President�s Report

							BASIC HEALTH AND SAFETY
 TOPICS FOR PHYSICIANS

 Information for Tulane University
 physicians who serve as residents,
   house officers, or medical staff
                        May 2007


   Tulane University - Office of Environmental Health & Safety (OEHS)
               OBJECTIVES

– Know the purpose of program
– Know how to respond if injured on the job
– Know how to report an emergency security
  situation
– Know how to respond if confronted by an
  individual with a weapon
– Know the types of external and internal
  disasters
   Tulane University - Office of Environmental Health & Safety (OEHS)
                    OBJECTIVES


– Know how to respond to a Bomb Threat
– Know the communication methods for emergency
  incident notification at Tulane University
– Know how to evacuate and respond to a fire
– Know locations and types of fire extinguishers and how
  to use them
– Know identification, handling, and disposal of
  hazardous materials
– Know how to respond to a hazardous material incident
    Tulane University - Office of Environmental Health & Safety (OEHS)
                   OBJECTIVES


– Know how to identify and report faulty,
  damaged, or in need of repair equipment
– Know the types of utility systems and how to
  report problems
– Know the location of the medical gas shutoff
  valves and how they can be shutoff in the case
  of an emergency
– Know radiation safety for patient care
   Tulane University - Office of Environmental Health & Safety (OEHS)
                              SCOPE
• This module applies to residents, house officers,
  and medical staff who are employed by the Tulane
  University Health Sciences Center (TUHSC).
• Please complete the quiz at the end of the training
  module.
• By successfully completing the quiz, a certificate
  will be issued and data indicating participation in
  this program will be electronically sent to OEHS
  for recordkeeping.
       Tulane University - Office of Environmental Health & Safety (OEHS)
                           SAFETY
• This program has been developed to describe how
  Tulane University will provide a physical environment
  free of recognized hazards and manage staff activities
  to reduce the risk of injuries.
• The Office of Environmental Health & Safety (OEHS)
  has been established to implement this program for
  Tulane University.
• The OEHS is not responsible for the Environment of
  Care Program at the Tulane University Hospital and
  Clinic (TUHC) except for Radiation Safety.



       Tulane University - Office of Environmental Health & Safety (OEHS)
POLICIES AND PROCEDURES
• The Tulane University Environmental Health & Safety Policies and
  Procedures Manual contains the safety policies and procedures for
  Tulane University. You should also become familiar with the health
  and safety policies and procedures for the facility at which you
  practice.
• If you are injured on the job, then complete the following checklist:
    – Notify your supervisor, Complete a First Report of Injury Form (FROI),
      Notify the Worker's Compensation (W/C) Specialist at 988-2869. If
      necessary, seek medical treatment at nearest hospital or clinic. Provide
      copy of FROI to healthcare provider. Provide all medical documentation
      to supervisor and W/C Specialist. Keep copies of documentations.
• For a copy of the FROI Form, go to the following website:
  http://www2.som.tulane.edu/oehs/safety/18F-oehss04.pdf



          Tulane University - Office of Environmental Health & Safety (OEHS)
                         SECURITY
• At TUHSC, to report an emergency security situation or if
  you observe a suspicious individual or circumstance, tell
  the nearest TUHSC Police Officer or dial 988-5555 or if
  on campus, dial 55555.
• The following locations are staffed by TUHSC Police staff
  at all hours: TUHC Emergency Room and the TUHSC
  Police Dispatchers Station in the Medical School Lobby.
• Know the emergency telephone number for your facility.
• To respond in the case of any or all suspected thefts or
  non-emergency events, call TUHSC Police at 988-5531, or
  contact the designated private security service at your
  healthcare location.
        Tulane University - Office of Environmental Health & Safety (OEHS)
                       SECURITY
• Always wear your identification badge on
  the outer clothing except when working in a
  sterile environment.
• Never unlock or leave security-sensitive
  areas unlocked.



      Tulane University - Office of Environmental Health & Safety (OEHS)
                         SECURITY
• If you are confronted by an individual with a weapon,
  cooperate and follow their specific instructions. Give them
  what they ask.
• Avoid eye contact and discreetly obtain description of the
  individual.
• After you are certain that the person has left, call TUHSC
  Police at 55555.
• If you are at a non-TUHSC facility, contact their security
  department or dial 911 if appropriate.



        Tulane University - Office of Environmental Health & Safety (OEHS)
                                  Security

• At TUHSC, to report security incidents involving
  patients, visitors, personnel and property, call
  TUHSC Police at 988-5555. If you are at a non-
  TUHSC healthcare facility, contact the designated
  security department or service.
• Advise your supervisor of the occurrence.
• For additional crime prevention and safety tips, go
  to the following website:
  http://www.tuhscpd.tulane.edu
       Tulane University - Office of Environmental Health & Safety (OEHS)
                        SECURITY
• If you have trouble starting your vehicular at the
  TUHSC campus, then contact TUHSC Police to
  attempt a jump start. They can not provide other
  roadside assistance.
• Upon request at all hours, TUHSC Police will
  provide foot and/or vehicle personal safety escorts
  within the TUHSC areas for anyone associated
  with Tulane University.
• Off campus escorts can not be provided.
       Tulane University - Office of Environmental Health & Safety (OEHS)
 EMERGENCY PREPAREDNESS
• Mass Casualty
  – In the case of an internal or external disaster involving
    injuries, an emergency situation will be announced by
    Administration or Nursing Supervisor.
  – An internal disaster can involve a hazardous material
    incident, fire, explosion, etc. in which rapid emergency
    response is needed to provide care and treatment for
    victims.
  – An external disaster can involve an explosion, building
    collapse, severe weather emergency, etc. in which mass
    casualties are generally transported to a healthcare
    facility.
      Tulane University - Office of Environmental Health & Safety (OEHS)
 EMERGENCY PREPAREDNESS
• Bomb Threat
  – If you receive a telephone call indicating a bomb threat,
    keep the caller on the phone. Pay attention to the caller,
    voice, mannerisms, background noises, etc. Have
    someone immediately call TUHSC Police at 988-5555.
    If you are at a non-TUHSC healthcare facility, contact
    the designated security department or service.
  – For response, complete the checklist found at the
    following website:
    http://www2.som.tulane.edu/oehs/safety/03F-
    oehss01.pdf
      Tulane University - Office of Environmental Health & Safety (OEHS)
 EMERGENCY PREPAREDNESS
• Severe Weather
  – Employees will be advised of an emergency
    situation via website, email, public address, or
    supervisors. For official information regarding
    Tulane University, staff must call the Alertline:
    862-8080 or 1-877-862-8080 or
    http://emergency.tulane.edu.
  – Stay in contact with your supervisor directly.
    Do not call the operators for information.
      Tulane University - Office of Environmental Health & Safety (OEHS)
 EMERGENCY PREPAREDNESS

• In order to continue patient services in the
  case of a severe weather emergency,
  physicians will be designated as essential by
  their departments or managers and may be
  asked to return to the facility to assist
  beyond their normal work schedule.
• However, if it is a major hurricane, then
  staff may be asked to evacuate.
      Tulane University - Office of Environmental Health & Safety (OEHS)
 EMERGENCY PREPAREDNESS
• Total Facility Evacuation
   – This is the movement of patients and occupants from an
     area or the entire hospital and clinic to outside grounds
     or an adjacent area which is safe.
   – Assist with patient care or other duties as requested by
     the Charge Nurse, Clinic Manager, or Supervisor.
   – Patients may be transported to designated facilities.



       Tulane University - Office of Environmental Health & Safety (OEHS)
          LIFE SAFETY (FIRE)
• Evacuate an area if a fire is discovered and occupants must
  be moved.
• For healthcare and ambulatory healthcare facilities, remain
  on the same floor. Relocate occupants to the next smoke
  compartment which is a designated safe area of refuge on
  the floors. For information as to their exact locations,
  contact your supervisor or the Hospital Safety Officer.
• If there is a fire inside a unit or area, then move all
  occupants through the designated smoke barrier doors to
  the next compartment and proceed to administer medical
  care and life support using available equipment.
• Occupants may move in any direction from one smoke
  barrier zone to another.
        Tulane University - Office of Environmental Health & Safety (OEHS)
          LIFE SAFETY (FIRE)
• If you discover a fire, follow the acronym: E S C A P E
   – E - Evaluate the situation.
   – S - Secure the area by removing occupants in the area of the fire.
   – C - Close the doors to the room where the fire is located.
   – A - Activate the building fire alarm system.
   – P - Phone 55555 for TUHSC or the appropriate emergency number
     for your healthcare facility. DO NOT CALL 911 unless it is the
     designated number to be used by your facility for emergencies.
   – E - Extinguish the fire as appropriate




        Tulane University - Office of Environmental Health & Safety (OEHS)
          LIFE SAFETY (FIRE)
• Remember – it is not required that you extinguish the fire.
• To enter the room to extinguish the fire, first feel the
  closed door with the back of your hand. If it is warm or
  hot to the touch, then do not open the door. Assist with
  evacuation and/or other functions.
• Do not enter the room or any area if it is filled with smoke.
• If the door is not warm or hot, then slowly open the door.
• Before entering make sure you keep your back to a safe
  and unobstructed exit to which the fire will not spread.
• Extinguish the fire using an available portable fire
  extinguisher.
        Tulane University - Office of Environmental Health & Safety (OEHS)
           LIFE SAFETY (FIRE)
• To use a portable fire extinguisher, follow the
  acronym: P A S S
   –   P - Pull the pin on the handle
   –   A - Aim the nozzle at the base of the fire
   –   S - Squeeze the handle
   –   S - Sweep the fire from side to side.


• Be sure that the fire is confined to a small area.

         Tulane University - Office of Environmental Health & Safety (OEHS)
         LIFE SAFETY (FIRE)
• Know the location of the nearest fire extinguisher
  and on what types of fires it can be used.
• Hallway fire extinguishers inside cabinets are
  generally dry chemical extinguishers which can be
  used on all common types of fires (Class ABC).
• Carbon dioxide fire extinguishers (Class BC) can
  not be used on fires involving combustibles (Class
  A) but can be used on all other types of common
  fires.
       Tulane University - Office of Environmental Health & Safety (OEHS)
HAZARDOUS MATERIALS AND
        WASTE
• For spills at TUHSC excluding TUHC, call OEHS
  at 988-5486 or go to
  http://www.som.tulane.edu/oehs/hazspill.htm.
• Hazardous materials include but are not limited to
  chemical, biological, explosive, flammable,
  radioactive and toxic materials.
• They may be solid, liquid, or gaseous in nature.
• Hazardous materials become hazardous waste
  when they are no longer usable or recyclable.
       Tulane University - Office of Environmental Health & Safety (OEHS)
HAZARDOUS MATERIALS AND
        WASTE
• When handling all hazardous materials or wastes, precautions must be
  taken to preclude accidental contact with the material/waste to include
  Personal Protective Equipment (PPE), work practice controls, and
  engineering controls, i.e. special exhaust ventilation.
• Staff must be familiar with the hazardous materials with which they
  come in contact.
• For information, refer to the label and to the Material Safety Data
  Sheets (MSDSs) which are usually located at the Nurse's Station, in
  departments, or designated areas.
• All hazardous materials and waste containers must be appropriately
  labeled.
• Hazardous gases i.e. ethylene oxide and nitrous oxide must be properly
  exhausted from work areas.


         Tulane University - Office of Environmental Health & Safety (OEHS)
HAZARDOUS MATERIALS AND
        WASTE
• Biohazardous waste, also referred to as Potentially Infectious
  Biomedical Waste (PIBW) includes diseased human and animal parts,
  contaminated dressings, pathological specimens and contaminated
  laboratory waste, hypodermic needles and other sharps, disposable
  contaminated clothing, contaminated bandages and gloves.
• Chemical waste includes those that may be toxic, corrosive, explosive,
  ignitable, or reactive and includes some chemotherapeutic agents.
• Physically hazardous waste includes non-infectious sharps and broken
  glass items.
• Hazardous materials are identified through the following: Chemical
  Inventory information provided to the purchaser at the time of
  purchase, Material Safety Data Sheets (MSDS), and labels on
  containers.


         Tulane University - Office of Environmental Health & Safety (OEHS)
HAZARDOUS MATERIALS AND
        WASTE
• All contaminated sharps must be properly
  disposed of by placing them in specifically
  labeled puncture-resistant, disposable
  containers with covers. Do not reuse them.
  Sharps must never be discarded into trash
  receptacles or linen receptacles.
• Sharp containers when 2/3’s full should be
  sealed and properly disposed.
      Tulane University - Office of Environmental Health & Safety (OEHS)
HAZARDOUS MATERIALS AND
        WASTE
• Prior to wearing PPE, first obtain information on
  the types of items needed, such as gloves,
  protective clothing, respirator, eye wear, etc.
• These items are available in your department and
  must be worn, as applicable. Review the Material
  Safety Data Sheets (MSDS) for information on the
  types of PPE needed.
• Be sure that the PPE is suitable for the hazardous
  material and that you know the limitations of the
  PPE and how to properly wear and use them.

       Tulane University - Office of Environmental Health & Safety (OEHS)
HAZARDOUS MATERIALS AND
        WASTE
• If you discover a hazardous material or waste incident,
  proceed as follows:
   – Alert persons in the immediate area; confine the spill safely to
     prevent further contamination, i.e. close doors, pull down sash of
     hood; evacuate spill area; notify immediate supervisor or
     Departmental Safety Representative; if personal contact occurs,
     use an eye wash fountain and/or safety shower for flushing of the
     eyes and body for at least 15 minutes. Contact OEHS at 988-5486.
     Document the occurrence.
• If the incident occurs at a non-TUHSC healthcare facility,
  then immediately contact your supervisor and the
  department responsible for spill clean up. Do not contact
  OEHS.

        Tulane University - Office of Environmental Health & Safety (OEHS)
HAZARDOUS MATERIALS AND
        WASTE
• Become familiar with the physical and
  health hazards associated with each
  hazardous material that you use. Refer to
  the MSDS for this information.




      Tulane University - Office of Environmental Health & Safety (OEHS)
HAZARDOUS MATERIALS AND
        WASTE
• Under the OSHA Hazard Communication - Right
  To Know Standard, employees have a right to
  know about the hazardous materials on the job and
  how to protect themselves, both under normal
  operating conditions and in foreseeable
  emergencies.
• You must know of operations in your work area
  where hazardous chemicals are present.
• This standard generally deals with labeling of
  containers, MSDSs, chemical inventories, and
  training of employees.
      Tulane University - Office of Environmental Health & Safety (OEHS)
    HAZARDOUS MATERIALS AND
            WASTE
•   To detect the presence or release of a hazardous chemical in your area, refer to
    the MSDS for visual appearance or odor information.
•   MSDS Contents include the following: Identity, Manufacturer,
    Characteristics, Physical and Health Hazards, Routes of Entry, Exposure
    Limits, Control Measures, First Aid, Precautions for Safe Handling and Use.
•   Terms/Definitions
     –   Carcinogen - causes cancer in humans
     –   Corrosive - causes irreversible alteration in living tissue
     –   Flammable – can easily fuel a fire
     –   Toxic - capable of causing health effects
     –   Irritant - can have reversible inflammatory effect
     –   Oxidizer - chemical that promotes combustion in other materials
     –   Routes of entry - points in which chemicals can enter the body
     –   Sensitizer - can cause an allergic reaction in some people
     –   TLV - Threshold Limit Value - exposure over 8 hour day
     –   Water Reactive - reacts with water.

            Tulane University - Office of Environmental Health & Safety (OEHS)
                       EQUIPMENT
• Equipment that is faulty, damaged, or in need of repair must be
  immediately reported to the charge nurse, clinic coordinator, or
  supervisor who will then contact the responsible department or
  contract service.
• If the device presents a safety hazard, then respond immediately by
  phoning the appropriate service department. Equipment in need of
  repair must be properly tagged and not used. Devices that are
  damaged, overheating, noisy, have frayed power cords or damaged
  plugs, must be reported using the above procedure. This also includes
  any loose controls, switches, burned out lamps or any suggestion of
  device malfunction.
• The user should conduct a Performance Check on the equipment upon
  its return from the service department.



         Tulane University - Office of Environmental Health & Safety (OEHS)
                     EQUIPMENT
• Electrical extension cords/adapters must not be
  used in lieu of permanent wiring.
• Electrical extension cords are permitted only for
  temporary use.
• Should a department express a need for such a
  cord/adapter, the following alternatives will be
  proposed: Relocate the equipment, lengthen the
  power cord, or install an additional outlet.

       Tulane University - Office of Environmental Health & Safety (OEHS)
                            UTILITY
• This applies to systems, i.e. Fire Alarm System,
  Elevators/Escalators, Electrical Distribution and
  Emergency Electrical Power System, Pneumatic Tube
  System, Plumbing System, Medical Gas System, Vacuum
  System, and HVAC (Heating, Ventilation, Air
  Conditioning), Telephones, Public Address System,
  Information Systems, and electrical equipment that by
  design, use or location may pose a possible electrical or
  safety hazard.
• Problems, failures, and user errors with a utility must be
  reported to the appropriate maintenance or facilities
  services department.
        Tulane University - Office of Environmental Health & Safety (OEHS)
                              UTILITY
• Hallway and stairwell lights, exit signs, Operating Rooms, Intensive
  Care Units, Emergency Room, nurse’s station, patient rooms (at least
  one duplex receptacle per bed), and designated systems, i.e. fire alarm,
  telephone, public address, at least one elevator, etc. are supplied with
  emergency power from the generators.
• Electrical receptacles and light switches with red covers indicate that
  they are connected to the emergency generators.
• Also, there should be flashlights at the nurse's stations.
• In areas with medical gases, shut off valves are located in the hallways
  and are labeled. During an emergency, these should be shut off with
  the approval of nursing in patient care areas.




          Tulane University - Office of Environmental Health & Safety (OEHS)
      RADIATION SAFETY FOR
          PATIENT CARE
• If a radiation therapy procedure involving sealed sources
  or radiopharmaceuticals is being performed in a patient
  room, the room door is labeled "Caution, Patient Contains
  Radioactive Materials."
• Prior to entering a patient room, one must check with the
  nursing station.
• The patient chart is also labeled "Caution, Radioactive
  Materials."
• Note the time that can be spent in the immediate proximity
  (i.e. within two feet) of the patient per day or per shift.
  This limit applies to medical personnel and visitors so that
  they do not exceed their Federal and State radiation
  exposure limit.
        Tulane University - Office of Environmental Health & Safety (OEHS)
      RADIATION SAFETY FOR
          PATIENT CARE
• Radiopharmaceutical therapy also results with radioactive
  contamination from urine, perspiration, and saliva. Items
  that come into direct contact with the patient, such as
  gloves and eating utensils, are assumed to be
  contaminated and must be left inside the room to be
  surveyed after the patient has been discharged.
• In all cases, radiation exposure can be reduced by
  minimizing TIME near radiation sources. Exposure can
  also be reduced by increasing DISTANCE from radiation
  sources. Standing behind portable lead
  SHIELDING can also reduce radiation exposure.
        Tulane University - Office of Environmental Health & Safety (OEHS)
    RADIATION SAFETY FOR
        PATIENT CARE
• For further information, refer to the Tulane
  University Radiation Safety Manual or the
  designated Radiation Safety Manual for
  your healthcare facility.
• If there are any questions, then contact the
  Tulane University Radiation Safety Officer,
  Mr. Charles Reindl, at (504) 988-2867.

      Tulane University - Office of Environmental Health & Safety (OEHS)
   OFFICE OF ENVIRONMENTAL
       HEALTH & SAFETY
           WEBSITE
The following OEHS website is a great resource tool
for health and safety information:

     www.som.tulane.edu/oehs



       Tulane University - Office of Environmental Health & Safety (OEHS)
   Tulane University
Office of Environmental Health & Safety (OEHS)
        Louis Mayer, RS, CSP, MPH, CFI
Manager – Training, Education, and General Safety
                 (504) 988-2447
               lmayer@tulane.edu
                                                                         Proceed to Quiz
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       https://pandora.tcs.tulane.edu/ehs/enterssn.cfm?testnum=27