bandage? Does the responder — or just a nearby helpful employee — see the need to wear disposable gloves? Bloodborne pathogens and other biohazards command little attention from most people, yet can cause critical illnesses and sometimes eventual death.

Defining the danger
Bloodborne pathogens are microorganisms (bacteria or viruses) carried in the blood that can be transmitted and cause disease in other people. Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) are two examples that are addressed by the OSHA Bloodborne Pathogen standard 29 CFR 1910.1030. Malaria and syphilis also are caused by bloodborne pathogens. Other body fluids also may transmit these and other diseases.

Infectious disease such as the H1N1 flu virus is a workplace concern that employers must address.

Transmission
Unbroken skin generally acts as a barrier to bloodborne pathogens. However, microorganisms can enter through any damaged or broken skin such as acne, sunburn, blisters, open sores, cuts or abrasions. They also may be transmitted through mucous membranes, including those of the eyes, nose or mouth.

Infectious diseases such as the H1N1 flu virus are primarily transmitted through airborne body fluids emitted with coughs and sneezes, and breathed in by others in the immediate vicinity. They also are transmitted when a hand used to cover the mouth then touches faucets, doorknobs and other surfaces from which it is later picked up by others.

OSHA first-aid regulations
Emergency medical services and first aid that general industry employers must provide are described in OSHA standard 29 CFR 1910.151. The standard recommends kits and supplies that are compliant with the minimum guidelines established by the American National Standards Institute (ANSI) in Z308.1-2009. It also incorporates other standards and measures by reference, such as 29 CFR 1910.1030, which deals with bloodborne pathogens.

OSHA’s 29 CFR 1910.1030 standard requires limiting employee exposure to blood and other potentially infectious materials. It specifies that training and personal protective equipment must be provided for employees who can be “reasonably anticipated” to face possible contact with blood or other potentially infectious materials on the job.

The standard, issued in 1991, was updated in 2001 in response to the Needlestick Safety and Prevention Act, and can be found at http://www.osha.gov, along with FAQs and various letters of interpretation issued over the years since then.

Best practices
Following the best PPE practices recommended below will help keep first responders safe from bloodborne pathogens and other infectious material.

1. “Universal precautions.” Treat every situation as potentially dangerous. OSHA’s universal precautions require that all human blood or other potentially infectious materials be considered hazardous.

2. Hand protection. Before donning gloves, cover any cuts or sores on your own hands with a bandage. Inspect the gloves and if the material is thin, doubleglove to provide another layer of protection. Do not use torn or punctured gloves, no matter how miniscule the damage might be. When removing used gloves, pull them off from the cuff, turning them inside out so the outside of the gloves do not touch your bare skin. Dispose of them in a designated biohazard bag. Immediately scrub your hands thoroughly, including under nails — and any other potentially contaminated skin — with nonabrasive soap and running water at hand-washing facilities that employers must provide in readily accessible areas.

3. Eye and face protection. While providing first aid or other medical assistance as well as working in labs or while cleaning up a spill, there may be a risk of splashing or vaporization of contaminated fluids. Use goggles to protect against transmission of pathogens through your eye membranes. Use a face shield in addition to goggles to protect against splashes to your nose and mouth.

4. Body protection. In some cases, you may need to wear aprons or body shields to protect your clothing and keep blood or other contaminated fluids from soaking through to your skin. Wear shoe covers to avoid contamination of your footwear.

5. Clean up. For clean-up of blood or other body fluids from sick or injured employees, use gloves and, depending on the situation, some or all of the above-mentioned PPE. In addition, you should have available a small shovel and scraper, appropriate absorbent materials, biohazard bags, ties, germicidal towelettes — and for large areas, a mop or sponge and bucket with a solution of 1/4 cup bleach to 1 gallon of water. Some manufacturers supply complete biohazard clean-up kits that contain all the necessary supplies, including special absorbent materials that deodorize as well as bind the hazardous body substances together.

6. Deposit waste. Once clean-up is complete, deposit the waste material first in a labeled, red biohazard bag and tie it tightly. Use germicidal towelettes or bleach solution to clean the contaminated area. Then put the first bag into a second biohazard bag, and add the used towelettes or sponges, your shoe covers, gown, face mask with eye shield and, lastly gloves in the same bag, and seal it with a tie. Discard the red bag in an appropriate container for infected solid waste as required by local regulations.

7. Sharps. For any broken glass or other sharp material, use a broom with shovel or dustpan, and deposit them in appropriate boxes. Never touch them with your gloved or ungloved hands and do not put them in a biohazard bag.

8. Decontamination. Finally, wipe your hands with antiseptic hand wipes that provide rapid bactericidal action and allow them to air dry. Next, go to the nearest handwashing area and wash your hands and all potentially exposed skin thoroughly with non-abrasive soap and running water.

9. Equipment decontamination. A person trained in the appropriate procedures must decontaminate and sterilize all non-disposable equipment and tools used, such as mops, buckets and re-usable gloves, as soon as possible.

No complacency
Factory or construction site, chemical, plastics or food and beverage processing plant — no matter what the workplace — there should be no toleration of complacency when there is potential for exposure to bloodborne pathogens and other infectious disease. The effects of exposure may not be immediate, but there is a definite potential for serious illness and eventual death.

Lisa J. Burns, Q.S.S.P. Lisa is associate product manager-personal protection- Americas at North by Honeywell. She is a member of the International Safety Equipment Association and a Qualified Safety Sales Professional. Lisa can be reached at (401) 275-2608 or by e-mail at Lisa.J.Burns@Honeywell.com.

The Federal Emergency Management Agency has released a new report titled Personal Preparedness in America: Findings from the 2009 Citizen Corps National Survey that offers data on the public’s thoughts, perceptions, and behaviors related to preparedness and community safety for multiple types of hazards. FEMA says the report’s findings are particularly relevant as the nation prepares for a possible pandemic flu outbreak, hurricane season, and other hazards.

Results from the national survey have important implications for the development of more effective communication and outreach strategies to achieve greater levels of preparedness and participation, the agency says. For example, the results indicate that 30 percent of Americans have not prepared because they think that emergency responders will help them and that more than 60 percent expect to rely on emergency responders in the first 72 hours following a disaster. While government will execute its functions, communications to the public should convey a more realistic understanding of emergency response capacity and emphasize the importance of self-reliance. FEMA concludes that messaging should thus speak to a shared responsibility and stress that everyone has a role to play in preparedness and response.

The survey also found that many people who report being prepared have not completed important preparedness activities or do not have a sound understanding of community plans. Of those who perceived themselves to be prepared, 36 percent did not have a household plan, 78 percent had not conducted a home evacuation drill, and 58 percent did not know their community’s evacuation routes.

Fourteen percent of respondents reported having a physical or other disability that would affect their capacity to respond to an emergency situation. Alarmingly, however, few individuals with disabilities had taken specific actions to help them respond safely in the event of an emergency, the study found. Only 27 percent had taken a CPR or first aid training and less than half (47 percent) had a household plan. Another 14 percent of survey participants indicated they lived with and/or cared for someone with a physical or other disability. Of these individuals, less than 40 percent reported taking a CPR or first aid training (36 percent and 39 percent respectively) and 53 had supplies set aside in their home.

The report notes that practicing response protocols is critical for effective execution; this is true for emergency responders and true for the public. Fewer than half the surveyed individuals (41 percent) had practiced a workplace evacuation drill, only 14 percent had participated in a home evacuation drill, and of those in school and/or with children in school, only 23 percent had participated in a school evacuation drill. And the numbers are much lower for shelter in place drills (27 percent, 10 percent, and 13 percent respectively). Drills and exercises for multiple hazards and multiple locations need to be conducted through social networks, the study found. In addition, community members need to be included more effectively in government-sponsored community exercises.

The survey results indicate that individuals’ perceived utility of preparing and their confidence in their ability to respond varies significantly by disaster type. Only 7 percent of individuals felt that nothing they did would help them handle a natural disaster, whereas 35 percent felt nothing they did would help them in an act of terrorism, such as a biological, chemical, radiological, or explosive attack. All-hazards terminology may mask important nuances relative to conveying personal preparedness guidance for specific hazards. The report thus says it is important to emphasize the survivability of manmade disasters and the relevant protective measures for these hazards.

The report notes that national leaders must be strong advocates for personal preparedness, but adds it is clear that messages specific to individual preparedness must include critical local information, such as information on local hazards, local alerts and warnings, and local community response protocols. Local social networks must also be used to support outreach and education on personal preparedness, such as neighborhoods, the workplace, schools, and faith communities. And the concepts of mutual support at the local, neighborhood level should be emphasized.

To read the survey report, go to www.citizencorps.gov/ready/2009findings.shtm.

The excerpt below is from the OSHA Best Practice guide on First Aid.  This publication is free to anyone wanting to improve on the first aid standard from OSHA. 

First aid is emergency care provided for injury or sudden illness
before emergency medical treatment is available. The first-aid
provider in the workplace is someone who is trained in the delivery
of initial medical emergency procedures, using a limited amount of
equipment to perform a primary assessment and intervention
while awaiting arrival of emergency medical service (EMS)
personnel.
A workplace first-aid program is part of a comprehensive safety
and health management system that includes the following four
essential elements1:

• Management Leadership and Employee Involvement
• Worksite Analysis
• Hazard Prevention and Control
• Safety and Health Training
  

The purpose of this guide is to present a summary of the basic
elements for a first-aid program at the workplace. Those elements
include:

• Identifying and assessing the workplace risks that have potential
  to cause worker injury or illness.
• Designing and implementing a workplace first-aid program that:
  • Aims to minimize the outcome of accidents or exposures
  • Complies with OSHA requirements relating to first aid
  • Includes sufficient quantities of appropriate and readily
  accessible first-aid supplies and first-aid equipment, such as
  bandages and automated external defibrillators.

Assigns and trains first-aid providers who:

• receive first-aid training suitable to the specific workplace
• receive periodic refresher courses on first-aid skills and
  knowledge.
• Instructing all workers about the first-aid program, including
  what workers should do if a coworker is injured or ill. Putting
  the policies and program in writing is recommended to
  implement this and other program elements.
• Providing for scheduled evaluation and changing of the first-aid
  program to keep the program current and applicable to emerging
  risks in the workplace, including regular assessment of the
  adequacy of the first-aid training course.
  

This guide also includes an outline of the essential elements of
safe and effective first-aid training for the workplace as guidance to
institutions teaching first-aid courses and to the consumers of
these courses.

So why is Best Practices important?  Chubb estimates workers compensation now accounts for 50 percent of medical care costs. Chubbs The Rewards of Managing Risk; A Guide for Entrepreneurs and Managers helps managers and safety professionals develop a best practice model to build a safety culture based on the “Best Practice” model.  OSHA standards are generally at a minimum standard because they cover a broad base of workplaces from very small companies/organizations to very large businesses.  Everyone has to be able to meet the standards. 

Building a safety culture based on ”Best Practices” means going above and beyond the standards.  Developing practices that create an injury free workplace and having everyone involved from the top down. 

What Best Practices does your company uses?  Let us know and we will pass them along for everyone to see.

The Bee Gees disco song “Stayin’ Alive” might help people stay alive when they get cardiopulmonary resuscitation (CPR) — if their rescuer knows the 1977 tune.

The University of Illinois medical school studied the effect the song had on keeping time during CPR. Five weeks after practicing CPR with the song playing on an iPod, doctors at the medical school were able to hum along without the music and keep time just a little bit faster than 100 per minute, which is perfectly fine when we’re talking about chest compressions.

Stayin’ alive,
Stayin’ alive,
Ha…ah…ah…ah
(this part is exactly 100 beats per minute)
Stayin’ a-li-ive
This tip helps rescuers keep the proper rate while doing CPR. Going too slow doesn’t generate enough blood flow, and going too fast doesn’t allow the heart to fill properly between compressions. Humming along with the Bee Gees is one way to stay on track.

(more…)

A typical day in the life of the EH&S manager might go something like this:

Get in the office at 7 AM and go over all the previous days reports about any incident(s) that occurred.  Next you get that cup of coffee to spill over all those reports.  Now you check out the 50 or so E-mails of which at least 30 require a response.  Now it is time to walk the facility and do a short audit to make sure the people are wearing their PPE.  Go back and check more e-mails, and go over the budget for this month.  It’s 9AM and time for your first managers meeting of the day.  You report on 1 incident and what is happening to the employee.  Now back to the office to write your agenda for the weekly safety meeting and go over the OSHA 300 log.  After a short break you need to go over training records to see who needs what training and when can you get it done. Time to start designing a hazardous materials training class for new employeesas some of your MSDS sheets have changed.  Lunch, and then back to designing the training class you use to outsource, but not in this year’s budget.   Call coming in from the floor about a machine-guarding problem (no one hurt).  Have to go on the floor with maintenance to check the machine (lockout/tagout), they need it running for the production line.  Another call on the Nextel that employee requires minor first aid.  Go back to the office to call supervisors to schedule training, but hey are NOT happy to have to take people away from production.  Your boss calls and wants a report about safety to give to his/her boss.  Day almost over, you go back and check on machine to make sure it is properly guarded and find some flammable hazardous materials left out unattended.  Talk with supervisors about this and how to put them away correctly. 5:30PM, time to leave the building, but have to keep Nextel on just in case.  Oh no, I forgot to get the safety meeting agenda put together, well tomorrow is another day.

Here is who I was today:

• A manager
• An IT person
• Asafety person
• Administrative assistant
• A finance person
• An instructional designer
• A maintenance person
• A medic
• An arbitrator
• An employee
• Oh Ya! a family person too!!!

So what do you think, sound something like your day?  How many other jobs do you do that I left out?  Send a comment and we will compile a complete (as possible) of all the jobs a safety manager has to do.  Let’s hear from you.