1. Review safety practices important when handling chemical disinfectants.
2. Explain the benets of Material Safety Data Sheets. 3. Highlight the importance of reporting employee injuries and accidents. 4. Discuss basic procedures to prevent patient injuries. CSSD Safety Practices: Part III Sponsored by: Handle Disinfectants Safely Disinfectants are chemicals that kill most pathogenic (disease-causing) microorganisms, but not spores. Therefore, they are not sterilants like ethylene oxide, hydrogen peroxide or ozone, which were discussed in Part II of this series. They are widely used to kill organisms on medical devices that do not need to be sterilized before reuse. Commonly-used disinfectants in healthcare facilities include quaternary ammonium compounds (quats), phenolics, alcohol, halogens (chlorine and iodophors), glutaraldehyde, ortho-phthaladehyde (OPA), and formaldehyde. 2 Processing recommendations issued by the disinfectant and medical device manufacturers should always be carefully followed to best ensure that the disinfection procedures used are effective and safe. All MSDSs for the chemicals should be available for easy reference, their instructions should be consistently followed, and the information they contain should be integrated into safety training programs. Applicable guidelines issued by national, state and local governmental agencies regarding these chemicals must be complied with, as well. Any guidelines published by voluntary associations should also be followed to ensure worker and patient safety. CIS technicians should follow general safety precautions when handling and working with disinfectants. Examples are: Wearing necessary personal protective equipment (PPE), including general purpose utility gloves, a uid-resistant gown or other covering with sleeves, full- face protection, and shoe covers. Using an exhaust hood because some disinfectants produce fumes that irritate the respiratory tract. Following previously developed spill plans and disposal procedures for each solution. Knowing where eye wash towers/stations and other rst aid supplies are located and how to use them. Material Safety Data Sheets CIS technicians and other healthcare personnel must be adequately informed about the risks associated with the hazardous materials with which they work or to which they are exposed. To this end, the Occupational Safety and Health Administration (OSHA), an agency within the U.S. Department of Labor, requires CIS SELF-STUDY LESSON PLAN LESSON NO. CIS 224 (Instrument Continuing Education-ICE) Instrument Continuing Education (ICE) lessons provide members with ongoing education in the complex and ever-changing area of surgical instrument care and handling. These lessons are designed for CIS technicians, but can be of value to any CRCST technician who works with surgical instrumentation. You can use these lessons as an in-service with your staff, or visit www.iahcsmm.org for online grading at a nominal fee. Each lesson plan graded online with a passing score of 70% or higher is worth two points (2 contact hours). You can use these points toward either your re-certication of CRCST (12 points) or CIS (6 points). Mailed submissions to IAHCSMM will not be graded and will not be granted a point value (paper/pencil grading of the ICE Lesson Plans is not available through IAHCSMM or Purdue University; IAHCSMM accepts only online subscriptions).
CHL CIS CRCST CHL CIS CRCST IAHCSMM LESSON PLANS Certied Instrument Specialist (CIS) technicians must consistently use safe work practices to protect themselves, their employee peers and the patients they serve. Unfortunately, this is much easier to say (and to insist upon) than it is to practice. Those working in Central Sterile Supply Departments (CSSDs) are confronted with a wide array of risks that require a great deal of knowledge to avoid. This lesson is the last of a three-part series examining some of the most important safety issues of concern to CIS technicians. In the rst lesson, we presented an overview of safety issues, and we took a tour through the CSSD to note specic risks in each work area. In the second lesson, we explained the role of governmental agencies and allied professional organizations in shaping safety practices, and we also discussed safety concerns applicable to chemical sterilants. In this lesson, we will discuss safety practices that should be used when working with chemical disinfectants, note the purposes of Material Safety Data Sheets (MSDSs), explain protocols for reporting employee injuries and accidents, and review practices to reduce patient injuries. 1 Series Writer/Editor Jack D. Ninemeier, Ph.D. Michigan State University East Lansing, MI
IAHCSMM CIS Self-Study Lesson Plan manufacturers of the materials to develop and supply MSDSs with their products. MSDSs are documents specic to each hazardous material that provide important information that employees must know to work safely with the material. This information is more detailed than that normally included on product labels or on other precautionary statements, and includes: Product name and manufacturers name and contact information List of hazardous ingredients Physical information, such as vapor pressure and density, evaporation rate, solubility in water, freezing and boiling points, specic gravity, acidity (pH), appearance, and odor Fire and explosion information, including ash point, ammable units, extinguishing media, special re ghting procedures, and unusual re and explosion hazards Reactivity information, such as stability, incompatibility, and hazardous decomposition products Health hazard data, including effects of over-exposure to the material Storage recommendations Emergency and rst aid procedures Spill or leak procedures, spill management, and waste disposal recommendations Protection information and control measures Special precautions While not every chemical is potentially hazardous, MSDSs should still be available for all products used in the CSSD. Employees should know about the chemicals they handle. Some staff members could have special health concerns, such as allergies, and will be alerted to potential problems by this information. Employers are responsible to ensure that MSDSs are available and, in turn, CIS technicians must become familiar with the information and comply with the instructions provided. Employers may ask staff members to review MSDSs on a regular basis. Safe practices suggested by MSDSs should be incorporated into work procedures to help reduce chemical accidents and injuries. Practice drills relating to chemical exposure, res and explosions may be helpful. Knowledge about rst aid and procedures to seek proper treatment is also important. This and other related emergency information is provided by MSDSs that should be sent with exposed or injured employees as they seek medical assistance. Reporting Employee Accidents and Injuries Even with signicant efforts to increase work safety awareness and prevent accidents, CIS technicians can still be involved in accidents, and injuries can still occur. Then it is necessary to document and report the incident to the appropriate administrative personnel to comply with OSHA healthcare facility regulations. An investigation must be conducted to provide information about the cause, the situation, and/or the behaviors involved. This will help identify the factors, hazards or unsafe practices that contributed to the incident. Then corrective actions can be taken to improve the systems, behaviors or physical conditions that caused the injury and will help prevent future injuries to other employees. CIS technicians should remember that no matter how insignicant an injury seems they should inform their supervisor, manager or director immediately. Time, place, tasks being performed, and a description of the incident must be recorded on the appropriate form. It should then be submitted to the safety ofcer, personnel department, employee health or other administrators, and risk management personnel must also be informed about potential problems. Preventing Patient Injuries CIS technicians have a responsibility to help prevent patient injuries, accidents and infections. They do so as they correctly perform the important tasks of decontaminating, disinfecting, inspecting, testing, assembling, packaging, sterilizing, and aseptically handling sterile items according to established procedures. If these tasks are done correctly, the chance of a patient being injured or involved in an accident related to sterile processing procedures is greatly reduced. A check and balance system should be used to ensure that these important functions are performed correctly. For example, sterilizers must be inspected while in use, they should be monitored with biological monitoring tests, and these results must be recorded and reviewed. Potential hazards can exist when CIS technicians have not correctly performed their jobs. Some examples include: Patient Care Equipment Patients receiving equipment that has not been tested for proper operation and function can be subjected to complications arising from malfunctioning equipment or delayed treatment. All equipment must be tested and documented according to manufacturers recommendations and guidelines before leaving the CSS department. All equipment must be properly decontaminated, and it should be free from soil, damage, defects, or hazards that could affect its use. Patient equipment must also be included in a scheduled preventive maintenance program. Contaminated Supplies or Reusable Medical Devices Contaminated supplies, equipment, and unsterile reusable medical devices, such as surgical instruments, are a hazard to patients undergoing surgical procedures or treatment because nosocomial (hospital- Picture courtesy of KEM Medical Exhaust hoods protect CIS technicians from potentially dangerous fumes. acquired) infections can occur. Also, complications resulting from delayed surgical procedures may result from having to ash sterilize an item that was not properly decontaminated and sterilized. All items must be properly processed from initial transport after use until they are stored and redistributed. CIS technicians must use correct processing procedures, sterilization equipment must operate properly and be carefully monitored, and sterilized items must be handled, transported and stored properly. Chemical Residues Patients coming in contact with items having chemical residues can receive chemical burns or other complications. Items sterilized with ethylene oxide (EtO) must be fully aerated to ensure that no EtO residue or its byproducts will remain and harm patients, and devices should be dry when sterilized to avoid ineffective sterilization. All items soaked in glutaraldehyde or other chemicals must also be completely rinsed to ensure that no residues or byproducts remain. Patient and Supply Transport Patients being moved are at risk from collision injuries resulting from poor transportation techniques. Often there is trafc in patient care areas caused by foodservice and supply carts and patient transportation devices such as gurneys/stretchers and wheelchairs. Hallways, corners and elevators can present hazards if the proper techniques are not used as employees transport patients. Safety tips include using caution at all times, not using a transport vehicle to push or prop open automatic doors, and never parking mobile equipment in hallways where it can block trafc or door access. When there is a patient accident/injury, it should be investigated, and a record of the incident should be developed. Practices and physical conditions within the facility that might cause a patient accident or injury must also be investigated and reported, and it is the responsibility of all healthcare workers to report unsafe practices or hazards. If a malfunction in the sterilization process has occurred (or appears to have occurred), all items in any loads thought to be unsterile must be recalled. Then they must be quarantined until biological and chemical indicators are read. CSSDs must have a recall procedure, and its basic tactics should include: Obtaining a list of all supplies known to be in the load. Verifying the sterilization controls. Notifying the CSSD supervisor, manager or director and those in the areas throughout the facility where any affected supplies could be stored. Retrieving as many affected items as possible. Notifying the Infection Control and Operating Room supervisor or coordinator and other personnel according to the facilitys policies and procedures. Notifying physicians if items known to be unsterile were used in any of their surgical procedures. Documenting all steps taken. Notifying risk management personnel about any possibility that unsterile devices were used on a patient. Ensuring that the malfunctioning sterilizer is removed from service if it caused the recall. Inspecting malfunctioning sterilization equipment by qualied service personnel. A comprehensive report must be developed and, after the equipment is repaired, a negative biological test must be veried before the equipments next use. In Conclusion Each of the three lessons in this series has addressed important safety concerns. While many topics and extensive information have been presented, CIS technicians are confronted by numerous other safety hazards in their work areas. CSSD professionals must have extensive knowledge about and require skills in a wide range of very important disciplines, and the ability to work safely is among their most important responsibilities. Endnotes 1. This lesson is adapted from: Central Service Technical Manual. Seventh Edition. Chicago, Il. International Association of Healthcare Central Service Materiel Management. 2007, and Managing Safety Hazards in Central Service. Module 6 in EXX CELL 2000 Plus: Strategies for Success. Chicago, Il. International Association of Healthcare Central Service Materiel Management. 2000. 2. See chapter 10 in the Central Service Technical Manual referenced above for detailed information about disinfectants. IAHCSMM CIS Self-Study Lesson Plan Technical Editor Carla McDermott, RN, ACE, CRCST Clinical Nurse III South Florida Baptist Hospital, Plant City, FL Series Writer/Editor Jack D. Ninemeier, Ph.D. Michigan State University East Lansing, MI CIS SELF-STUDY LESSON PLANS IAHCSMM is looking for volunteers to write or contribute information for our CIS Self-Study Lessons. Doing so is a great way to contribute to your own professional development, to your Association, and to your Central Sterile Supply Department peers. Our team will provide guidelines and help you with the lesson to assure it will be an enjoyable process. For more information, please contact Elizabeth Berrios (elizabeth@iahcsmm.org). Keep hallways clear for the free ow of trafc. CIS Self-Study Lesson Plan Quiz (Instrument Continuing Education-ICE) Lesson No. CIS 224: CSSD Safety Practices: Part III Questions (circle correct answer): CHL CIS CRCST CHL CIS CRCST IAHCSMM LESSON PLANS 1. Which is true about disinfectants? a. They kill spores b. They are sterilants c. They kill most disease-causing microorganisms d. They are not used in healthcare facilities 2. Which of the following is not a commonly used disinfectant in healthcare facilities? a. Citric acid b. Alcohol c. Glutaraldehyde d. Formaldehyde 3. Guidelines by voluntary associations ________ followed to best ensure worker and patient safety when handling disinfectants. a. Should be b. Do not need to be 4. Which of the following is not part of personal protective equipment (PPE)? a. Fluid-resistant gown b. Shoe covers c. Full-face protection d. All the above are part of personal protective equipment 5. Material safety data sheets (MSDSs) are required by which federal government agency? a. FDA b. OSHA c. EPA d. CDC 6. Material safety data sheets are developed by: a. Healthcare facilities b. U.S. Department of Labor c. Manufacturers of chemicals to which they apply d. Independent testing laboratories 7. Information that must be included on a material safety data sheet includes all of the following except: a. List of hazardous ingredients b. Health hazard data c. Purchase container size d. Reactivity information 8. Which of the following statements is true? a. Not every chemical is potentially hazardous b. Every chemical is potentially hazardous c. Material safety data sheets need only be available for hazardous products d. The FDA is responsible to ensure that MSDSs are available in each healthcare facility 9. Which type of employee accident/injury must be investigated? a. Only those that cause an injury or death b. Only those that occur when instruments are being processed c. All injuries and accidents, regardless of signicance d. Only those covered by each specic healthcare facilitys policies 10. Patient care equipment must be free from which of the following before it is issued for patient use? a. Soil b. Damage c. Defects d. A and C above e. All the above 11. Which is true about ash sterilization? a. It can delay surgical procedures b. It may be necessary when an item was not properly decontaminated c. It minimizes the need for careful sterilization in CSS departments d. A and B above e. All the above 12. Chemical residues on patient-contact equipment ________ cause chemical burns for the patients on which it is used. a. Can b. Cannot 13. Who should be contacted if a process load is thought to be unsterile and must be recalled? a. The CSSD supervisor, manager or director b. Infection control supervisor or coordinator c. Operating room supervisor or coordinator d. A and C above e. All the above 14. Malfunctioning sterilization equipment should be inspected by: a. The Central Sterile Supply Departments administrators b. Qualied service personnel c. Infection control personnel d. All the above 15. Who is responsible to report unsafe practices or hazards? a. Only managers in the departments in which the practices or hazards occur b. Only risk management personnel c. All healthcare workers d. 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