Sponsored by: by Carla McDermott, RN, CNOR, CRCST OBJECTIVE 1: NOTE FOUR GOVERN- MENTAL AGENCIES THAT IMPACT SAFETY ACTIVITIES FOR CSSD There are several federal governmental agencies that have enacted laws designed to protect workers on their jobs, along with healthcare patients and the environ- ment. The U.S. Food and Drug Admin- istration (FDA), Occupational Safety and Health Administration (OSHA), Environmental Protection Agency (EPA), and the Agency for Healthcare Adminis- tration (AHCA) enact statutes (laws) to provide a reasonable degree of safety for all healthcare workers, including CSSD personnel. CRCST lesson 112 (May-June, 2010) provides a detailed description of the specic areas impacted by each of these agencies. Additionally, several professional associations which have published voluntary standards to enhance healthcare safety and quality service are discussed in that lesson. This information is well worth another review. LEARNING OBJECTIVES 1. Note four governmental agencies that impact safety requirements for CSSD personnel 2. Discuss the types of safety hazards that confront CSSD personnel 3. Explain why safety concerns are critical in CSSDs 4. Evaluate the benets of safety audits in CSSDs 5. Describe a proactive approach to preventing workplace violence This series of self-study lessons on CSSD topics was developed by the International Association of Healthcare Central Service Materiel Management (IAHCSMM). Purdue Universitys Extended Campus and IAHCSMM both offer grading opportunities for Extended Campus points. Earn Continuing Education Credits: Online: You can use these lessons as an in-service with your staff, or visit www.iahcsmm.org for online grading at a nominal fee. By mail: For written grading of individual lessons, send completed 15-question quiz and $15 to: PEC Business Ofce, Purdue University, Stewart Center Room 110, 128 Memorial Mall, West Lafayette, IN 47907-2034. Scoring: Each 15 question online quiz with a passing score of 70% or higher is worth two points (2 contact hours) toward your CRCST re-certication (12 points).
IAHCSMM provides online grading service for any of the Lesson Plan varieties. Purdue University provides grading services solely for CRCST and CIS lessons. More information: Direct any questions about online grading to IAHCSMM at 312.440.0078. Questions about written grading are answered by Purdue University at 800.830.0269. T HE VITAL WORK PERFORMED IN CENTRAL STERILE SUPPLY Departments (CSSDs) has always required attention to details and safety. Patients, surgeons, nurses and coworkers have always depended on skilled and conscientious CSSD personnel to provide the necessary instrumentation and equipment required to provide care for patients. The very nature of this work can expose one or all of the parties to a wide variety of hazards. Acute awareness of these hazards and the knowledge required to avoid injuries must be an integral part of the basic education for CSSD personnel. In this lesson, several common safety concerns will be explored. Central Sterile Supply Department Safety Practices CRCST Self-Study Lesson Plan OBJECTIVE 2: DISCUSS THE TYPES OF SAFETY HAZARDS THAT CON- FRONT CSSD PERSONNEL A list of every safety hazard that CSSD personnel might encounter would be very lengthy. However, there are ve major types of hazards in the healthcare workplace: biological, chemical, physical, physiological, and social. Biological hazards include bloodborne pathogens, which may cause acquired immune deciency syndrome (AIDS) and hepatitis, and have received a great deal of attention in the media and in the work- place. Only slightly less attention is given to the multiple drug-resistant super-bug bacteria that have evolved and become extremely difcult to treat or manage with medications. Commonly referred to by their acronyms, these are multiple drug-resis- tant staphylococcus aureus (MRSA) and VRE (vancomyocin-resistant enterococ- ci). The list of super bugs is growing, and CSSD personnel must remain vigilant as they perform their cleaning, disinfection and sterilization duties. Chemical hazards are also prevalent in CSSDs. Chemicals take many forms, such as concentrated liquids with extreme pH levels, sterilization liquids and gases, plas- ma vapors, and other disinfecting liquids and aerosols. Chemical-resistant personal protective equipment (PPE) is required for CSSD personnel as they use these products, as is training in and supervision to ensure their safe use. Physical hazards include the extremely sharp surgical instruments with which CSSD personnel must work. It is also extremely difcult to maintain dry oors in the decontamination area, so slips and falls can occur. Surgical instrument sets can be heavy, bulky and difcult to lift properly, so muscle strains are possible. Sterilizers generate heat and steam, which presents burn hazards. Pneumatic instruments must be man- ually cleaned and tested, and this creates a double hazard: the compressed gas used for the testing, and a ruptured hose that can fail the test. Some facilities are fortunate enough to have medical air or nitrous gas piped into the CSSD; however, others still use large H size cylinders, which are large and heavy, and a rolling stand to transport them. OSHA requires that they be secured while being moved and when in use, and frequently, they are chained to the wall. This creates a safety hazard involving the tanks neck and reg- ulator. For example, if the tank falls over and is damaged, the cylinder can act like a torpedo and critically injure personnel and cause extensive damage to the facility. In the same way that rapidly escaping gas can propel the cylinder, a hose being tested can also explode and injure the person holding it. The gas supply should be in the off position before connecting the hose to the gas supply. It should then be visually inspected rst for obvious signs of excessive wear, bubbling or holes. Likewise, the gas should be off and the line pressure released by activating the drill or saw hand piece before disconnect- ing the hose. Physiological hazards can occur with the repetitive motions of instrument assembly and wrapping items for steriliza- tion. For example, these motions can cause carpal tunnel syndrome of the wrist. Also, computerization of the work ow adds a new level of safety concern. When computers are added to existing work spaces, they can cause crowding of the work space. This, in turn, results in the need for additional and excessive turning or twisting to view the monitor and the work surface. Glare from the computer screen can also strain eyesight. There are additional safety hazards in CSSD, as well. The environment can be excessively cold or hot depending on the facilitys location and the ability to control the immediate environment. Extended periods of standing or bend- ing can cause muscle fatigue and strain. Respiratory irritation can be caused by ber ock shedding from wrap mate- rials. When CSSD personnel service the Radiology area, Cardiac Cath Lab and Surgery areas, they may be exposed to X-rays, laser beams or chemicals other than those routinely found in CSSD areas. Knowledge is power and everyone deserves to know what the potential hazards are and how to avoid exposure to them. More in-depth information about these topics can be obtained by reviewing CIS Lesson Plans 222 and 223. (November-Decem- ber, 2010, and January-February, 2011). A fth category of hazards is those that are less often considered until one of them becomes an acute problem in the CSSD. Social hazards include work-relat- ed stress, burn-out and depression. While these maladies seem very personal, the effects impact the workplace. They are, in Chemical hazards are also prevalent in CSSDs. Chemicals take many forms, such as concentrated liquids with extreme pH levels, sterilization liquids and gases, plasma vapors, and other disinfecting liquids and aerosols. CRCST SELF-STUDY LESSON PLAN a sense, contagious and unless co-workers or managers recognize the symptoms and work to combat them, they will spread to other personnel. A few signs and symptoms to be alert for include increased absenteeism, extended breaks or lunches, and any unusual changes in behavior patterns. Pay attention to increased or unusual emotional outbursts, belligerence, threats, or changes in appearance and attitude of a teammate. Share your observations with and seek assistance from a manager if these patterns become apparent. Many workplaces have access to Employee Assistance Programs that can be very benecial. Other social hazards include various forms of discrimination. For example, the U.S. Equal Employment Opportunity Commission (EEOC) enforces laws that prohibit numerous types of discrimina- tion that relate to age, disability, equal pay/compensation, genetic information, national origin, pregnancy, race/color, religion, retaliation, sex, and sexual harassment. These laws exist to protect workers from the identied social hazards and provide opportunities for CSSD personnel to reduce these types of workplace abuse. OBJECTIVE 3: EXPLAIN WHY SAFETY CONCERNS ARE CRITICAL IN CSSDs The impacts of safety hazards in the workplace include bodily harm and even death. They also include decreased morale and productivity, and increased absenteeism and the number and severity of accidents. CSSD employees know that patients, surgeons, nurses, and coworkers are also at risk when safety hazards exist. While accidents can just happen, these are frequently other forces at work which allow them to occur. Sometimes there are human factors and attitudes that can lead to injuries. It may be as simple as thinking It cant (or wont) happen to me, or Ive never seen that happen. CSSD personnel can inuence the human dynamics of safety and decrease the frequency and severity of accidental injuries in their department. 1 For example, if employers are away from work recovering from injuries, they cannot protect their patients or each other, and this adds to the stress and workload of their coworkers. OBJECTIVE 4: EVALUATE THE BEN- EFITS OF SAFETY AUDITS IN CSSDs Safety audits can help to identify and reduce risks in CSSD. One common tactic is to analyze the last ve CSSD audits that have occurred. Are there signicant risk ndings? If they were performed by a CSSD employee, they may be less effective because they may be seen as simply normal to those who work in the area with the same equipment and instruments every day. Invite someone from another department to perform the audit. For example, when a public university hospital invited a Preliminary Risk Analysis (PRA) team to audit their CSSD, the results were astound- ing. The team identied 416 hazardous situations with 81 listed rst in priority leading to 141 risk scenarios. The PRA team helped to develop 23 follow-up actions and preventive measures and 13 safety parameters. 2 Take the challenge and invite a Safety or Risk Manager in your facility to perform an audit or invite a colleague from another facility to tour the CSSD. Any risk or hazard that is eliminated will improve the functioning and safety of the department. OBJECTIVE 5: DESCRIBE A PROAC- TIVE APPROACH TO PREVENTING WORKPLACE VIOLENCE Workplace violence is on the rise in the United States. Contributing factors to a nearly three-fold increase in this type of violence include a weak economy and labor markets. Stress is everywhere and appears to be coming from all direc- tions. For example, family, friends and coworkers deployed in the military, the banking and healthcare crises, recession, and massive unemployment all contrib- ute to stress levels. Those who attempt to further their education and secure gainful employment face an uphill battle, as well. Working full-time, attending college and maintaining a family can be exhausting. When the candle is burning at both ends Safety audits can help to identify and reduce risks in CSSD. One common tactic is to an- alyze the last ve CSSD audits that have oc- curred. Are there signicant risk ndings? If they were performed by a CSSD employee, they may be less effective because they may be seen as simply normal to those who work in the area with the same equipment and in- struments every day. CRCST Self-Study Lesson Plan without relief, a meltdown is almost a sure thing (pun intended!), and violence can erupt. Healthcare- and hospital-based jobs are not immune from these forces. The National Institute for the Prevention of Workplace Violence denes workplace violence as: Acts of aggression or violence that occur in, or are related to the work- place, whether intentional or reckless, including assaults, threats, disruptive, aggressive, hostile or verbal, or emotion- ally abusive behaviors that generate fear for ones safety or entail a perceived risk of harm to individuals, or damage to an organizations resources or capabilities. 3 This is a rather broad denition be- cause it includes any action that makes another person feel fearful, and it includes anyone in the workplace who is physically or emotionally injured. All CSSD person- nel must be able to recognize and report potential risks for workplace violence and know what should be done if an incident occurs. The CSSD workplace is a stressful environment, and there are physical haz- ards that must be avoided every day. The job requires acute attention to detail. Sometimes the smallest of things can push a person to violence just like the story of the straw that broke the camels back. Employees can note any unusual changes in behavioral patterns as they interact with coworkers and report the changes to the manager. Discussing the issue with the manager is typically better than discussing it with the employee be- cause the manager may have knowledge of personal or other matters that have not been shared with coworkers. Additional information, recommendations and ac- tion plans are available from OSHA and The National Institute for the Prevention of Workplace Violence. IN CONCLUSION CSSD personnel should be congratulated for consistently doing the right things every shift and every day. Their diligent attention to detail and willingness to do what is required ensures that patient care products are safe to use. Their actions, including continuing education, safety re- views, and team-building activities, help to ensure that coworkers and patients do not contract an illness, disease or disabili- ty while on the job. REFERENCES 1. E Scott Geller. The Psychology of Safety Hand- book. Virginia Tech, Blackburg, Virginia. 2000. 2. British Medical Journal: Quality & Safety. (Published online March 8, 2011) 3. The National Institute for the Prevention of Workplace Violence, Inc.2011. Workplace Vio- lence Prevention Fact Sheet. ADDITIONAL READING International Association of Healthcare Central Service Materiel Management. Certied Instru- ment Specialist (CIS) Lesson Plans 222 & 223. International Association of Healthcare Central Service Materiel Management. Certied Regis- tered Central Service Technician Lesson Plan 112. Michael Woodward. Tips for Recognizing and Preventing Workplace Violence. www.foxbusi- ness.com. IAHCSMM acknowledges the assistance of the following two CSSD professionals who reviewed this lesson plan: LISA HUBER, BA, CRCST, ACE, FCS; Sterile Processing Manager, Anderson Hospital, Maryville, IL PAULA VANDIVER, CRCST, CIS, CS Technician; Orthopedic Specialist, Anderson Hospital, Maryville, IL SCOTT DAVIS, CMRP, CRCST, CHMMC Materials Manager, Surgical Services University Medical Center of Southern Neva- da, Las Vegas, NV SUSAN KLACIK, ACE, CHL, CRCST, FCS CSS Manager, St. Elizabeth Health Center Youngstown, OH PATTI KONCUR, CRCST, CHMMC, ACE Educational Specialist, IAHCSMM NATALIE LIND, FCS, CRCST, CHL Educational Director, IAHCSMM DAVID NARANCE, RN, BSN, CRCST Nurse Manager, Sterile Reprocessing Med Central Health System, Manseld, OH CAROL PETRO, CNOR, CRCST, RN, BSN OR Room Educator for Surgical Services IU Health Nor Hospital, Carmel, IN TECHNICAL EDITOR CARLA MCDERMOTT, RN, CRCST Clinical Nurse III, South Florida Baptist Hospital, Plant City, FL SERIES WRITER/EDITOR JACK D. NINEMEIER, PH.D. Michigan State University East Lansing, MI ADVISORY COMMITTEE FOR SELF-STUDY LESSONS JULY / AUGUST 2012 Communiqu 53 www.iahcsmm.org CRCST Self-Study Lesson Plan Quiz - Central Sterile Supply Department Safety Practices Lesson No. CRCST 125 (Technical Continuing Education - TCE) Lesson expires July 2015 OBJECTIVE 1 1. Professional associations publish ________ standards to enhance healthcare safety and quality. a. Mandatory b. Voluntary OBJECTIVE 2 2. Bloodborne pathogens are an example of which type of healthcare workplace hazard? a. Chemical b. Physical c. Physiological d. Biological 3. Super-bug bacteria are creating signicant challenges for healthcare operations because they: a. Multiply quickly b. Live for a long time c. Are multiple drug-resistant d. Are not killed by sterilization 4. Chemicals used in the CSSD include: a. Plasma vapors b. Sterilization liquids c. Sterilization gases d. Concentrated liquids e. All of the above 5. Pneumatic instruments are best cleaned and tested with automated equipment. a. True b. False 6. A cylinder hose used to test pneumatic equipment should not be connected to the gas supply when the test is done. a. True b. False 7. Viewing a computer can cause carpal tunnel syndrome of the wrist. a. True b. False 8. Which can cause respiratory irritation? a. Fiber ock b. Excessive periods of standing c. Exposure to laser beams d. A cold or hot environment 9. Which is a potential sign of social hazards? a. Stress b. Burn-out c. Depression d. All the above 10. Employee assistance programs can be benecial when addressing what category of safety hazard in CSS departments? a. Biological b. Physical c. Psychological d. Social 11. Which form of discrimination is not prohibited by the U.S. Equal Employment Opportunity Commission (EEOC)? a. Age b. Weight c. Pregnancy d. Religion OBJECTIVE 3 12. Employee attitudes can lead to injuries in CSS departments. a. True b. False 13. The impact(s) of safety hazards in the work place may include: a. Decreased morale b. Decreased productivity c. Increased absenteeism d. A and B above e. All the above OBJECTIVE 4 14. How many CSSD safety audits are commonly analyzed to help identify and reduce risks in CSSDs? a. One b. Three c. Five d. Seven 15. CSSD safety audits performed by a CSSD employee are probably the best type of safety audits that can be performed because employees know about safety concerns. a. True b. False 16. Any risk or hazard that is eliminated because of a CSSD safety audit will improve the functioning and safety of the department. a. True b. False
OBJECTIVE 5 17. Stress is a common cause of workplace violence. a. True b. False 18. What type of aggression or violence is classied as workplace violence? a. Intentional b. Reckless c. A and B above d. It depends upon the situation 19. Any action that makes another person feel fearful is considered workplace violence. a. True b. False 20. Employees who note unusual behavior of a coworker should discuss this immediately with that coworker. a. True b. False Sponsored by: REQUEST FOR PAPER/PENCIL SCORING (please print or type information below) REQUEST FOR ONLINE SCORING (payment and scoring made directly online at www.iahcsmm.org using either online check or credit card) m I have enclosed the scoring fee of $15. (please make checks payable to Purdue University. We regret that no refunds can be given) m Check here if you have a change of address m Check here if you wish to have your results emailed to you DETACH QUIZ, FOLD, AND RETURN TO: Purdue University PEC Business Ofce Stewart Center, Room 110 128 Memorial Mall West Lafayette, IN 47907-2034 800.830.0269 _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Name Mailing Address (be sure to include apartment numbers or post ofce boxes) City State/Province Zip Code/Postal Code ( ) Daytime telephone IAHCSMM Membership Number Email Address If your name has changed in the last 12 months, please provide your former name Purdue University is an equal access/equal opportunity institution