Slips/Trips/Falls

Potential Hazard Because of the emergency atmosphere, (i.e., high traffic and compact treatment spaces) slips/trips/falls may be a specific concern for ED areas. There is a potential slip and fall hazard if water is spilled on the floor accidentally, electrical cords run across pathways, and/or if emergency equipment or supplies block passageways. Possible Solutions Provide safe clean-up of spills, and keep walkways free of obstruction.  Keep floors clean and dry [1910.22(a)(2)]. Keep access to exits clear at all times [Means of Egress 1910 Subpart E (b)(4)]. For more information see HealthCare Wide Hazards - Slips/Trips/Falls.

 

Latex Allergy

Potential Hazard Gloves must be worn frequently in the ED, because of occupational exposure to blood and OPIM, creating a potential for employees to develop latex allergy from wearing latex gloves. Possible Solutions Employers must provide appropriate gloves when exposure to blood or other potentially infectious materials (OPIM) exists [1910.1030 Bloodborne Pathogens Standard].  Alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided [1910.1030(d)(iii)]. For more information see HealthCare Wide Hazards-Latex Allergy.

 

Equipment Hazards

Potential Hazard Injury may occur to employees from improper training or use of equipment (e.g., defibrillators). Electric shock may also occur as a result of lack of maintenance or misuse of equipment and/or its controls. Oxygen-enriched atmospheres and water may contribute to hazardous conditions. Possible Solutions A program that routinely monitors the status of equipment and proper training of employees to use equipment safely. For more information see HealthCare Wide Hazards-Electrical.

 

Workplace Violence

Potential Hazard   Workplace violence is an issue in ED's because of the crowded and emotional situations that can occur with emergencies. In addition, ED patients could be involved with crimes, weapons, or violence from other people that could put the ED employee at an increased risk of workplace violence.  Possible Solutions Good work practice recommends a security management program that addresses workplace violence in the ED and could include: Trained staff to recognize and diffuse violent situations and patients. Be alert for potential violence and suspicious behavior and report it.  Provide intervention measures including verbal, social, physical, and pharmacologic interventions. Warning Signs of Increasing Anger/Violence include: Pacing and/or restlessness Clenched fist Increasingly loud speech Excessive insistence Threats Cursing Adequate staffing levels, with experienced clinicians on each shift. Counseling and treatment for employees who have experienced workplace violence. The use of appropriate engineering controls to provide security such as: Install concealed panic buttons in the ED, on staff, and at the check-in area, that can be pushed for emergency help. These buttons could notify hospital security as well as directly reach the local Police Department. Improve lighting and video surveillance. Use an escort or buddy system. Limit access to ED area and personnel, by implementing: A waiting room area with controlled access to ED area. Patients must be buzzed in by receptionist from a secure door. ED exits that exit out only, so people off the streets can't access the ED unless they enter through the waiting room area. The use of metal detectors. Provide a "secure" room for patients identified to be violent. This room could include controls such as: Video camera surveillance Visual surveillance: provide a window Door locks on patient rooms Bed with tie down straps Locked cabinets Attach furniture and equipment to the floor so patients can't throw them at employees.     For more information see HealthCare Wide Hazards-Workplace Violence.

 

Tuberculosis

Potential Hazard Exposure to Tuberculosis and other infectious agents from patients in waiting room and treatment areas. Staff may be treating an emergency and be unaware of other pre-existing infectious conditions. Possible Solutions Provide and practice early patient screening in the ED to identify potentially infectious patients, and provide isolation to prevent employee exposures. Provide engineering, work practice, and administrative procedures to reduce the risk of exposure. For example:  Patients with a productive cough could be asked to wear a mask to prevent the spread of infection.    Post waiting rooms signs that state, "If you are coughing you may be asked to wear a mask." Isolate patient until verification testing is negative. Some EDs provide an isolation room to safely isolate potentially infectious patients. Others can designate an isolation area for infectious patients. Isolation rooms must be respiratory acid-fast bacilli (AFB) rooms that are maintained under negative pressure Directive CPL 2.106 (1996, February 9)]. AFB isolation refers to a negative-pressure room or an area that exhausts room air directly outside or through HEPA filters if re-circulation is unavoidable. Protect employees from exposure to the exhaled air of an individual with suspected or confirmed TB [1910.139(a)(1)] and [OSHA Directive CPL 2.106 (1996, February)].  Isolate patients who have suspected or confirmed TB [OSHA Directive CPL 2.106 (1996, February 9)]. Post a warning sign outside the ED respiratory isolation room 1910.145(a)(1) to prevent accidental entry. 1910.145(f)(4) Requires that that a signal word (i.e. "STOP", "HALT", or "NO ADMITTANCE") or biological hazard symbol be presented as well as a major message (e.g., "Special respiratory isolation," "Respiratory isolation," or "AFB isolation"). An example of a description of necessary precautions is "Respirators must be donned before entering." Employers must provide suitable respirators when such equipment is necessary to protect the health of the employee [1910.139(a)(2)]. The minimally acceptable level of respiratory protection for TB is the Type N95 Respirator.  Establish and maintain a respiratory protective program which includes the requirements outlined in [1910.139(b)].  Worker education: OSHA [Directive CPL 2.106 L.e.4] requires worker education and training to ensure employee knowledge of TB including: signs, symptoms, transmission, controls, and post-exposure protocols. For more information see HealthCare Wide Hazards-Tuberculosis.