≥90% of participants will know the actions to take to avoid workplace hazards.
After completing this continuing education course, the participant will be able to:
Occupational Safety and Health Administration (OSHA) is part of the United States Department of Labor. OSHA covers most private sector employers and their workers, in addition to some public sector employers and workers.1
Employers must comply with the General Duty Clause of the OSHA Act of 1970. This clause requires employers to keep their workplaces free of serious recognized hazards. OSHA covers most private sector employers and workers. Federal OSHA does not cover state and local government workers. Still, they do have protections in states that operate their programs.1
Employers are required to meet OSHA standards. These standards include1:
A Note About Employer Responsibility & PPE (PPE) in the New Viral Outbreak Era
With the emergence of novel viral outbreaks, such as COVID-19 from the coronavirus category of viruses, it is important to know that employers must pay for most types of required PPE (e.g., PPE), under American law.1
"There is No Such Thing as an Accident, only a Failure to Recognize the Hand of Fate," Napoleon Bonaparte.2
There are risks every time an individual decides to leave the comfort and control of their home environment and enter the workplace. Every American needs to know their rights under American law. Employees have the right to1:
While OSHA may not be able to protect every worker from every possible accident or scenario, OSHA standards are created to establish a system from which risk, hazard, and responsibility may or may not be applicable. Specifically, OSHA standards are rules that describe how employers are legally required to follow to protect their workers from hazards.1
Standards protect workers from a wide range of serious hazards. These standards limit the amount of hazardous chemicals workers can be exposed to, require the use of certain safe practices and equipment, and require employers to monitor certain workplace hazards.1
Examples of OSHA worker safety standards include1:
Few workplaces are as complex as a healthcare facility. Such complex situations provide a lot of potential health and safety hazards.1 When compared with the total civilian workforce, hospital workers have a greater percentage of workers' compensation claims for sprains and strains, infectious and parasitic diseases, dermatitis, hepatitis, mental disorders, eye diseases, influenza, and toxic hepatitis.1
The list of potential hazards includes radiation, toxic chemicals, biological hazards, heat, noise, dust, and stress.1 The risks and exposures for blood and body fluids are important, but not included in this course. Information about the risks and exposures to blood and body fluids are available in a separate course entitled OSHA: Occupational Exposure to Blood and Body Fluids, at www.CEUFast.com.
All healthcare facilities are required to have detailed information about the chemicals that are at the worksite. This information is in a standard format called a Material Safety Data Sheet (MSDS).3
A typical MSDS will include the following sections3:
The MSDS should be readily available to every worker. Access to the MSDS allows every worker to educate himself about the chemicals at the worksite.3
Chemicals may exert either acute or chronic effects on workers. The effects depend on the extent (concentration and duration) of exposure, the route of exposure and the physical and chemical properties of the substance.3 The effects of a substance may also be influenced by the presence of other chemicals and physical agents or by an individual's use of tobacco, alcohol, or drugs.3
When you are exposed, the substance continues to be present in the body until it is metabolized or eliminated. Although some chemicals metabolize rapidly, others are not and might be excreted unchanged or stored in the fatty tissues (solvents), lungs (dust and fibers), bone (lead and radium), or blood (soluble gases).3
Toxic substances can enter the body through several routes, including the intact skin, the respiratory system (inhalation), the mouth (inhalation and ingestion), the eyes, and by accidental needle punctures.3 Inhalation and skin exposure are the most likely.3
Some substances can also damage the skin or eyes directly without being absorbed. Not all substances can enter the body through all routes. Inorganic lead, for example, can be inhaled or swallowed, but it does not penetrate the skin.3
Exposures routes for antineoplastic (cancer drugs) and other hazardous drugs are inhalation (breath it in), skin absorption, ingestion (swallow it), and injection.3 Although exposure to hazardous drugs and antineoplastics can put the healthcare worker at risk, there are guidelines for handling these drugs safely.3
The National Institute of Occupational Health and Safety (NIOSH) released new guidelines, in 2016, about the handling of antineoplastic (cancer drugs) and other hazardous drugs.3
The pharmacist or registered nurse is responsible for following special steps to handle hazardous drugs. Hazardous drugs are mixed in special locations to prevent contamination. Do not enter the area where hazardous drugs are being mixed.
There should be specific procedures that the CNA or HHA is trained to follow before working with patients treated with hazardous drugs. The special procedures may include3,4:
Following these guidelines and understanding responsibilities may be the difference between an injury or fatality, and safe employee experience.
"The Injuries We Do and Those We Suffer Are Seldom Weighed in the Same Scales," Aesop5
Nursing aides, orderlies, and attendants have the highest rates of musculoskeletal disorders (MSDs). The rate is more than seven times the average for all industries. The average incidence rate for MSD cases with days away from work increased four percent, while the MSD incidence rate for nursing aides, orderlies, and attendants increased ten percent.3,5,6
These injuries are due in large part to overexertion related to repeated manual patient handling activities, often involving heavy manual lifting associated with transferring, and repositioning patients and working in extremely awkward postures.3,5,6
Nearly half of all compensation claims for hospital workers involved back injuries.3,5,6
The most common causes of all work-related back pain are3,5,6:
Factors that contribute to these causes of back pain are:
Written guides and programs for preventing back injuries are available for all workers. The primary approach to preventing back injury involves reducing manual lifting and other load-handling tasks that are biomechanically (body movement) stressful. The secondary approach is to train workers on how to perform stressful tasks while minimizing the biomechanical forces on their backs and how to maintain flexibility and strengthen the back and abdominal muscles.3,5,6
To prevent back injury, workers should3,5,6:
Patient transfers are particularly hazardous for hospital workers. The following fundamental points should be emphasized to prevent back injuries during transfers3,5,6:
Accident hazards such as wet floors, stairway obstructions, and faulty ladders should be reduced. Wet-floor hazards can be reduced by proper housekeeping procedures such as marking wet areas, cleaning up spills immediately, cleaning only one side of a passageway at a time, keeping halls and stairways clear, and providing good lighting for all halls and stairwells. Workers should be instructed to use the handrail on stairs, to avoid undue speed, and to maintain an unobstructed view of the stairs ahead of them. Request help to manage a bulky load.3,5,6
The consequences of work-related musculoskeletal injuries among CNAs and HHAs are substantial. Along with higher employer costs due to medical expenses, disability compensation, and litigation, injuries also are costly in terms of chronic pain and functional disability, absenteeism, and turnover. Approximately 20% of nurses who leave direct patient care positions do so because of risks associated with the work. Many healthcare workers, who experience pain and fatigue, may be less attentive, less productive, more susceptible to further injury, and may be more likely to affect the health and safety of others.3,5,6
David, a float CNA, was educated on how to use the newest lift equipment and techniques to use when transferring patients from their wheelchairs to their beds and visa-versa. He constantly encouraged the staff he worked with to ask for assistance when handling residents who were unable to help themselves or required more than one person to assist them in moving. Before using any lifting equipment, he made sure all lines and hooks were secure, and the equipment functioned safely and properly. Especially in the secured units where many of the patients have dementia or Alzheimer's disease, he instructed the staff to always work as a cohesive team. The individual at the head of the patient is designated to be in charge, and they would discuss ahead of time the process they would use. Patients are told what was going to be done and why before staff transferred them. Questions are answered at the patient's level of understanding.
This approach is time-consuming and may seem redundant. However, these steps can prevent injuries.
A major point to remember is that the better a healthcare worker takes care of their own body and protects themselves from diseases and injuries, the more patients they can help every day. Taking care of yourself is just as important as taking care of your patients. There are many ways to be injured in the healthcare workspace, and the savvy healthcare worker knows how to work with those risks while protecting their health & safety!
Hospital fires and disasters are especially dangerous because workers must protect themselves and evacuate large numbers of patients.7 Almost one-third of hospital fires originated within patient rooms or worker quarters. Matches and smoking is the most frequent cause.7 Other causes are malfunctioning or misused electrical equipment include hot plates, coffeepots, and toaster ovens.7
Deaths during hospital fires are overwhelmingly due to inhaling the toxic products of combustion rather than direct exposure to the fire. Another obvious fire hazard is the use of oxygen within patient areas. Oxygen increases the combustion of fire. Fires can occur in an oxygen-enriched atmosphere because of patient smoking, electrical malfunctions, and the use of flammable liquids. Procedures should be developed and strictly enforced to prevent fire hazards within patient areas where oxygen is used. When entering a new work area, look around and find fire alarms, fire extinguishers, exit signs and oxygen cut off valves.7
One way to remember fire safety is the acronym, RACE7:
When rescuing anyone in immediate danger, remember to stay low. Smoke rises to the ceiling and forms a heavy, dense cloud that slowly descends. This cloud is deadly because it contains toxic gases. Do not ever hesitate to sound the alarm with any suspicion of fire, but never yell fire. That will only create panic. Call out the facilities code for fire. Call the switchboard to report the fire and pull the fire alarm. When calling the switchboard, be sure to stay on the phone long enough to assure they got the correct information.7
Healthcare units are separated by heavy fire doors that close automatically when the alarm is sounded, to keep the fire from spreading. Additional measures to take to confine a fire include:
Usually, someone in charge is designated to decide when to turn off oxygen supplies.7
If a fire is small and confined, you may be able to extinguish it. If a patient's clothes are on fire, wrap the patient tightly in a large blanket to extinguish the flames. If a piece of equipment catches fire, pull the plug or cut the electricity as soon as possible.7
If a fire cannot be extinguished and smoke, fumes or flames threaten patient safety, you may have to evacuate (move patients out of danger). Evacuate ambulatory patients first. Stay calm and give clear directions. Evacuate horizontally (sideways) as long as you can. Then evaluate vertically (up and down) to a lower level. Never use an elevator to escape during a fire. A sudden loss of power could leave you trapped inside the elevator.7
Fire extinguishers come in different classes for use on fires of different sources. The extinguisher has small pictures on the label that help you identify the type of fire source material the canister will extinguish. Class A puts out fires involving ordinary combustibles (cloth, wood). Class B extinguishers smother fires involving flammable liquids or gases. Class C extinguishers put out fires in or near electrical equipment. Type ABC extinguishers can be used to fight all three types of fires. To use an extinguisher, pull the pin; aim the nozzle at the base of the fire, and squeeze the trigger, while you make sweeping strokes.7
For anyone at a healthcare site, having clear and explicit directions for fire safety as well as disseminating that knowledge to other colleagues at that site is critical to everyone's safety. Fires can get out of control very quickly. The more informed the staff is, and the more frequently the staff practices important fire safety protocols, the more lives will be saved should a terrible situation occur!
A major hazard in all hospitals is the widespread use and storage of flammable and combustible liquids. Many liquids have vapors that are flammable or combustible and can be ignited by a spark from a motor, friction, or static electricity. Handling and storage directions must be followed.7
Compressed gas cylinders are under pressure and are flammable, so they must be handled with extreme care. An exploding cylinder can have the same destructive effect as a bomb. The proper handling of compressed gas cylinders requires training. Storage areas for compressed gas cylinders should be well ventilated, fireproof, and dry.
Cylinders should not be stored near steam pipes, hot water pipes, boilers, highly flammable solvents, combustible wastes, unprotected electrical connections, open flames, or other potential sources of heat or ignition. Cylinders should be properly labeled. The valve protection cap should not be removed until the cylinder is secured and ready for use.7
Acetylene, ethylene oxide, methyl chloride, and hydrogen are flammable, as are the anesthetic agents, cyclopropane, diethyl ether, ethyl chloride, and ethylene. Although oxygen and nitrous oxide are labeled as nonflammable, they are oxidizing gases that will aid combustion.7
Before opening, a healthcare facility cannot correctly estimate the patient load, number of machines, and required safety checks. Over time, minor repairs, haphazard extensions, and replacements might cause some wires to come in contact with each other or create a short-circuit, which may cause a very high current flow through wires and cause fire.8
Violation of standards and procedures to use electrical equipment are the most frequently cited causes of electrical fires.1,8 Thorough electrical maintenance records should be kept, and considerable effort should be devoted to electrical safety, particularly in areas where patient care is involved. Equipment and appliances that are frequently ungrounded or incorrectly grounded include1,8:
As a healthcare worker, you can be the eyes and ears of the facility! If you are in a patient's room and something just does not look right, it is more important to ask and investigate. Whenever possible, take a look at your patient's room and report anything suspicious, in terms of electrical equipment or wiring, to the person in charge! Electrical fires and other hazardous events are largely out of our control. Still, we can be on the lookout in the hopes of preventing a terrible situation from occurring.
"I am Oz, the Great and Terrible." L. Frank Baum9
Disaster plans should be prepared for natural events (e.g., tornadoes, earthquakes, and hurricanes), gas leaks, and bomb threats. The plans should be written and readily available. Supervisory workers will initiate the disaster plan and designate tasks to workers. Workers are responsible for knowing the alarm code for a disaster and the exit routes.
Up to 4 million women employed in hospitals may be exposed to hazards to a normal pregnancy. However, there is no clear evidence that exposure conditions in hospitals have resulted in an excess rate of birth defects among the children of hospital workers.10
Studies do support more general associations between employment in hospitals or laboratories and an increased risk of adverse pregnancy effects. The primary effect is spontaneous abortion.10
In addition to many of these drugs being cytotoxic (destructive action on cells), the majority are hazardous to males or females who are actively trying to conceive, women who are pregnant or may become pregnant, and women who are breastfeeding. The substance may be present in breast milk. These drugs represent an occupational hazard to healthcare workers. They should always be handled with the use of recommended engineering controls and PPE, regardless of their route of administration.10
Cancer treatment drugs (e.g., methotrexate)
Infertility, miscarriage, birth defects, low birth weight
Ionizing radiation (e.g., X-rays and gamma rays)
Infertility, miscarriage, birth defects, low birth weight, developmental disorders, childhood cancers
Miscarriage late in pregnancy, premature delivery
|Disease||Observed effects||Preventive Measures|
|Birth defects, low birth weight, developmental disorders|
Good hygienic practices such as handwashing
Hepatitis B virus
|Low birth weight|
Human immuno-deficiency virus (HIV)
|Low birth weight, childhood cancer|
Practice universal precautions
Human parvovirus B19
Good hygienic practices such as handwashing
Rubella (German measles)
|Birth defects, low birth weight|
Vaccination before pregnancy if no prior
Varicella-zoster virus (chickenpox)
|Birth defects, low birth weight|
Vaccination before pregnancy if no prior
Workers with immunity through vaccinations or earlier exposures are not generally at risk from diseases such as hepatitis B, human parvovirus B19, German measles, or chickenpox. However, pregnant workers without prior immunity should avoid contact with infected children or adults. Workers should also use good hygienic practices such as frequent handwashing to prevent the spread of infectious diseases and universal precautions.11
|Activity||Double chemo-therapy gloves||Protective gown||Eye/face protection||Respiratory protection|
Drugs and metabolites in body fluids
|Disposal and cleaning||Yes||Yes||Yes, if liquid that could splash|
Yes, if inhalation potential
|Disposal and cleaning||Yes||Yes||Yes, if liquid that could splash|
Yes, if inhalation potential
Skin injuries and diseases account for a large proportion of all occupational injuries and diseases. Skin injuries in the hospital environment include cuts, lacerations, punctures, abrasions, and burns. Skin diseases and conditions of hospital workers include dermatitis, allergic sensitization, infections such as herpes, and skin cancer. Chemicals can directly irritate the skin or cause allergic sensitization. Physical agents can also damage the skin, and skin that has been chemically or physically damaged is vulnerable to infection.11
The most common and often the most easily preventable of all job-related health problems are skin reactions (dermatitis).11 The skin is the natural defense system of the body: it has a rough, waxy coating, a layer of protein, keratin, and an outer layer of dead cells to help prevent chemicals from penetrating the tissues and being absorbed into the blood.11
Many chemicals cause irritation on contact with the skin, irritant contact dermatitis, by dissolving the protective fats or keratin protein layer, dehydrating the skin, or killing skin cells. Symptoms of this kind of irritation are red, itchy, peeling, dry, or cracking skin. Some chemicals are not irritants under normal conditions, but they will irritate skin that has already been damaged by sunburn, scratching, prolonged soaking, or other means. Tars, oils, and solvents can plug the skin pores and hair follicles, causing blackheads, pimples, and folliculitis (inflammation of hair follicles).11
Some persons become sensitized to chemicals days, months, or even years after their first exposure. This allergic reaction does not occur in every worker who contacts the chemical. Symptoms are red, itchy, and blistering skin, like poison oak or ivy reaction, and maybe much more severe than the direct irritation described in the previous subsection.11
The association between basal and squamous cell carcinomas and ultraviolet radiation has been well established. The association between skin cancer and exposure to other agents is less well documented. Still, ionizing radiation and antineoplastic drugs have been implicated. Other evidence indicates that malignant transformation of cells damaged by chronic allergic contact dermatitis may occur.11
The skin can be damaged by a variety of microorganisms, including bacteria, fungi, viruses, and parasites. Herpes simplex is the most common dermatologic infection among healthcare workers.11
Relatively simple precautions can greatly reduce skin hazards. Effective measures include work practices and engineering controls (procedure steps that prevent exposure) that limit solvent exposure, the use of PPE, the substitution of less irritating chemicals, use of non-powdered gloves, and the institution of good hygiene program.11
Job stress refers to the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker. Job stress can lead to poor health and even injury.12,13 Hospital work often requires coping with some of the most stressful situations found in any workplace.12,13
Hospital workers must deal with life-threatening injuries and illnesses complicated by complex hierarchies of authority and skills, dependent or demanding patients, and patient deaths; all of these contribute to stress.12,13 Other important stress factors include job specialization, discrimination, concerns about money, lack of autonomy, work schedules, ergonomic factors, and technological changes.12,13
The increasing size and bureaucracy of many hospitals may depersonalize the environment and leave many workers feeling isolated, fatigued, angry, powerless, and frustrated.12,13 These feelings may be expressed as apathy, loss of self-confidence, withdrawal, or absenteeism. Failure to recognize and treat the sources of stress results in workers who suffer burnout.12,13
Factors commonly mentioned as causes of stress by all categories of hospital workers are12,13:
Stress has been associated with loss of appetite, ulcers, mental disorder, migraines, difficulty in sleeping, emotional instability, disruption of social and family life, and the increased use of cigarettes, alcohol, and drugs. Stress can also affect worker attitudes and behavior. Some frequently reported consequences of stress among hospital workers are difficulties in communicating with very sick patients, maintaining pleasant relations with coworkers, and judging the seriousness of a potential emergency.12,13
Understanding stress in the healthcare workplace could be vital in preventing a harmful, dangerous, or violent situation from erupting.
Workplace violence is a serious concern for the approximately 15 million health care workers in the United States.14 OSHA does not require employers to implement workplace violence prevention programs, but it provides voluntary guidelines and may cite employers for failing to provide a workplace free from recognized serious hazards.14
The circumstances of hospital violence differ from the circumstances of workplace violence in general. In other workplaces such as convenience stores and taxicabs, violence most often relates to robbery. Violence in hospitals usually results from patients and occasionally from their family members who feel frustrated, vulnerable, and out of control.14
Common risk factors for hospital violence include the following14:
Violence may occur anywhere in the hospital, but it is most frequent in psychiatric wards, emergency rooms, waiting rooms, and geriatric units. Studies indicate that violence often takes place during times of high activity and interaction with patients. Assaults may occur when service is denied, when a patient is involuntarily admitted, or when a healthcare worker attempts to set limits on eating, drinking, or tobacco or alcohol use.14
Patients with a condition that causes confusion and impaired judgment are more likely to become violent than a patient with normal mentation.14 Confusion and impaired judgment may be caused by neurologic conditions, seizures, hypoglycemia, or dementia. Watch for signals that may be associated with impending violence14:
Note how your coworkers behave. If a colleague's demeanor or behavior has changed for the worse, notify the person in charge.14 For example, slamming equipment around is red-flag behavior. Learn from their history. If a patient has a history of violent behavior (such as acting combative in the ambulance or waiting room), prepare yourself for potentially violent behavior and warn others who are caring for this patient. Let security know if you feel threatened or if you find or suspect that the patient is carrying a weapon. Notify your nursing supervisor, manager, and hospital security if you suspect a patient is going to be violent. Keep your patient informed. Help relieve patient's tension and anxiety by keeping him/her informed about when examinations/treatments will be performed and what is going on.14
Always keep an open path for exiting. Do not let the potentially violent person stand between you and the door. When you are with an upset patient or coworker, avoid areas of the room that do not have an accessible exit. If you are going to an isolated part of your facility, let others know where you are going and when you expect to return. Consider asking for an escort.
Observe your surroundings and note anyone who is not wearing staff ID and is lingering where they should not be. Ask politely if you can help and notify security if you are not satisfied with the answer. If you would rather not approach someone, call security, and provide a full description.
Evaluate the way you wear equipment to be sure it cannot be used as a weapon against you. For example, consider that a stethoscope or ID badge without a breakaway necklace can be used to choke you. Carry your stethoscope in a pocket and use an ID badge necklace that has a breakaway feature. If you wear a necktie, opt for a clip-on style. If your hair is long, wear it in a way that is not easy to pull, and do not wear dangling jewelry.14
In the presence of a potentially violent person, DO14:
In the presence of a potentially violent person, DO NOT:
Take these steps if you cannot defuse the situation quickly14:
In the presence of a weapon, maintain behavior that helps diffuse anger14:
You can make all the difference in violent situations! Staying calm and following these quick tips just might diffuse a violent situation from deteriorating into a worse one.
The demand for home healthcare services is escalating in step with the aging population, resulting in an ever-growing number of paid caregivers providing in-home services for individuals with illnesses and disabilities.
Multiple types of home hazards have been identified by CNAs, and HHAs.15 Homes can harbor a variety of hazards, including throw rugs, pests, tobacco smoke, mold, sharps, inadequate lighting, cluttered hallways and rooms, and inaccessible bathrooms.15
Despite high rates of work-related injuries and the identification of a variety of hazards, scant research describes hazards by specific locations in the home. Hazards also negatively affect job performance, job satisfaction, and health.15 In the only published study describing specific locations in the home of injuries incurred by HHC providers, researchers found that 60% of HHAs injuries occurred inside patient homes, with the most common locations being the bedroom (24%), bathroom (18%), and kitchen (9%).15
Half of the injuries were associated with patient handling, 8% with specific objects (e.g., needles, pets), 8% with cleaning, 4% with lifting objects, 2% with trash disposal, and 28% were not specified. Patient handling tasks that resulted in injury included moving patients in bedding, bathing, and transferring patients.15
Recommendations to reduce exposure to trip/slip/lift hazards include making changes in the work environment, (e.g., removing throw rugs, securing cords, providing adequate lighting), using assistive devices such as transfer or gait belts, participating in ergonomics training, and wearing sturdy shoes with slip-resistant soles.15
Water and grease spills were described frequently on kitchen floors; tight spaces and missing equipment in bathrooms; clutter, tight spaces, and lifting hazards in the bedroom; electrical cords and oxygen tubing in the living room; and clutter in the hallway.15
Pet droppings were key biohazards in the kitchen and living room; human waste was commonly noted as bathroom and bedroom hazards.15 The rooms in patients' homes in which HHAs work varied by type of healthcare worker and patients' needs. For example, nurses may not go into a patient's bedroom or kitchen if patient care is provided in the living room.15
By contrast, home health aides are often in all rooms if they provide cleaning, meal preparation, and personal care services. A key implication of these findings is that health care agencies should provide tailored training that addresses the different hazards HHC providers are likely to encounter by room.15
Many healthcare workers must constantly deal with exposures to neoplastic and hazardous drugs. Every year new drugs are developed, and each has certain side effects. Fortunately, organizations such as NIOSH, CDC, and DHHS are constantly updating important information telling us how to be safe, along with the side effects of new chemical agents. Healthcare workers in all departments need to know where their MSDS book is located and have easy access to it. Educators must constantly up-date their safety manuals, educate works on all shifts, and in all departments. In today's volatile world, healthcare workers and others need to stay informed of how to handle fires and to be prepared for disasters, both man-made and natural.
Knowing how to use equipment that can prevent injuries, along with practicing using this equipment is necessary. Workplace violence is everybody's concern. The key to success is to learn to listen effectively, know when to speak and what to say, respect everybody's personal distance, and show genuine concern for all those you are in contact with. People need to feel valued and appreciated and know what the consequences are for their actions. Administrators have the responsibility of making sure healthcare workers are protected from injuries while at work and enforce the consequences when a worker is physically or mentally abused by a patient, relative, or coworker.