OSHA and Veterinary Medicine

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OSHA and Veterinary Medicine

• Office Management

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Introduction

• OSHA stands for Occupational Safety and Health
  Administration and was founded in 1970 to ensure
  employee safety.
• www.osha.gov
• Employer is responsible for providing a safe
  working environment for all team members and will
  be penalized if they do not.
• Up to 70,000 per violation
• OSHA oversees workplace hazards, including safe
  use and disposal of chemicals.
• Must have MSDS (Material Safety Data Sheets)
  sheets on hand for quick reference.

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Why do we need OSHA in Veterinary Medicine?

• Essential to prevent transmission of zoonotic
  disease.
• Safety plans are needed in case of fire or
  natural disaster.
• Normal day to day potential hazards should be
  addressed.
• Proper protection should be utilized when
  handling chemicals, or other dangerous situations.

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Zoonotic Diseases

• Zoonoses- diseases that may be directly or
  indirectly transmitted to humans from wild or
  domesticated animals.
• More than 1400 diseases are currently known to be
  zoonotic.
• 60 are caused by pathogens known to cross
  species lines.
• Veterinary team members may be held liable if not
  properly educating the public and are vital in
  the public health role of control of zoonotic
  diseases.
• All employees should sign statement that they
  have received prevention training.

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Disease Transmission

• Mode of disease transmission is important to
  understand when trying to prevent the spread of a
  disease.
• Reservoir- place where infectious organism
  survives and replicates (within animal or soil)
• Host- living organism that offers an environment
  for maintenance for the organism but that may not
  be required for the organisms survival.
• Depending on disease, organism may be transmitted
  to more than one host or reservoir.
• Control methods are generally aimed at reservoirs
  and hosts.

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Type of Transmission

• Direct
• Requires close contact between the reservoir of
  the disease and the susceptible host
• Indirect
• Intermediaries carry the agent of disease from
  one source to another
• Vector- living organism that transports
  infectious agents
• Ex fleas, ticks, mosquitos
• Vehicle- mode of transmission of an infectious
  agent from the reservoir to the host.
• Ex food, water

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Control of Zoonotic Diseases

• Is important as a technician to recognize early
  symptoms of zoonotic diseases and know how to
  treat.
• Those at risk are immune compromised, the old,
  and the young.
• Prevention may be aided by good hygiene,
  vaccination, and water filtration.

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Animal Handling and Husbandry

• Animal related injury number one injury in a vet
  clinics
• Potential of zoonotic diseases
• Training is a must with new employees!!
• When bitten, employee should wash area for at
  least 5 minutes and seek medical attention.

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Personal Hygiene

• Regular Hand washing is strongly encouraged
• Before eating, drinking
• Before smoking
• Before leaving
• Before and after using restroom
• After handling specimens
• After handling animals

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How to perform a thorough Hand Washing

• Wet both forearms with warm water
• Apply a generous amount of disinfecting soap in
  the palm of one hand
• Using a vigorous motion, scrub each side of the
  hand, between the fingers and at least halfway up
  the arm
• If there is debris under the fingernails, use a
  hard pick or stiff brush to remove matierial
  while soap is still on the hands
• Rinse both hands thoroughly with warm or tepid
  water
• Dry both hands and arms with a towel or air dryer

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Safety Hazards in the Veterinary Practice

• Moving Equipment/Lifting
• Multiple employees should be involved if over 40
  lbs.
• Lift with legs. NOT BACK!

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• Wet Floors
• Signs should be posted to indicate a wet floor
  hazard.
• May need to dry the floor sometimes
• Running
• Team members should not be allowed to run through
  the practice.

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• Toxicities
• Chemicals
• Radiology chemicals
• Cleaning supplies
• Should not mix certain chemicals together
• Chemotherapy agents
• Sometimes are expelled in urine and feces of pets
• Medications
• Excess drug powder and residue can collect on the
  hands
• Repeated ingestion may not be safe
• Washing hands is essential after handling
  medication

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• Radiation
• Must be taken seriously
• Excess can cause birth defects, sterility and
  even cancer
• Must wear proper PPE
• OSHA states that employees must provide and
  demonstrate proper use of PPE in veterinary
  clinics
• Collimation also important when it comes to
  radiation as well
• A dosimeter badge is worn on collar to measure
  radiation exposure
• Allowed .05 Sv/year as occupationally exposed (5
  rem/year)
• Appropriate signs must be posted to indicate
  radiology sites

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Anesthetic Gases

• Practices are expected to properly store, label
  and use chemicals safely.
• Should help to keep employee exposure under
  allowed limits.
• Should
• Have periodic monitoring of equipment and
  exposure levels.
• Have proper ventilation.
• Have proper scavenging systems.
• Train staff appropriately.

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Masking and Tank Induction

• Make sure masks and tanks have tight-fitting
  seals and are connected to scavenging systems.
• Use proper fitting masks for patients
• Only use masking procedures when medically
  indicated
• Remember to turn on oxygen, place mask, then turn
  on gas, reverse order to remove mask.

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Simple Anesthetic Exposure Badges

• Used to help test exposure to anesthetic gases.
• Can be obtained from several labs.
• Should be worn by a typical employee on typical
  workload day.
• OSHA recommends testing every 6-12 months.

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Waste Anesthetic Gas Scavengers

• Active Scavengers
• Fan in a box that creates vacuum
• Cost from 400-1000
• Will need maintenance and replacement
• Manual activation, must be turned on
• Passive Exhaust
• Channels gases through a tube from patients
  diaphragm
• Limited distance
• Adsorption
• Charcoal absorption canisters
• Should be monitored and changed

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Biohazards

• Sharps containers
• Biological bags

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Formalin/Formaldehyde

• Make sure properly identified and stored.
• Keep least amount on hand as possible.
• Wear Appropriate PPE.

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Ethylene Oxide

• Form of sterilization procedure.
• Not used as commonly today.
• MUST be used with a ventilation system.
• Link with cancer.
• Fines associated with trying to shortcut the
  process.
• OSHA requires monitoring to take place. Will use
  bade devices to detect exposure levels.
• Detailed written plan also required.
• Make sure to follow manufacturer instructions.
• Make sure to follow proper storage and training
  recommendations.

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Ethylene Oxide Continued

• Emergency Plans
• If exposed, adequate fresh air is the treatment
  of choice.
• If irritation persists, consult physician.
• If in contact with liquid form, removal all
  contaminated clothing and wash skin surfaces for
  15 minutes.
• If in contact with eyes, use eyewash for at least
  15 minutes and consult an ophthalmologist.

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Chemicals

• Five Specific requirements that veterinary clinic
  must follow
• 1. Practice must have a written chemical plan.
• 2. A complete list of all hazardous chemicals
  must be maintained.
• 3. The practice must maintain a library of
  material safety data sheets.
• 4. All containers of hazardous chemicals must be
  properly labeled.
• 5. The practice must train all staff members on
  the dangers and safety aspects of the chemicals.

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Bulk Chemicals

• If more than 20 gallons, should consult with
  fire department about storage.
• Should make sure areas with large amount of
  chemicals are properly identified.
• Should have plans in place if emergency occurs
  for avoiding areas with bulk chemicals.

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Chemical Safety Training

• Conduct training as soon after the person is
  hired as possible.
• Prepare workbook or handout for training.
• Include workers rights.
• Provide hospital policy copies.
• Stress importance of PPE.
• All chemicals must be stored in tightly sealed
  containers and be placed below eye level in case
  they are spilled.
• If have to store on higher shelves, use step
  stool to retrieve.

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Determining Chemicals Hazard

• Health Hazard chemical for which there is
  evidence that acute or chronic health effects may
  occur in exposed employees. Falls into following
  categories
• Carcinogen
• Toxic
• Irritant
• Sensitizer
• Any agent which damages the lungs, skin, eyes or
  mucous membranes.
• Physical Hazard chemical that is
• Combustible liquid
• Compressed gas
• Explosive
• Flammable
• Organic peroxide
• Oxidizer
• Pyrophoric
• Unstable
• Water-reactive

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Hazardous chemical Labels

• All chemicals should be properly labeled
• Should always label secondary containers
• No special labels are required, but should be
  uniform throughout practice.
• If cant physically label, use a color code
  system.
• If is a prescription, no additional information
  is needed than is what is found on a customary
  prescription label.

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Diamond Labeling System

• National Fire Protection Association uses colored
  diamond labels to indicate the risks associated
  with health, fire, reactivity, and special
  hazards of specific chemicals.
• Diamond stickers are placed at entry point of the
  practice, along with the room the hazard is
  located in.
• Good for any emergency personnel that may be
  responding to a situation.
• Also should be placed on chemicals that are
  transferred from their original bottle.

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Exemptions

• Hazardous waste- by EPA not OSHA
• Tobacco products
• Wood or wood products
• Articles (what is product of hazardous materials)
• Food, drugs, cosmetics or alcoholic beverages
  that are packaged to be sold to consumers and
  that are not opened in the hospital.
• Foods, drugs, cosmetics intended for personal
  consumption by the employee while in the
  workplace.
• Any common cleaner that is is used in way as is
  used by average consumer.
• Any drug sold in final solid form to client for
  immediate consumption by patient.

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Written Chemical Plan

• Should be reviewed and revised often.
• Should include hazardous material and what PPE is
  recommended for use while using this chemical.
• Should describe training offered to employees on
  a chemical.
• Should outline MSDS system.

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Chemical Spills

• Spill kit should be developed and maintained in a
  location that is easy to access.
• Should include
• Cat litter
• Dustpan
• Broom
• Nitrate gloves
• Eye protection
• Copy of cleanup procedures

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Chemical Spill Cleanup Procedures

• Remove all unnecessary people and pets from area
  to prevent spreading and exposure to chemical.
• Increase ventilation to area. Open windows and
  turn on exhaust fans and vents.
• Put on protective gloves. Put on gown if needed.
• Cover spill with absorbable material, either cat
  litter or paper towels.
• Clean up saturated absorbent material.
• Place chemicals in a trash bag and dispose of it
  properly.
• Wash hands
• Replace materials used in spill kit.

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Material Safety Data Sheets

• Produced by the chemical manufacturer.
• Should be kept together in one location.
• Should be indexed in a systematic way.
• Call distributor or manufacturer if need a MSDS.
• Should be current within 3 years

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Contents of MSDS sheets

• Each MSDS sheet should contain
• The identity of the chemical
• Physical and chemical characteristics
• Health hazards
• Permissible exposure limits
• Whether the product is a carcinogen
• Emergency first aid procedures
• Specific hazards

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Eye wash devices

• Mounted and eyewash bottles.
• Mounted stations should not be on faucet used for
  bathing animals because of exposure to other
  chemicals.
• Device should not be locked.
• Hand held bottles are designed for foreign bodies
  and not chemicals.
• Employees should be trained as to location and
  operation.
• Flushing is recommended for 5- 10 minutes, refer
  to MSDS sheet.

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Food and Beverages

• Consumption of food and beverages must be limited
  to areas free of toxic and biologically harmful
  substances.
• Staff lunches, drinks, condiments and snacks
  must be stored in an area free from biological or
  chemical hazards.

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Electricity

• Outlets should not be overloaded with excessive
  plugs and extension cords
• Symptoms of electrical problems include frequent
  tripping of circuits and lights that dim when
  large pieces of equipment are used.
• Extension cords should not be used on a permanent
  basis
• If used, use with a 3 way conductor for better
  protection and should never be run through
  doorways or windows.

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Exits

• Should never be blocked
• Use caution where storing supplies
• Signs must indicate where the exit is located.
• If door looks like exit but is not must be marked
  as NOT an EXIT
• Emergency lights are required and must be tested
  on a yearly basis.
• Lights must be installed in locations that lead
  to the exits

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Autoclaves

• Generate a high amount of heat and steam
• Should be properly ventilated before opening
  door.
• Face and hands should be kept away from both the
  vent and door when venting and opening the
  autoclave.

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Large animals

• Never be in chute with large animal
• Make sure stalls are locked
• Make sure approach slowly and use common sense.

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Bathing, Grooming and Insecticides

• Wear appropriate PPE.
• Make sure that wet areas or dangerous areas are
  identified.
• All chemicals should be stored and labeled
  properly.
• Anything changed from one container to another
  should be properly labeled.

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• Compressed air cylinders
• Should be stored in a dry, cool place, away from
  potential heat sources.
• Must be secured in an upright position by holder,
  bracket, chain or strap.
• Sign should identify where these cylinders are
  kept.
• http//www.youtube.com/watch?vejEJGNLTo84

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Dress

• Must dress appropriately for job.
• No open toed shoes
• Jewelry should be kept to a minimum

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Noise Hazards

• Generally the kennel area.
• If prolonged exposure, may be harmful.
• Should be identified by a sign and ear protection
  should be provided.
• Sound Panels may be used to help reduce noise.

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Ergonomics

• Repetitive movements.
• Have computers and office equipment comfortable
  and able to prevent injury.

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OSHA Required Training Topics

• Animal handling
• Chemicals
• Ethylene oxide
• Emergency and fire prevention plan
• Formaldehyde
• Ionizing radiation
• Medical services and first aid
• Noise exposure
• Medical waste and sharps
• Personal safety, violence prevention
• Portable fire exit
• Personal Protective Equipment
• Signs and tags
• Workers Rights and Responsibilities

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Developing Safety Protocols

• Should be developed in each practice to ensure
  employee safety.
• Must be instituted regarding how employees will
  be notified in case of emergency. Where to meet
  in case of emergency, and how safety plan will
  take effect.
• Role playing may be needed

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Implementing Safety Plans and Protocols

• 4 steps
• 1. Gather information
• Designate a safety officer
• Make sure all registrations are current
• 2. Delegation and Preparation
• Hazards can be placed in different sections
• 3. Training
• Training on the different sections
• 4. Implementation
• Following previous three sections

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Developing a Hospital Safety Manual

• Should include an overview of all materials
  covered so far.
• Include hazards communication plan, MSDS filing
  system, and explanation of secondary labeling
  system.

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Hazard Communication Employees Right to Know

• To establish compliance, a practice must have
• A designated safety manager. This employee is
  responsible for training all team members and
  ensuring the safety program meets standard
  requirements.
• A written plan
• A summary of all hazardous chemicals available,
  including injectable medications, pesticides,
  antiseptics. Disinfectants, and laboratory
  agents.
• MSDSs available at all times. If any chemicals
  are transmitted to another container, the new
  container must be accurately labeled with
  descriptions that are transferred to a spray a
  bottle to clean exam room tables.
• An explanation of the labeling system.
• A protocol for emergency evacuation.
• A training program implementing the use of PPE
  and monitoring devices as well as hazards of the
  practice. Required for all practices with 11 or
  more employees.

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Staff Responsibilities

• Read the OSHA poster
• Comply with standards
• Follow rules and regulations
• Wear PPE while working
• Report hazardous conditions
• Report any job-related injury or illness to
  employer and seek treatment
• Cooperate with OSHA compliance officers

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Employers Responsibilities

• Responsibilities
• Provide a hazard free workplace
• Set and enforce safety rules
• Provide Personal Protective Equipment (PPE) with
  proper instructions
• Provide training on any potential workplace
  hazards

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Employers Rights

• Rights
• Enforce workplace rules
• Be present during an inspection or investigation.
• Require a warrant for inspection.
• Request postponement of inspection.
• Expect that no trade secrets will be divulged
• Consult an attorney
• See any complaints
• Have employees interviewed at a time that does
  not interfere with staff members job
• Right to appeal findings

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Accident Reporting and Investigation

• Every accident must be reported to the safety
  manager and/or practice manager and owner.
• If medical treatment is needed, appropriate
  paperwork should be available for employee to
  take to hospital or doctor.
• Paperwork may include First Notice of Accident or
  Injury and Illness Accident Report as well as
  Workers Compensation Insurance Claim form.
• Paperwork should be sent to appropriate
  authorities upon employees return.
• Documentation of the safety program must exist.

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Fire Prevention

• Most common causes of fire are overloaded
  electrical circuits and items stored too close to
  heat sources.
• Practices with 10 or more employees must have a
  written OSHA plan that includes fire prevention
  and response.
• Fire codes vary by location and inspection is
  conducted by the fire department.
• Before using fire extinguisher, make sure alarm
  has sounded.

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Fire Extinguishers

• Must be located no more than 75 feet from any
  distance within the clinic and placed 32 to48
  inches above the ground surface.
• Should be placed near the exit doors of the
  practice.
• All employees must be trained in the use of the
  fire extinguisher
• PASS
• P pull the pin
• A Aim low. Point the extinguisher to the bottom
  of the fire
• S Squeeze the handle
• S Sweep from side to side at the base of the
  fire until it appears to be out.

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Fire Extinguishers continued

• Made of carbon dioxide, dry chemicals, halon or
  water.
• Carbon dioxide is most effective on class B and C
  fires (liquid and electrical) but is only
  effective for 3 to 8 feet because carbon dioxide
  disperses quickly.
• Dry chemical fire extinguishers are used for a
  variety of fires and contain and extinguishing
  agent and compressed gas a propellant.
• Halon extinguishers contain a gas that interrupts
  the chemical reaction taking place when fuel
  burns
• Water extinguishers are used for combustible
  (Class A) fires only,

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Smoke Detectors/ Fire Sprinklers

• Batteries in smoke detectors should be replaced
  on a yearly basis.
• Monthly testing is recommended.
• New buildings are required to have sprinklers and
  should be evaluated to ensure they are working
  order.

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Escaping Animals

• Windows should never be left open.
• Doors should never be left open.
• Should use slip leash when removing dogs from
  kennels (double leash in opposite directions is
  ideal).
• Feral animals should be handled with caution.

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Veterinary Practice and the Law

• Clients that are injured on the premises may be
  tempted to sue. Prevention is the key.
• Team members must report any injury and be aware
  of all potential hazards in the clinic.

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OSHA Inspections

• Know who is allowed to admit inspectors.
• On-site inspection must be triggered by at least
  one of the following
• Written complaint and OSHA must believe that a
  safety or health danger exists.
• Complaint must allege that physical harm has
  occurred and that hazards still exists.
• Must allege imminent danger
• Employer failed to provide adequate response to a
  compliant
• Business has history of failure-to-abate
  citations during last 3 years.
• Discrimination issues for filing complaints about
  OSHA standards

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How to Survive Inspection

• Be polite and cooperative
• Verify credentials
• Request that inspection take place at a more
  convenient time
• Make time for inspection
• Take notes and pay attention during inspection
• Have employees stand-by during inspection
• Show officer only what he or she asks to see
• Have copies of hospital policies readily
  available
• Correct any violations immediately

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What should you do?

• Mr. Yazzi, a long term client, has come into your
  practice with Taco, his Pomeranian. Upon walking
  to the counter to check out, Mr. Yazzi trips on
  the scale, which was recently moved into the
  hallway between the exam rooms. He is able to
  catch himself but twists his back, sending it
  into muscle spasms. He states he is fine and it
  was his fault for not looking down. You offer
  him a chair to sit down and rest and let his back
  relax but he refuses and pays his bill and leaves
  practice.
• What should you do?