15. Occupational health and safety

AMBULATING RESIDENTS

• Check care plan for mobility status or acute medical problems that may have an effect on mobility.
• Ensure that the resident has designated and placed walking aids in front of the resident.
• Confirm that the resident is wearing proper shoes.
• Ensure the space is free from obstacles.
• Instruct residents to sit on the bed’s edge.
• Instruct resident to look forward and keep their back straight.
• If support is needed, allow the resident to hold your elbow.
• If the resident is unsteady, retrieve a second caregiver to stand on the other side and help assist.
• Use gate belts to hold on to resident and provide more stability.

SAFE HANDLING OF CARTS & WHEELED EQUIPMENT

• Equipment must be pushed or pulled only, by handles only, not the sides.
• Movements should be slow with full view of the way ahead.
• Two people are required when the load is blocking the view of the driver or traffic, or if the load is too heavy.
• When pushing the cart alone it must be pushed for long distances and pulled for short distances.
• Must be pulled when going through swinging doors and elevators
• Must never be left blocking stairways or exits
• Use ramps where there is a space between the floor area and where the cart is moving.
• Never lift the cart – if the cart is stuck, maintenance department should be called for assistance.
• Cart must always yield right of way to pedestrians.
• Carts must only carry the type of load for which they are designated.
• Safety straps must be securely anchored if required.
• Carts must not be overloaded so as to obstruct the driver’s view.
• Brakes must be set before loading.
• Only one vehicle to be moved at a time by one individual.

Safety Circle Check:

• Ensure handle grips are tight so they will not come off during transit.
• Electrical or motorized cars should be checked for leakage regularly.
• Brakes and wheels should always be in good condition.
• Defects should be reported and the defective vehicles should be appropriately tagged as faulty.

Cart Operation:

1. Safe Limits

Many factors can affect the amount of force that a worker can administer in a horizontal push and pull such as:

• Body weight and strength
• The height of force application
• The direction of force application
• The distance of force application from the body
• Posture
• Friction coefficient (amount of grip between floors and shoes)
• Duration and distance of push or pull

2. Limits for Horizontal Pushing and Pulling

These limits should not be exceeded in a work situation. It is safer if pushing and pulling tasks require lower forces.

NOTE: kilogram-force (Kgf), pound-force (lbf); 10N is about the same as 1 Kgf or 2 lbf. The values in each unit system – newtons, kilogram-force and pound force, respectively – are provided in the table because all are used in the literature and on instruments, depending on the country of origin.

Hazards:

• Overexertion
• Fingers and hands being caught in, on or between the cart and other objects
• Toes, feet and lower legs being bumped or crushed by the cart
• Strained arms shoulder and back muscles and joints

A good selection of a handcart suitable for the task can reduce the risk of injury of any kind. Points to consider when selecting cares:

• Expected load (weight, size, shape)
• Frequency of use
• Distance to cover
• Work area characteristics (aisle width, type of flooring)
• Type of wheels or casters

General recommendations for selection are:

• The load on two, three, and four-wheel handcarts should not exceed 200 kg (approx. 450 lbs).
• The load on hand pallet carts can be up to approximately 700 kg (1500 lbs).
• The load should not be transported more than 30-35 meters (approx. 100 feet) per “shipment”.

There are certain conditions that should be examined in order to modify the above limits. Floors that are in poor condition and make operating care more difficult. The remedy for this situation is to use a cart with bigger wheels or to reduce the load.

If ramps are being used, limits must be lowered. Complicated maneuvering calls for a considerably lower limit; particularly where there is not enough space to get one’s body weight behind the cart.

It is also recommended that the cart should not exceed the speed of the person’s walking space (3 – 4 km/h or about 1.9 – 2.5 mph).

Modifying limits for pushing, pulling or maneuvering for any given work situation is essential not only for the safety of the operator but also for other workers within the area.

CRUSHING MEDICATION

1. Place medication pouch in crushing space of the “Silent Knight”.
2. Gently lower the handle until the two anvils meet, keeping wrists in a neutral position.
3. Apply gentle pressure to the handle.
4. Between each crush, release the handle to check for desired results.
5. The pills will crush by using the least amount of force without the unnecessary repetitive motion of the wrist.

DISPOSING OF SHARP OBJECTS

These policies are applied in order to properly dispose of needles, razor blades, broken glass and other sharps materials. All sharp objects like safe engineered needles with auto covers or slide on covers, razors, broken glass and scalpels will be disposed of in BIOHAZARDOUS materials containers which are located on medication carts, pharmacies, and tub rooms. NEVER throw any of these objects in a regular garbage.

• Only safe needles with safety devices are used in the home.
• Covers slide on and clip needles safety.
• Manufactured engineered needle slide on covers protect nurses from needle stick injuries.
• Always cover needles with the slide on safe covers.
• Always bring small biohazard container to the area where the injection will be given for immediate disposal.
• Place used syringes/needles directly into a labeled yellow biohazard container.
• When the container is full, replace the cap and notify Housekeeping staff to remove and replace the container.
• Wear protective equipment when necessary and dispose of inappropriate waste / bio-hazardous containers.

Nurses are to be sure that the mechanism has covered and secured all needles before discarding.

HAND HYGIENE

It is important to be aware that hand hygiene does not only apply to hand washing. Proper hand hygiene also includes not wearing any jewelry on the hands or wrists (for the exception of a plain wedding band), not wearing any nail polish and/or any artificial nails including but not limited to acrylic and gel nails.

Wash both hands with soap and water or an alcohol-based hand rub for routinely decontaminating hands in the following situations:

• Before having direct contact with residents or caring for immune-compromised residents
• Before and after performing invasive procedures. (e.g. inserting catheters)
• After contact with a patient’s intact skin. (e.g. when taking a pulse, blood pressure or repositioning)
• Between every different procedure on the same patient/resident
• Immediately after contact with bodily fluids or excretions, mucous, non-intact skin, and wound dressings even if hands are not visibly soiled
• When moving from a contaminated-body site to a clean-body site
• After contact with inanimate objects (including medical equipment) in the immediate vicinity of the resident
• Immediately after removing gloves
• Before eating, preparing and serving food or feeding a resident
• Between handling dirty dishes and food
• After using or assisting a resident in the restroom
• Before entering and after leaving the unit
• Whenever hands are visibly soiled

NOTE: Bar soap is not accepted in the healthcare setting unless it is for a resident’s personal use.

Resident’s hands should also be washed before eating, after toileting and when soiled. To reduce the frequency of hand washing, minimize unnecessary direct contact with the resident and their immediate environment. Residents and their families should be instructed in proper hand hygiene.

Technique: Wet hands first with water then apply soap and rub together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers and under fingernails.
Rinse hands with water and dry thoroughly with a disposable towel. Use a towel to turn off the faucet in order to avoid recontamination of hands.

Alcohol-based gels are the preferred method for decontaminating hands as running water is not always readily available and it is less abrasive to the skin than scrubbing with soap and water.

Technique: Remove hand and arm jewelry.
Apply product to palm of one hand and rub hands together covering all surfaces of hands and fingers, until hands are dry.
Follow manufacturer’s recommendations regarding the volume of product to be used.

4 Moments of Hand Hygiene

As established by Public Health Ontario, the 4 Moments of Hand Hygiene has been established to illustrate when it is imperative to wash your hands in order to minimize the risk of contamination. The “Patient Environment”, means anything that is in the patient’s room or within the boundaries of their curtain in a shared room (including furniture and other possessions). The “Health Care Environment” includes all other spaces outside the patient’s room including nurses’ stations, hallways, dining areas, etc.

Hands must be washed immediately before:

1. Initial patient/patient environment contact (e.g., shaking hands, taking a pulse or touching anything in the patient environment like an alarm clock or bed rail)
2. Aseptic procedure (e.g., oral/dental care, giving eye drops, changing a wound dressing)
3. After body fluid exposure risk (e.g., handling a fluid sample, opening a draining system, or cleaning up body fluids)
4. After any contact with a patient and/or patient environment

You may visit the Public Health Ontario website to watch the short instructional video.

Reference: http://www.publichealthontario.ca/en/Articulate/4_Moments_Hand_Hygiene_May_2014/story.html

PERSONAL PROTECTIVE EQUIPMENT (PPE)

All persons are responsible for complying with regulations regarding PPE, including visitors. This includes everyday practices as well as situational requirements during any infection control issue that may occur. Be aware of any signage that indicates the need for PPE, or that designate any areas that have been quarantined in order to control the spread of infection. Failure to wear proper PPE, especially in a highly dangerous situation, will result in disciplinary action. It is imperative that all employees are familiar and follow the PPE requirements for their work areas in order to protect themselves and others.

Gloves

Wear clean, non-sterile gloves when:

• There is anticipated contact with blood, bodily fluids, secretions, mucous, draining wounds or non- intact skin
• When handling items that are visibly soiled with blood or bodily fluids
• When the caregiver has non-intact skin on his or her hands
• For all procedures in which the hands or instruments being handled are entering a sterile body cavity or tissue
• Change gloves between care activities and procedures with the same resident after contact with materials that may contain high volumes of microorganisms to avoid cross-contamination of body sites.
• Remove gloves immediately after completion of care or a specific task, at the point of use, and before touching clean environmental surfaces or clean equipment.
• Change gloves if a leak is suspected.
• Do not reuse or wash single-use gloves, doubling up on gloves is also not permitted.

Mask and Eye Protection

Fluid resistant masks and goggles protect caregivers from splatter and aerosolized body fluids as well as reduce the potential for infection of blood borne pathogens. When they are within one (1) meter of a resident who is coughing or sneezing, a caregiver should wear a mask.

After each use, goggles and face shields should be washed thoroughly to prevent cross-contamination. When cleaning your goggles or face mask, please use a disinfectant which is safe to use and follow these steps:

1. Remove any debris or visible dirt with soap and water then dry completely.
2. Saturate a cloth with disinfectant and wipe down all surfaces of the eye/face protection.
3. Different disinfectants will be used for different Homes, so be sure to read the instructions attentively for proper instruction and drying time required.

Gowns

Gowns prevent contamination of clothing and skin from exposure to blood, bodily fluids, and secretions. When donning and removing a gown, follow these steps:

Gown Donning:

1. Perform hand hygiene.
2. Put gown on.
3. Fasten neck and waist ties.

Gown Removing:

1. Unfasten ties at waist.
2. Remove gloves and wash hands with sanitizer.
3. Unite gown at neck, hold one tie in each hand and pull gown away from you.
4. Slip fingers under the wrist cuff of the gown and pull sleeve off.
5. With hand inside the gown, pull off the other sleeve (do not shake the gown).
6. Fold dirty side inward and roll into a bundle.
7. Discard into a proper container.
8. Wash hands.

If you are in a situation where you are fully donned with all types of PPE, you should remove each piece of equipment in a particular order. This order is as follows:

1. Gloves
2. Gown
3. Wash Hands
4. Goggles or Face Shield
5. Mask
6. Wash Hands