OSHA AND VETERINARY MEDICINEOffice Management

INTRODUCTION OSHA stands for Occupational Safety and

Health Administration and was founded in 1970 to ensure employee safety.

www.osha.gov Employer is responsible for providing a safe

working environment for all team members and will be penalized if they do not. Up to $70,000 per violation

OSHA oversees workplace hazards, including safe use and disposal of chemicals.

Must have MSDS (Material Safety Data Sheets) sheets on hand for quick reference.

WHY DO WE NEED OSHA IN VETERINARY MEDICINE? Essential to prevent transmission of zoonotic

disease. Safety plans are needed in case of fire or

natural disaster. Normal day to day potential hazards should

be addressed. Proper protection should be utilized when

handling chemicals, or other dangerous situations.

ZOONOTIC DISEASES Zoonoses- diseases that may be directly or

indirectly transmitted to humans from wild or domesticated animals.

More than 1400 diseases are currently known to be zoonotic.

60% are caused by pathogens known to cross species lines.

Veterinary team members may be held liable if not properly educating the public and are vital in the public health role of control of zoonotic diseases.

All employees should sign statement that they have received prevention training.

DISEASE TRANSMISSION Mode of disease transmission is important to

understand when trying to prevent the spread of a disease. Reservoir- place where infectious organism

survives and replicates (within animal or soil) Host- living organism that offers an environment

for maintenance for the organism but that may not be required for the organism’s survival.

Depending on disease, organism may be transmitted to more than one host or reservoir.

Control methods are generally aimed at reservoirs and hosts.

TYPE OF TRANSMISSION Direct

Requires close contact between the reservoir of the disease and the susceptible host

Indirect Intermediaries carry the agent of

disease from one source to another Vector- living organism that transports

infectious agents Ex: fleas, ticks, mosquitos

Vehicle- mode of transmission of an infectious agent from the reservoir to the host. Ex: food, water

CONTROL OF ZOONOTIC DISEASES Is important as a technician to recognize

early symptoms of zoonotic diseases and know how to treat.

Those at risk are immune compromised, the old, and the young.

Prevention may be aided by good hygiene, vaccination, and water filtration.

ANIMAL HANDLING AND HUSBANDRY Animal related injury

number one injury in a vet clinics

Potential of zoonotic diseases

Training is a must with new employees!!

When bitten, employee should wash area for at least 5 minutes and seek medical attention.

PERSONAL HYGIENE Regular Hand washing is strongly

encouragedBefore eating, drinkingBefore smokingBefore leavingBefore and after using restroomAfter handling specimensAfter handling animals

HOW TO PERFORM A THOROUGH HAND WASHING Wet both forearms with warm water Apply a generous amount of disinfecting

soap in the palm of one hand Using a vigorous motion, scrub each side

of the hand, between the fingers and at least halfway up the arm

If there is debris under the fingernails, use a hard pick or stiff brush to remove matierial while soap is still on the hands

Rinse both hands thoroughly with warm or tepid water

Dry both hands and arms with a towel or air dryer

SAFETY HAZARDS IN THE VETERINARY PRACTICE Moving Equipment/Lifting

Multiple employees should be involved if over 40 lbs. Lift with legs. NOT BACK!

Wet Floors Signs should be posted to

indicate a wet floor hazard. May need to dry the floor

sometimes Running

Team members should not be allowed to run through the practice.

Toxicities Chemicals

Radiology chemicals Cleaning supplies

Should not mix certain chemicals together Chemotherapy agents

Sometimes are expelled in urine and feces of pets Medications

Excess drug powder and residue can collect on the hands

Repeated ingestion may not be safe Washing hands is essential after handling medication

Radiation Must be taken seriously Excess can cause birth defects, sterility

and even cancer Must wear proper PPE OSHA states that employees must

provide and demonstrate proper use of PPE in veterinary clinics

Collimation also important when it comes to radiation as well

A dosimeter badge is worn on collar to measure radiation exposure

Allowed .05 Sv/year as occupationally exposed (5 rem/year)

Appropriate signs must be posted to indicate radiology sites

ANESTHETIC GASES Practices are expected to properly

store, label and use chemicals safely. Should help to keep employee

exposure under allowed limits. Should:

Have periodic monitoring of equipment and exposure levels.

Have proper ventilation.Have proper scavenging systems.Train staff appropriately.

MASKING AND TANK INDUCTION Make sure masks and tanks have tight-fitting seals and are connected to scavenging systems. Use proper fitting masks for patients Only use masking procedures when medically indicated Remember to turn on oxygen, place mask, then turn on gas, reverse order to remove mask.

SIMPLE ANESTHETIC EXPOSURE BADGES Used to help test

exposure to anesthetic gases.

Can be obtained from several labs.

Should be worn by a typical employee on typical workload day.

OSHA recommends testing every 6-12 months.

WASTE ANESTHETIC GAS SCAVENGERS Active Scavengers

Fan in a box that creates vacuum Cost from $400-$1000 Will need maintenance and replacement Manual activation, must be turned on

Passive Exhaust Channels gases through a tube from patients diaphragm Limited distance

Adsorption Charcoal absorption canisters Should be monitored and changed

BIOHAZARDS Sharps containers Biological bags

FORMALIN/FORMALDEHYDE Make sure properly identified and stored. Keep least amount on hand as possible. Wear Appropriate PPE.

ETHYLENE OXIDE Form of sterilization procedure. Not used as commonly today. MUST be used with a ventilation system. Link with cancer. Fines associated with trying to shortcut the process. OSHA requires monitoring to take place. Will use

bade devices to detect exposure levels. Detailed written plan also required. Make sure to follow manufacturer instructions. Make sure to follow proper storage and training

recommendations.

ETHYLENE OXIDE CONTINUED Emergency Plans

If exposed, adequate fresh air is the treatment of choice.

If irritation persists, consult physician. If in contact with liquid form, removal all

contaminated clothing and wash skin surfaces for 15 minutes.

If in contact with eyes, use eyewash for at least 15 minutes and consult an ophthalmologist.

CHEMICALS Five Specific requirements that

veterinary clinic must follow:1. Practice must have a written chemical

plan. 2. A complete list of all hazardous

chemicals must be maintained. 3. The practice must maintain a library of

material safety data sheets.4. All containers of hazardous chemicals

must be properly labeled. 5. The practice must train all staff

members on the dangers and safety aspects of the chemicals.

BULK CHEMICALS If more than 20

gallons, should consult with fire department about storage.

Should make sure areas with large amount of chemicals are properly identified.

Should have plans in place if emergency occurs for avoiding areas with bulk chemicals.

CHEMICAL SAFETY TRAINING Conduct training as soon after the person is

hired as possible. Prepare workbook or handout for training. Include worker’s rights. Provide hospital policy copies. Stress importance of PPE. All chemicals must be stored in tightly sealed

containers and be placed below eye level in case they are spilled.

If have to store on higher shelves, use step stool to retrieve.

DETERMINING CHEMICAL’S HAZARD Health Hazard: chemical for which there is evidence that

acute or chronic health effects may occur in exposed employees. Falls into following categories: Carcinogen Toxic Irritant Sensitizer Any agent which damages the lungs, skin, eyes or mucous

membranes. Physical Hazard: chemical that is:

Combustible liquid Compressed gas Explosive Flammable Organic peroxide Oxidizer Pyrophoric Unstable Water-reactive

HAZARDOUS CHEMICAL LABELS All chemicals should be properly labeled Should always label secondary containers No special labels are required, but should be uniform throughout practice. If can’t physically label, use a color code system. If is a prescription, no additional information is needed than is what is found on a customary prescription label.

DIAMOND LABELING SYSTEM National Fire Protection Association uses

colored diamond labels to indicate the risks associated with health, fire, reactivity, and special hazards of specific chemicals.

Diamond stickers are placed at entry point of the practice, along with the room the hazard is located in.

Good for any emergency personnel that may be responding to a situation.

Also should be placed on chemicals that are transferred from their original bottle.

EXEMPTIONS Hazardous waste- by EPA not OSHA Tobacco products Wood or wood products Articles (what is product of hazardous

materials) Food, drugs, cosmetics or alcoholic beverages

that are packaged to be sold to consumers and that are not opened in the hospital.

Foods, drugs, cosmetics intended for personal consumption by the employee while in the workplace.

Any common cleaner that is is used in way as is used by average consumer.

Any drug sold in final solid form to client for immediate consumption by patient.

WRITTEN CHEMICAL PLAN Should be reviewed and revised often. Should include hazardous material and what

PPE is recommended for use while using this chemical.

Should describe training offered to employees on a chemical.

Should outline MSDS system.

CHEMICAL SPILLS Spill kit should be developed and maintained

in a location that is easy to access. Should include

Cat litter Dustpan Broom Nitrate gloves Eye protection Copy of cleanup procedures

CHEMICAL SPILL CLEANUP PROCEDURES Remove all unnecessary people and pets from

area to prevent spreading and exposure to chemical.

Increase ventilation to area. Open windows and turn on exhaust fans and vents.

Put on protective gloves. Put on gown if needed. Cover spill with absorbable material, either cat

litter or paper towels. Clean up saturated absorbent material. Place chemicals in a trash bag and dispose of it

properly. Wash hands Replace materials used in spill kit.

MATERIAL SAFETY DATA SHEETS Produced by the

chemical manufacturer.

Should be kept together in one location.

Should be indexed in a systematic way.

Call distributor or manufacturer if need a MSDS.

Should be current within 3 years

CONTENTS OF MSDS SHEETS Each MSDS sheet should contain:

The identity of the chemical Physical and chemical characteristics Health hazards Permissible exposure limits Whether the product is a carcinogen Emergency first aid procedures Specific hazards

EYE WASH DEVICES Mounted and eyewash

bottles. Mounted stations should not

be on faucet used for bathing animals because of exposure to other chemicals.

Device should not be locked.

Hand held bottles are designed for foreign bodies and not chemicals.

Employees should be trained as to location and operation.

Flushing is recommended for 5- 10 minutes, refer to MSDS sheet.

FOOD AND BEVERAGES Consumption of food

and beverages must be limited to areas free of toxic and biologically harmful substances.

Staff lunches, drinks, condiments and snacks must be stored in an area free from biological or chemical hazards.

ELECTRICITY Outlets should not be

overloaded with excessive plugs and extension cords

Symptoms of electrical problems include frequent tripping of circuits and lights that dim when large pieces of equipment are used.

Extension cords should not be used on a permanent basis If used, use with a 3 way

conductor for better protection and should never be run through doorways or windows.

EXITS Should never be blocked Use caution where storing supplies Signs must indicate where the exit is located. If door looks like exit but is not must be

marked as “NOT an EXIT” Emergency lights are required and must be

tested on a yearly basis. Lights must be installed in locations that lead

to the exits

AUTOCLAVES Generate a high amount of heat and steam Should be properly ventilated before opening

door. Face and hands should be kept away from

both the vent and door when venting and opening the autoclave.

LARGE ANIMALS Never be in chute with

large animal Make sure stalls are

locked Make sure approach

slowly and use common sense.

BATHING, GROOMING AND INSECTICIDES Wear appropriate PPE. Make sure that wet

areas or dangerous areas are identified.

All chemicals should be stored and labeled properly.

Anything changed from one container to another should be properly labeled.

Compressed air cylindersShould be stored in a

dry, cool place, away from potential heat sources.

Must be secured in an upright position by holder, bracket, chain or strap.

Sign should identify where these cylinders are kept.

http://www.youtube.com/watch?v=ejEJGNLTo84

DRESS Must dress

appropriately for job. No open toed shoes Jewelry should be kept

to a minimum

NOISE HAZARDS Generally the

kennel area. If prolonged

exposure, may be harmful.

Should be identified by a sign and ear protection should be provided.

Sound Panels may be used to help reduce noise.

ERGONOMICS Repetitive movements. Have computers and office equipment

comfortable and able to prevent injury.

OSHA REQUIRED TRAINING TOPICS Animal handling Chemicals Ethylene oxide Emergency and fire prevention plan Formaldehyde Ionizing radiation Medical services and first aid Noise exposure Medical waste and sharps Personal safety, violence prevention Portable fire exit Personal Protective Equipment Signs and tags Worker’s Rights and Responsibilities

DEVELOPING SAFETY PROTOCOLS Should be developed in each practice to

ensure employee safety. Must be instituted regarding how employees

will be notified in case of emergency. Where to meet in case of emergency, and how safety plan will take effect.

Role playing may be needed

IMPLEMENTING SAFETY PLANS AND PROTOCOLS 4 steps:

1. Gather information Designate a safety officer Make sure all registrations are current

2. Delegation and Preparation Hazards can be placed in different sections

3. Training Training on the different sections

4. Implementation Following previous three sections

DEVELOPING A HOSPITAL SAFETY MANUAL Should include an overview of all materials

covered so far. Include hazards communication plan, MSDS

filing system, and explanation of secondary labeling system.

HAZARD COMMUNICATION: EMPLOYEES RIGHT TO KNOW

To establish compliance, a practice must have: A designated safety manager. This employee is

responsible for training all team members and ensuring the safety program meets standard requirements.

A written plan A summary of all hazardous chemicals available, including

injectable medications, pesticides, antiseptics. Disinfectants, and laboratory agents.

MSDS’s available at all times. If any chemicals are transmitted to another container, the new container must be accurately labeled with descriptions that are transferred to a spray a bottle to clean exam room tables.

An explanation of the labeling system. A protocol for emergency evacuation. A training program implementing the use of PPE and

monitoring devices as well as hazards of the practice. Required for all practices with 11 or more employees.

STAFF RESPONSIBILITIES Read the OSHA poster Comply with standards Follow rules and regulations Wear PPE while working Report hazardous conditions Report any job-related injury or illness to

employer and seek treatment Cooperate with OSHA compliance officers

EMPLOYER’S RESPONSIBILITIES Responsibilities

Provide a hazard free workplace Set and enforce safety rules Provide Personal Protective Equipment (PPE) with

proper instructions Provide training on any potential workplace

hazards

EMPLOYER’S RIGHTS Rights:

Enforce workplace rulesBe present during an inspection or

investigation.Require a warrant for inspection.Request postponement of inspection.Expect that no trade secrets will be divulgedConsult an attorneySee any complaintsHave employees interviewed at a time that

does not interfere with staff member’s jobRight to appeal findings

ACCIDENT REPORTING AND INVESTIGATION Every accident must be reported to the safety

manager and/or practice manager and owner. If medical treatment is needed, appropriate

paperwork should be available for employee to take to hospital or doctor.

Paperwork may include First Notice of Accident or Injury and Illness Accident Report as well as Workers’ Compensation Insurance Claim form.

Paperwork should be sent to appropriate authorities upon employee’s return.

Documentation of the safety program must exist.

FIRE PREVENTION Most common causes of fire are

overloaded electrical circuits and items stored too close to heat sources.

Practices with 10 or more employees must have a written OSHA plan that includes fire prevention and response.

Fire codes vary by location and inspection is conducted by the fire department.

Before using fire extinguisher, make sure alarm has sounded.

FIRE EXTINGUISHERS Must be located no more than 75 feet from any

distance within the clinic and placed 32 to48 inches above the ground surface.

Should be placed near the exit doors of the practice. All employees must be trained in the use of the fire

extinguisher PASS

P= pull the pin A= Aim low. Point the extinguisher to the bottom of the

fire S= Squeeze the handle S= Sweep from side to side at the base of the fire until it

appears to be out.

FIRE EXTINGUISHERS CONTINUEDMade of carbon dioxide, dry chemicals, halon or water. Carbon dioxide is most effective on class B and C fires

(liquid and electrical) but is only effective for 3 to 8 feet because carbon dioxide disperses quickly.

Dry chemical fire extinguishers are used for a variety of fires and contain and extinguishing agent and compressed gas a propellant.

Halon extinguishers contain a gas that interrupts the chemical reaction taking place when fuel burns

Water extinguishers are used for combustible (Class A) fires only,

SMOKE DETECTORS/ FIRE SPRINKLERS Batteries in smoke detectors should be

replaced on a yearly basis. Monthly testing is recommended. New buildings are required to have sprinklers

and should be evaluated to ensure they are working order.

ESCAPING ANIMALS Windows should never be left open. Doors should never be left open. Should use slip leash when removing dogs

from kennels (double leash in opposite directions is ideal).

Feral animals should be handled with caution.

VETERINARY PRACTICE AND THE LAW Clients that are injured on the premises may

be tempted to sue. Prevention is the key. Team members must report any injury and

be aware of all potential hazards in the clinic.

OSHA INSPECTIONS Know who is allowed to admit inspectors. On-site inspection must be triggered by at

least one of the following: Written complaint and OSHA must believe that a

safety or health danger exists. Complaint must allege that physical harm has

occurred and that hazards still exists. Must allege imminent danger Employer failed to provide adequate response to a

compliant Business has history of failure-to-abate citations

during last 3 years. Discrimination issues for filing complaints about

OSHA standards

HOW TO SURVIVE INSPECTIONBe polite and cooperativeVerify credentialsRequest that inspection take place at a

more convenient timeMake time for inspectionTake notes and pay attention during

inspectionHave employees “stand-by” during

inspectionShow officer only what he or she asks to

seeHave copies of hospital policies readily

availableCorrect any violations immediately

WHAT SHOULD YOU DO? Mr. Yazzi, a long term client, has come

into your practice with Taco, his Pomeranian. Upon walking to the counter to check out, Mr. Yazzi trips on the scale, which was recently moved into the hallway between the exam rooms. He is able to catch himself but twists his back, sending it into muscle spasms. He states he is fine and it was his fault for not looking down. You offer him a chair to sit down and rest and let his back relax but he refuses and pays his bill and leaves practice.

What should you do?