Environmental Health & Safety 4-6783

www.stonybrook.edu/ehs/healthcare

Hazard Communication/Right-to-Know

for MSO, Medical Students and Nursing Students

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Training Outline

1. Hospital Safety Information Environment of Care Respiratory Protection Injury/Illness Reporting Reducing SB Medicine Staff Exposures

Contaminated Sharps Injuries Formaldehyde (Formalin) Safety Glutaraldehyde/OPA Safety Hazardous Drugs (HD) Safety - New Ethylene Oxide (EtO) Safety - New Waste Anesthetic Gases (WAG) Safety - New

Ergonomics Policy Environmental Awareness Transporting Infectious and Diagnostic Specimens

2. Hazard Communication/Right to Know 2

Management Plans:• Each reference card has

critical information• Posted in all patient care

areas• Please review; you are

responsible for knowing information on cards

Environment of Care (EOC)

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Top 12 Ways to Insure EOC

Compliance1. Always wear your Stony Brook ID badge.2. Know proper procedure for Major Chemical

Spill response. – Call University Police at 911 or 631-632-3333

from cell phone. (Off sites call 911)3. Know the location of your department’s

Emergency Management Manual and Plan.4. Know location of your unit’s disaster kit for

power outages (flashlights, batteries, extension cord, duct tape, glow sticks).

5. Know how to shut off the oxygen supply valve.

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Top 12 Ways to Insure EOC

Compliance6. Report building issues to Plant Operations at

4-2400.7. Know proper fire response procedures (RACE).8. Know locations of nearest fire alarm pull

stations and how to use a fire extinguisher (PASS).

9. Secure your personal belongings.10. Know how to access Safety Data Sheets, SDS,

on-line (formerly referred to as MSDS).11. Adhere to no smoking policy.12. Report building related issues. (Tech Park:

Contact Facilities Manager, 4-4380)

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Respiratory Protection

• SBUH requires all hospital employees, who come in contact with patients with known or suspect TB or another airborne pathogens, be annually fitted with a hospital approved N95 respirator.

• If you experience significant weight gain or loss, dental or facial surgery, or other condition that may affect respirator fit, you must be re-fitted, even if it is within a year of your last fit test.

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N95 Respirator- User Instructions

1. Prior to wearing a respirator you must be medically cleared by Employee Health, and trained/fit tested by EH&S.

2. Only wear the Type, Make, Model and Size respirator you were fitted with (e.g., N95, 3M 1860S). Keep fit test card with respirator information in your ID badge.

3. Read user instructions.4. Inspect your respirator and conduct the User Seal Check

prior to each use.5. Before you enter an isolation room that requires a

respirator, put on your respirator in the corridor (not in the ante-room or patient room).

6. For TB exposure, discard the N95 respirator when soiled or damaged. For SARS or smallpox exposure, discard after each use, unless directed otherwise.

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N95 - No Interfering Facial Hair

• Anyone with interfering facial hair cannot be fit tested or wear a N95 respirator because it prevents a good seal around the face.

• A small goatee or mustache that fits inside the respirator may be OK, but a full beard or substantial “stubble” is not.

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Do I need to Wear a Surgical Mask over the N95 Respirator?

Typically no. The hospital approved N95 respirators (3M 1860

and the Moldex/Inovel 1500 series) are both rated as surgical masks.

N95 Respirators

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N95 Annual Respirator

Fit Testing For Residents: Fit testing will take place the day of Orientation. (If you are not able to get fit tested at Orientation, you can be fit tested at one of the open monthly sessions).

==================================Open monthly fit testing schedule is provided in the Hospital weekly announcements and on the

Hospital’s intranet under “Hot Topics”.

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Injury/Illness Reporting

Report any work related injury/illness to your supervisor.

If necessary, seek medical attention at Employee Health and Wellness. If life threatening or off hours, go to the ED.

Complete an Employee Injury/Illness Report and fax to 2-2687.

Contact the Accident Reporting System (ARS) at 888-800-0029.

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How can we prevent future injuries?

Contaminated Sharps Injuries

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Reducing Contaminated

Sharps InjuriesUse a device with a safety, if available. If you are unsure how to use a device, seek

guidance.Actively participate in trials of new safety devices.Limit distractions and conversations -- Don't

disturb a colleague while they are using a sharp.Avoid multiple attempts during phlebotomy, ABGs,

IV catheter insertions, CV catheter placement, and lumbar punctures.

Use blunt tip needles in OR.Use extreme care when suturing.

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Reducing Contaminated Sharps

InjuriesTake your time, don't rush. "Cool off" after interpersonal conflict.Avoid passing. Immediately discard used sharp in sharps

container.When a sharps containers is ¾ full, have

someone contact Hospital Custodial Services at 4-1455. (Off-sites: call Bob Weniger at 4-4066).

Report all injuries and complete an Employee Injury/Illness Report and Sharps Injury Log.

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Formaldehyde/Formalin Safety

-human carcinogen-

When using specimen containers with formalin:

• Minimize length of time containers are open

• Avoid spillage• Clean up any spillage

immediately• Wear PPE – nitrile gloves

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Glutaraldehyde and Cidex OPA –

eye, skin, respiratory tract irritant

How to minimize exposure:• Use appropriate ventilation: GUS• Wear PPE (gloves, gown and eye

protection).• Pour carefully. • Keep containers closed when not in

use.• Use Glute-out neutralizer prior to drain

disposal and for spills.

Glutaraldehyde and Cidex OPA Safety

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Glutaraldehyde and Cidex OPA –

eye, skin, respiratory tract irritant

• Look for “HD Precautions” sign on in-patient room doors

• Wear appropriate PPE Anticipation of hand exposure – wear double nitrile

gloves, change out after 30 minutes For chemo and for anticipation of body splash –

wear chemo gown

• Avoid crushing or cutting HD tablets• Review HD Management policy, EC:0048

Hazardous Drugs (HD) Safety

Hazardous Drug - as defined by NIOSH (National Institute of Occupational Health & Safety), any drug identified by at least 1 of the following 6 criteria: carcinogenicity, teratogenicity or other developmental toxicity, reproductive toxicity in humans, organ toxicity at low doses in humans or animals, genotoxicity, or new drugs that mimic existing HDs in structure or toxicity. Include drugs for cancer chemotherapy, antiviral drugs, hormones, some bioengineered drugs and other miscellaneous drugs and are identified on NIOSH’s List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings.

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Ethylene Oxide (EtO) Safety

• EtO is a flammable, colorless gas used to sterilize surgical equipment

• Central Sterile Supply (CSS) uses EtO in closed system sterilizers/ aerators

• 2 EtO abators works automatically and interface with sterilizer/aerators

• CSS has gas alarm system with master alarm panel outside EtO room with visual and audible alarms– 3 separate EtO monitors, in EtO Room

and by each abator

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• WAG = nitrous oxide and halogenated anesthetics (e.g., halothane, enflurane, isoflurane, desflurane). – exposure from leakage of patient's anesthetic breathing

circuit during delivery of anesthetic and exhalations of patients recovering from anesthesia

• Use anesthesia delivery units with gas scavenging as per manufacturer’s instructions.

• Face masks used for administrating inhaled anesthetics should be available in variety of sizes, pliable, provide effective seal to prevent leakage, and positioned on the patient’s face properly.

• Wear PPE during spills of liquid anesthetic agents (gloves, goggles, face shields)

Waste Anesthetic Gases (WAG) Safety

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Ergonomics Policy

EH&S is responsible for managing the

Ergonomics Program, in consultation with

Employee Health & Wellness

Ergonomics: science of human work focusing on designing work stations, tools & tasks for safety, efficiency & comfort.

Musculoskeletal Disorders: (SDS) result from bodily reactions due to bending, climbing, crawling, reaching, twisting, overexertion, or repetitive motion. Injuries can occur to muscles, nerves, tendons, ligaments, joints, cartilage, and spinal discs in back, neck shoulder, elbow, wrist or hand.

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Ergonomics Policy

Reporting: Employees need to report work related injuries to their supervisor.

Incident Trending: when a trend of MSD injuries is identified in an area, a hazard assessment will be conducted.

Response: Controls may be used to reduce hazards

Training: General ergonomics awareness will be provided by EH&S during Orientation, recertification classes and online.

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Environmental Awareness

What happens to waste that is poured down the

drain?

It goes to the Sewage Treatment Plant at the University and then into the Long Island Sound.

Sewage Treatment Plant at the University

Long Island SoundPort Jefferson, NY

Remember: Do not put any hazardous waste down the drain.

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What is Chemical

Hazardous Waste?

• Chemical hazardous waste can include medications, cleaning products, paints, solvents, acids/bases.

• Most hazardous wastes have been identified throughout the Hospital and are being collected.

• If you are unsure whether you are generating a hazardous waste or are disposing of a new chemical product, complete a Waste Determination (Admin P&P EC:0045).

• If you have any questions, contact EH&S at 4-6783.

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You might see the following 4 waste disposal containers on the units:

• Pharmacy Return Box – all unused or expired drugs

• Black 2-gallon container – Partially Used Drugs with a label.

• Locked Box (Critical Care areas) – Epinephrine, Propofol (Diprivan), Eptifibatide (Integrilin) and Nitroglycerin

• Chemo container (Oncology areas) – Chemotherapy waste.

HW

HW

Common Chemical

Waste Containers

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Regulated Medical Waste

(Red Bag Waste)• Place the following in Red

Bags:• All waste generated in

diagnosis, treatment or immunization of humans:

• Cultures and stocks• Human pathological

waste excluding teeth• Human blood and

blood products• Waste products must be

“saturated” with blood or bodily fluids so that when squeezed produces free flowing fluid or flecks

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Sharps Waste

• Needles• All Syringes with needles• Syringes without needles that

have come in contact with blood or body fluids

• Pipettes• Slides and cover slips• Scalpel blades• Glass test tubes• Disposable staples• Explanted orthopedic

hardware

Place in Sharps Containers:

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• All Infectious substances must be packed and shipped by specially trained employees.

• Hazardous materials MUST be properly labeled and packed for shipment.

• Training for shipping infectious substances and other hazardous materials is required and available from EH&S (4-6783).

Transporting Infectious Substances

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OSHAOccupational Safety & Health Administration

Oversees Hazard Communication Standard in the private sector

PESHPublic Employees

Safety & Health BureauOversees Hazard Communication (RTK) Standard for public employees at the state and local level

Hazard Communication/RTK - OSHA & PESH

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Required Departmental

Postings

Employers must post a sign in every workplace to inform employees that they have a right to hazard information.

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Employer Responsibilities

• Notify you about your right to request information

• Provide information within 72 hours

• Maintain information• Provide education and

training

• Maintain records on exposures

• Maintain labeling system

• Provide hazard information to non-employees

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Employee Rights

• Submit written requests for information

• Refuse to work with a toxic substance if no reply received within 72 hours

• Obtain access to University’s written Hazard Communication, Right to Know program

• Can not be forced to waive any rights under the Law as a condition of employment

• Can file complaints with Department of Labor or NYS Attorney General

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The Hazard Communication Standard has aligned with the UN Globally Harmonized System of Classification and Labeling of Chemicals (GHS):

• Provides common and coherent approach to classifying chemicals and communicating hazard information on labels and safety data sheets (SDS)

• Improves quality and consistency of hazard information, making it safer for workers by providing easily understandable information on handling and safe use of hazardous chemicals

Revised Haz Comm Standard

Changes• New Hazard classifications• New Labeling requirements

– Signal words (Danger or Caution), pictograms, hazard statements, precautionary statements

• Standardized Safety Data Sheets (SDS)

Major changes to Haz Comm Standard

NEW

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Previous Labeling - NFPA

Safety Diamond

Assign a number to reflect the degree of hazard to the worker

RATING SYSTEM: 0-4The higher the number, the higher the hazard!

Label all secondary containers with product and hazard information!

Flammability

Health Reactivity

Special Hazard

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New GHS Labeling

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New Pictograms and Hazard Classes on Labels and Safety Data Sheets

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Safety Data Sheets (SDS)

– Your Guide to Workplace Safety

• Material Safety Data Sheets are now called Safety Data Sheets (SDS)

• SDS will be uniform, with the same 16 sections in the same order

• SDS will have:– Signal word (Danger or

Warning)– Hazard Pictograms – Hazard Statements– Precautionary Statements

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Accessing SDS &

Chemical Inventories• SDS and departmental

inventories are available on-line at Hospital intranet, “Inside SBUMC”, under “RESOURCES” or go to: http://asa-msds.campus.stonybrook.edu/

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Accessing Pharmaceutical SDS

• On the Hospital Intranet page, scroll down to Resources.

• Select drop down for Drug References and Select MicroMedex.

• Type in the name of the drug in the search field and click “Search”.

• Scroll down and click on the "Toxicology and Exposure Information" section.

• Click on MSDS.

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Why are SDS important to me?Provides details on:1.Hazards2.How to be protected from injury or illness

– What PPE to wear– Safe work practices– Exposure controls

3. What to do if a spill occurs

4. What to do if a co-worker or I get exposed– First aid

Look for the red arrows throughout the MSDS sections.

Safety Data Sheets (SDS)

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Review of a Sample SDS• Formalin Solution, neutral buffered, 10%– Sigma Aldrich

SDS Review

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16 sections:1. Identification2. Hazards Identification3. Composition/Ingredients4. First Aid Measures5. Fire Fighting Measures6. Accidental Release

Measures7. Handling & Storage8. Exposure Controls &

Personal Protection

9. Physical & Chemical Properties10. Stability & Reactivity11. Toxicological Info.12. Ecological Info.13. Disposal Info.14. Transport Info.15. Regulatory Info.16. Other Info.

SDS Review

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Section 1 - Identification

In case of an emergency.

SDS – Section 1

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Section 2 - Hazards Identification

How can this product harm me if improperly handled?

SDS – Section 2

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2. Hazards ID – Pictograms, Hazard Statement,

Precautionary statement

You need to know how this chemical could harm you, if not handled properly

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SDS – Section 3

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Section 4 – First Aid MeasuresWhat do I do if this chemical get on my skin, in my eyes, or if I breathe it in?

SDS – Section 4

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Section 5 – Firefighting Measures

SDS – Section 5

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What do I do for a release or spill ?

SDS – Section 6

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Spill Kits for Minor

Chemical SpillsGlutaraldehyde Spill Kits Located near GUS stations and areas where glutaraldehyde/Cidex OPA used

Chemotherapy Spill KitsLocated in areas where chemotherapy are prepared and administered

Formalin Spill Kits Located in labs and areas using formalin

Battery Acid Spill KitsLocated in powered industrial truck charging areas and other non-alkaline battery areas.

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Chemical Spill Response

• Minor spills of less than a gallon can be cleaned up by trained staff using a spill kit (chemo spills: < 50 ml).

• Major spills over 1 gallon, call University Police at 911 (cell: 631-632-3333). – Offsites: call 911

If at any time during clean up of a minor spill, you need assistance, call 911 (631-632-3333).

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Section 7 – Handling & StorageHow should I handle and store this product safely?

SDS – Section 7

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Section 8-Exposure Controls & Personal

Protection

How much can I be exposed to without experiencing problems?

SDS – Section 8

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Section 8 – Personal ProtectionWhat must I wear to protect myself… gloves, goggles, respirator?

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Section 9 – Physical & Chemical Properties

SDS – Section 9

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Section 10 – Stability & Reactivity

SDS – Section 10

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Section 11 – Toxicological InformationHow can this product harm me?

SDS – Section 11

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Section 12 – Ecological Information

SDS – Section 12

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Section 13 – Disposal Considerations

How should I dispose of this product safely?

SDS – Section 13

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Section 14 – Transport Information

What must I do if I need to ship this product?

SDS – Section 14

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Section 15 – Regulatory Information

SDS – Section 15

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Section 16 – Other InformationCodes used in Section 3

SDS – Section 16

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• Contact EH&S at 4-6783– Ask to speak to a staff member in

the Healthcare Safety team!• Email us at

ehsafety@stonybrook.edu• Review Admin and EH&S P&Ps at Inside

SBUMC under “Policies & Procedures”

• For additional reference material go to: www.stonybrook.edu/ehs/healthcare

Questions or Comments?

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