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

Roles & Responsibilities of Safety Coordinators in Peshawar - Do it the Safe way & Do it the Right way

Safety Coordinators play significant role in order to ensure safe and secure environment for their staff and patients. They are responsible to ensure compliance of all the guidelines in order to reduce work related injury. Following are the roles and responsibilities of safety coordinators: 

                    

1	Facility Inspection  Rounds Participate in Facility Inspection/Environmental Rounds and ensures follow-up on observation/improvement opportunities
2	Risk Assessment Active role in departmental Risk Assessment at least annually. Maintain close liaison with Facilities Safety team during risk assessment and share all the identified risks. Ensure display of PCRA before and during renovation and construction activities within the department.
3	Departmental FMS Trainings & FMS Quiz Arrange and conduct trainings on FMS within department and maintain record/attendance in hard form or in TMS: FMS Quiz – 100% Fire Quiz – 100%
4	Knowledge of Fire & Awareness of Firefighting Equipment Knowledge of RACE & PASS Must be aware of locations of nearest firefighting equipment, fire exit, evacuation plan, evacuation routes followed by assembly points. Monitor inspections of departmental equipment as per requirement. Ensure corridors and exit points free from obstructions. Intimate Security in case of any ambiguity in the maps, routes etc.
5	Knowledge of Utilities Knowledge of  Electrical DB location & handling  Knowledge of location of Oxygen Shut off valves  All the oxygen cylinders must be clamped or in trolleys, shouldn’t be left unattended
6	Knowledge of Hazmat Ensure Hazardous Material Inventory followed by MSDS is updated on HIS and same record is maintained in hard form (blue file). Ensure staff knowledge about hazardous material labels/symbols. Staff knows about chemicals followed by MSDS, which are used in their respective area. Staff education is mandatory regarding MSDS
7	Knowledge of Spill & Spill Kit Knowledge of role during spill. Ensure availability of spill kits where hazardous materials/chemicals are placed and it should be easily accessible. Knowledge of spill kit item and its location  Ensure spill kit has all the relevant items available Frequent opening of spill kit for training or checking of spill kit items especially disinfectant. For more info, please refer to: 1.        Multi Purpose: Tricky Questions - Spill Management in Healthcare Facilities (multipurpose15.blogspot.com) 2.        Multi Purpose: Spill Management in Hospitals and Healthcare Facilities (multipurpose15.blogspot.com)
8	Personal Protective Equipment (PPEs) PPEs are available, in use where required and are in good condition. Ensure PPEs availability and usage as per MSDS when chemicals are used.
9	Emergency facilities and Eyewash Must ensure that Emergency facilities such as eyewash bottles, eyewash stations & showers are operational, their labels are uniformed and logs are maintained.
10	Departmental Incident Participate in Incident Investigation and responsible to raise QIO.
11	Knowledge of Emergency Codes In case of CODE RED (Fire): Liaison with \ Security regarding fire incident/ issue Control and direct all fire prevention efforts till the arrival of firefighting team. Assist firefighting team and make report of any missing staff members in assembly area after head counting. In Case of  Spill: Stop the source of the spill  Cordon of the area and take measures to reduce the likelihood of exposure according to spill management guidelines.  For major spills, CODE YELLOW is announced at extension 2500. In case of Bomb  & Terrorist threat: Record as much information as possible on the Bomb Threat Checklist then announce CODE BLACK at 2700. In case of Child Abduction: Call security at 2700 and / or exchange for announcement of CODE PINK and provide relevant information.   (For more details: https://multipurpose15.blogspot.com/2021/01/hospital-emergency-codes-codes-code.html )
12	Utilities Failure In case of Utilities Failure – Power Outage, Medical gases Outage or Water Failure: Notify shift supervisor/EMD. Determine the impact of utilities failure on patient care Check backup system
13	Waste Management Ensure appropriate segregation of hazardous waste as per Waste Management Programme. Ensure display of  disposal guidelines where different color bins are placed. Impart knowledge to other staff members.
14	Preventive Maintenance   Ensure that PM or PPM (Periodic Preventive Maintenance) of all utilities and medical equipment is done before due date.
15	Close Liaison with Facilities Safety    Maintain close liaison with Facilities Safety in case of any confusion while implementing any of these guidelines.

    

    Roles and Responsibilities will be updated as per need. To ensure compliance, these roles

    may be displayed in the respective area of safety coordinators. 

Remember Safety is more important than Convenience