Tricky Questions - Spill Management in Healthcare Facilities

WHAT IS SPILL? 

An unintentional or accidental fall, flow or runout of something can be termed as Spill. In Hospitals, these spills include chemicals, hazardous material, drug, blood and other bodily fluids. 

WHAT ARE THE COMMON KINDS OF SPILLS IN THE HEALTHCARE FACILITIES? 

There are four common or major kinds of spills such as: 

Biological Spills – Blood and other bodily fluids, culture of micro-organisms and other infectious materials. 

Chemical Spills – formalin, xylene and other acid, bases and drugs 

Mercury Spills – B.P Apparatus & thermometer mostly but mercury compounds are also used in preservatives and reagents. 

Cytotoxic Spills – cytotoxic drugs and medicines 

HOW SPILLS INTERACT WITH HUMAN BODY?
Harmful materials such as bacteria, viruses and other small organisms, fumes and vapors and inappropriate drug or medicine can enter in to the body by four ways such as: 

• 1.     Inhalation (breathing)
• 2.      Ingestion (swallowing)
• 3.      Absorption (through skin)
• 4.      Injection

WHAT ARE THE RISKS ASSOCIATED WITH THESE SPILLS?

• ·       They may have serious health consequences for instance; microorganism (bacteria, viruses) may gradually impact internal organs badly.
• ·       Mercury beads and its fumes can disrupt nervous system.
• ·       Chemicals and their vapors may cause skin & eye irritation depending upon their properties and nature.
• ·   Cytotoxic drugs (Cancerous drugs) are highly toxic to cells that may lead to adverse effects during exposure. 

WHAT IS THE ROLE OF SAFETY COORDINATOR IN THE EVENT OF A SPILL?

Assess nature of spill and adopt safety measures accordingly:

• ·         Stop the source of spill
• ·         Place caution sign or cordon off the area
• ·         Wear appropriate PPEs from spill kit
• ·         Use appropriate spill items to tackle spill such as absorbent pad etc.
• ·         Dispose of contaminated material including PPE in waste bags (Yellow & Red) or sharp container
• ·         Wash Area or disinfect area through housekeeping staff
• ·         Wash hands
• ·         Re-stock spill kit item

WHAT TO DO IF SAFETY COORDINATOR IS NOT AROUND DURING SPILL?

In this particular scenario, one must stop the source of spill, cordon off the area to avoid exposure and announce code yellow.

WHAT IS MEANT BY MINOR OR MAJOR SPILLS?

Spills that can be triggered through spill kits and without spill kits are termed as minor spill whereas spills that are unmanageable or cannot be tackled through spill kits are major spills. Hence, code yellow is announced for major spills or whenever concerned safety coordinator is not around.

WHAT TO DO IN TERMS OF EXPOSURE?

Try to reach nearby emergency facility such as eyewash bottle, eyewash station and emergency shower depending upon the severity of exposure. If problem still persists, visit EAR or employee health clinic as per need.

WHAT IS THE QUANTITY OF DISINFECTANT (SODIUM HYPOCHLORITE) SHOULD BE USED TO DISINFECT THE AREA?

In the guidelines, its mentioned 2gm/liter for sodium hypochlorite for all others except biological spill that is 100gm/liter.  Remember, the main purpose is to protect yourself and people in the surrounding from the exposure. It’s the minimum quantity and fluctuation in it is acceptable because it’s not a dose to be given to the patient. 

WHAT IS CODE YELLOW?

CODE YELLOW refers to major spills that can be radioactive, gas leakage, hazardous material or chemical spills. However, when safety coordinator is not around then code yellow may be announced.

WHEN CODE YELLOW SHOULD BE ANNOUCED?

In case of spill, one should stop the source of spill, cordon off the area and then inform departmental safety coordinator. He will take rest of the measures.

WHO RESPONDS WHEN CODE YELLOW IS ANNOUNCED?

Team to respond in case of CODE YELLOW:

• ·         Firefighting team because chemical may have flammable characteristics
• ·         Engineering & Maintenance Department (EMD) team to stop the flow, to cut off ignition source and to shut off valve.
• ·         Housekeeping for final cleaning

WHAT IS MEANT BY MSDS?

A Material Safety Data Sheet (MSDS) is a document that contains information on the potential hazards (health, fire, reactivity and environmental) and how to work safely with the hazardous materials. Hence, it’s mandatory to keep MSDS file near hazardous materials.

WHAT IS THE USE OF EYEWASH BOTTLE?

Eyewash bottle provides immediate flushing, consists of distilled water and used to clean, refresh & soothe eyes when exposed to chemicals and hazardous materials. 

                            

Remember Safety is more important than Convenience

HOSPITAL EMERGENCY CODES – CODES & CODE ANNOUNCEMENT IN HOSPITAL

 (Things you must know in case of unfortunate situation)

Hospitals are the most common institutions that use color codes to designate emergencies. The use of codes is intended to convey essential information quickly and with minimal misunderstanding to staff while preventing stress and panic among employees, patients and visitors. These emergency codes are not only displayed on departmental boards but are printed on employee ID cards as well.

CODE YELLOW – Hazardous materials & Gas leakage

CODE YELLOW EXTENSION: 2100

Description of Code YELLOW:                                                                 

Code YELLOW refers to Major spills that can be radioactive, gas leakage, hazardous material or chemical spills.

 Code YELLOW is not announced for minor spills. Each and every location of the hospital is equipped with spill kit where likelihood of spill is there.

Probability of Code YELLOW announcement:

Likelihood of Code YELLOW announcement in our hospital is near to negligible because of stringent measures. However, following areas of the hospital where there is a probability of major chemical spills are:

a)      Chemical Store

b)      Laundry Area

c)       Pathology Lab where formalin, xylene and ethanol are used

d)      Diesel storage area where generators are installed

Additional measure for major spills:

Sand trolley or sand bags are placed in those areas where likelihood of major spill is there in order to tackle any unfortunate situation because spill if not controlled well in time might have toxic effects for surrounding environment.

Team to respond in case of CODE YELLOW:

1.       Firefighting team because chemical may have flammable characteristics

2.       Engineering & Maintenance Department (EMD) team to stop the flow, to cut off ignition source and to shut off valve.

3.       Housekeeping for final cleaning

CODE PINK – Prevention of Child Abduction

CODE PINK EXTENSION: 2300

Code Pink is announced to prevent infant or child abduction. It’s announced in the hospital when a child is reported to be missing. Overhead code announcement is taken place at extension – 2300.

Steps to be followed in case of Code PINK:

a)      Additional security staff is deployed at all the entrances and exits  of the hospital

b)      All entrance points/gates are closed

c)       No car or individual is allowed to leave the vicinity unless got vehicle or belonging searched.  

d)      Assistance from CCTV camera’s installed at hospital is taken.

e)      Details of missing child such as age and physical appearance is shared with security staff for identification and search purpose.

f)       Additional staff remains present at all entrances unless code Pink is called off.

g)      Additional measures are taken to limit the probability of such incidents in future. 

CODE BLACK – (Bomb or Terrorist threat)

CODE BLACK EXTENSION: 2300

Code BLACK typically means there is a bomb and terrorist threat to the facility. In case of threat, inform Safety & Security immediately at extension 2300.

Types of threats:

a)      Call threat

b)       Incendiary bombs or inflammable material – ( These devices may create small explosion leads to fire)

c)       Letter & Parcel Bomb

Do’s	Don’ts
Call Threat
·      All call should be taken seriously ·       Hear the threat call seriously	No need to panic
Incendiary bombs or Inflammable material
·      This threat should be treated in the same way as threat posed by explosive device	No need to panic
	No ignorance at all
Letter and Parcel bombs
·      This should be taken seriously and take actions as per guidelines	No need to panic
	No ignorance at all
·      Be vigilant	Don’t open the parcel
·      Inform Security on extension 2300 immediately	Don’t place it in water or put anything on top of it
	Do not leave it unsupervised

Procedures to be followed for letter and parcel bombs:

It’s a special threat that shouldn’t be ignored. Staff dealing or handling with unopened letters and parcels must be vigilant to identify following:  

Unfamiliar post marks	Inappropriate address
Excessive weight or uneven weight distribution	Springy parcels

In case of suspected package or letter, following measures are to be taken:

·         Do not try to open the parcel/letter.

·         Do not place it in water or put anything on top of it.

·         Isolate it where it poses no harm, ideally outside but avoid carrying it through crowded places.

·         Do not leave it unsupervised or allow anyone near it.

·         Inform Safety & Security at extension 2300 immediately. Police and bomb disposal squad are informed by security department.

·         Building Evacuation will trigger as per nature of threat.

NO THREAT SHOULD BE IGNORED

CODE RED – (Prevention from the menace of Fire)

CODE RED EXTENSION: 2100

Code Red is announced to protect patients, visitors and employees from fire and non-fire emergencies. It’s announced on Extension: 2100

 

Things To Remember – Fire Response
Do’s	Don’ts
Be calm and follow RACE & PASS as per need          If need be, announce Code RED	No need to panic            No need to shout near patients or manifest excitement or fear
Exits may be closed	Exits shouldn’t  be blocked or unobstructed
If need be, prepare to evacuate patients in following order: a)      Patients who can walk b)      Patient in wheel chairs c)      Patients on beds	Don’t leave patients helpless
Transfer patients from central oxygen system to portable cylinders	If fire is in piped oxygen area,  Don’t  leave patients on central oxygen system

 

Steps to be followed when code RED is announced:

·   In case of fire expands, Code RED is announced and building evacuation plan is triggered.

·         Safety coordinator will be responsible to lead his staff to designated assembly area.

·         Rescue 1122 authority will be called by the security department.

·         No employee is permitted to re-enter the hospital building until Code RED is called off.

CODE BLUE – (Medical Emergency)

CODE BLUE EXTENSION: 2200

It’s a medical emergency code. Upon announcement, the team members respond immediately to all calls for assistance to provide resuscitation and/or life support measures. The team is to reach at the said location within 5 minutes. 

Similarly, relevant nurse manager/designee ensures that the crash cart is easily accessible, fully functional and complete in all respects. For more details, please refer to the ‘Policy of Resuscitation’.

Note:

All the information is obtained from Policies, Plans and manuals of Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC)

Haider Ali is young professional works in Health Safety & Environment sector at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC), holds a degree in MPhil Environmental Science from GC University, Lahore. He writes on burning issues and has been involved in various projects.