INTRODUCTION MITIGATION

Transcription

1 SOUTHEASTERNHEALTH

2 INTRODUCTION The protection of our patients, visitors and staff from fire is entrusted to each one of us. Therefore, our goal is TOTAL fire prevention! However, fires do happen. Each employee/volunteer is required to be familiar with the overall fire plan that includes knowing how to RACE for fire safety and PASS, when using a fire extinguisher. It is especially critical for each employee/volunteer knows their role in their department or unitspecific fire plan. After reviewing this plan, please refer any questions to your department supervisor or any member of the Environment of Care Key Function Team (safety committee). We have a specific Policy for EOC in the Volunteer Services Department. MITIGATION Some of the ways SRMC uses to mitigate fire hazards include: planning, preparation, engineering and training. Planning includes: pre-building assessments (AIA Guidelines, DFS Regulations, site visits, etc.); building to codes (International Building Code, National Electric Code, NFPA, etc.); review by Local Authority Having Jurisdiction (AHJ); outside consultants and insurance carrier recommendations. Preparation to reduce fire damage or fire and smoke spread, starts with a properly trained staff, who are taught how to stop an incipient fire. Buildings are prepared by installation of mechanical aids to help stop fire and smoke from spreading by using rated fire and smoke doors and dampers, sprinkler systems in newly constructed facilities and storage areas and electronic aids, such as heat and smoke sensors.

3 PREPARATION AND RESPONSE PLAN ahead! Know your duty in case of fire 1. R Rescue patients/anyone in immediate danger 2. A Activate fire alarm and call Inside hospital 7311 or Outside hospital C Close all doors and windows. Clear ALL items from hallways. 4. E Evacuate (leave area) or if the fire is very small and your safety can be assured, use portable extinguishers. Using a Portable Extinguisher (ONLY if safety permits) P pull the safety pin out of the extinguisher A aim at the base of the fire S squeeze the handles together S sweep from side to side ~~~ PLAN ahead! Know where to find the specific safety devices in your area: 1. Telephone 2. Fire alarm pull station/activation switch 3. Exits 4. Fire extinguishers ~~~ PLAN ahead! Practice fire prevention habits 1. DO NOT block exits with any type of rolling stock, chairs, boxes, etc. 2. DO NOT block fire hose and fire extinguisher (glass) cabinets. 3. DO practice good housekeeping trash cans with lids must be covered and not overloaded, store combustibles properly, flammable liquids must be in approved containers. 4. DO observe SRMC s NO Smoking policy and help others do the same. ~~~ PLAN ahead! If automatic devices fail, you must act to: 1. Insure fire doors close and clear everything from hallways, when the alarm is sounding. 2. Call 7311 even if you have pulled the alarm (911) for outside SRMC. 3. Close all doors and windows. 4. STOP anyone, except emergency responders from using elevators.

4 WHEN A FIRE ALARM SOUNDS A. Fire alarms may be sounded in two ways: 1. Automatic system or audible alarm (if available in the building you are located). The words Code Red and a location within the building will be announced. (The phrase Code Red is used rather than the work fire to prevent panic among our patients and visitors. 2. Manual systems person to person or local alarms and overhead announcement. B. When the alarm is sounded Code Red on paging system or by flashing lights in hallways, your action depends on your location. If the alarm has been sounded for your specific area, you should: 1. Rescue any endangered persons 2. Close all doors and windows. Clear all items from the hallway. 3. If unknown, determine the location of the fire. 4. Use available fire extinguishing aides to control an incipient fire until help arrives. 5. If staff cannot extinguish an incipient fire, begin an orderly evacuation to the department s designated safety zone. Department safety zones are listed in department specific plans. Or if the above items are being handled, you should: 1. Close all doors and clear all halls. 2. Advise visitors to either stay in the room with the patient or leave the floor by stairs. 3. Account for all patients and advise those on the floor to stay in their room. 4. Stand by the nurse s station or in your department for further instructions. C. If the alarm is sounded for an area away from your location, you should: 1. Close all doors and windows. Clear all items from the hallway. 2. Account for all patients and advise those on the floor to stay in their rooms. 3. Advise visitors to stay with their patients. 4. Continue normal duties unless conditions change or you are instructed otherwise. D. If personal safety allows, do the following: 1. Remove flammable items from areas adjacent to fire, if possible. 2. Alert fire brigade and fire department personnel of fire and if any hazards are present. 3. Account for all personnel and visitors who were present at the time of the fire. 4. When the fire is over, assist as directed in salvage and recovery operations. E. Vertical Movement (Up/Down) If you are away from your assigned area, use the stairs for vertical movement. The elevators should be used only at the direction of the fire department. Revised: 1/96, 12/96, 12/02, 4/03, 7/07 Reviewed: 2/92, 8/83, 1/94, 1/95, 9.00, 2/01, 4/02, 4/03, 2/04, 7/07, 10/09, 1/12, 11/12, 12/12, 1/14

5 EVACUATION GENERAL GUIDELINES Evacuation shall be done only on an as needed basis. The determination of need shall be made by the senior person on the fire scene or by the local authority having jurisdiction (most responsible trained person present). Determination of degree of evacuation shall be made in stages, each stage being dictated by the severity of the fire and/or by the order of the Administrative staff or fire officials. Physical movement of patients may be horizontal (side to side) or vertical (upward or downward) depending on the circumstances. Selection of an appropriate exit shall be made at the time of evacuation as dictated by the situation (fire or smoke). Horizontal evacuation (side to side) to a safe area is preferred. If horizontal evacuation is required, move through two sets of hall/corridor doors. In SRMC s old main building, horizontal evacuation is towards the center or opposite wing. For example: staff and patients on the OB floor (old west wing), will evacuate towards Heart Center Administration. In the tower, horizontal evacuation is to the opposite wing. For example: North goes to South and South goes to North). Vertical evacuation (SRMC main campus only) downward evacuation should be to an area where the patients can be accommodated. Upward evacuation shall be avoided. Evacu-chairs are strategically placed inside the stairwell landings on 3North, 4South, 5North and 6South in the tower, but may be used wherever there is a need. Preparation for patient evacuation 1. One person shall be sent ahead of evacuees to determine if the way is clear. 2. Patient charts shall accompany each patient as they are evacuated. 3. As each room is emptied, a pillow will be placed against the closed door to signify the evacuation has been accomplished. 4. After evacuation, make sure the total number of patients evacuated, equals the floor census.

6 Two Types of Evacuation Partial Evacuation for the main hospital, Hospice House and Woodhaven, partial evacuation is part of defending in place. Only the specific area affected by the fire is evacuated. Evacuees are moved through two sets of hall/corridor doors (horizontal) or down (vertical) two floors. There is no partial evacuation plan for facilities other than the main hospital, Hospice House and Woodhaven. All freestanding facilities will proceed with a total evacuation. Total Evacuation for all facilities other than the main hospital, Hospice House or Woodhaven, a total evacuation of the facility shall be completed in the event of a fire drill or actual event. ORDER OF EVACUATION First Ambulatory patients send one hospital employee with each group of patients, (not more than 6 per employee) with instructions to stay with group until they are returned to a patient room or otherwise processed. The designated employee shall take the individual patient chart(s) to the new location. Second wheelchair patients patients who can sit in wheelchairs may be moved to a safe area in a wheelchair. One hospital employee should transport/accompany each wheelchair patient. The employee who is transporting/accompanying the patient will take the individual patient chart to the new location. When in a safe place, the employee who arrived with a wheelchair patient shall remove the patient from the wheelchair and stay to aware arrival of other patients. Other employees bringing wheelchair patients should remove the patient from the wheelchair and return the wheelchairs to the area being evacuated. A maximum of 6 patients should be left with the first employee and then an additional employee should remain with each group of patients thereafter. Third bedridden or orthopedic patients - will have to be moved from their beds. Beds shall not be used to evacuate patients since they block halls and hinder both rescue and fire fighting capabilities. Stretchers and evacu-chairs shall be used in place of beds. Waiting areas, lounges and any other available safe space may be used to temporarily shelter evacuated patients. SOUTHEASTERNHEALTH PERSONNEL Follow the department specific guidelines. The senior person on duty in each department shall account for all on-duty personnel.

7 INCIDENT COMMAND In the event of a fire, SoutheasternHealth personnel will follow the Unified Command Structure HEICS. For events at free standing centers, the senior person present will assume the duties of the incident commander until relieved by a more responsible individual from either SRMC or the local Authority Having Jurisdiction (fire service or law enforcement). INCIDENT COMMANDER CHIEF EXECUTIVE OFFICER OR DESIGNEE 1. Assume control of Code Red Center at switchboard, implement HEICS as needed. 2. Obtain the fire control radio transceiver and communicate with SRMC s first responders on Channel Deploy personnel as needed within the HEICS framework. 4. Open the Incident Command Center, if needed. ALL VICE PRESIDENTS AND ADMINISTRATIVE ASSISTANTS 1. Stay in own department and await further instructions from Incident Command. 2. Assist Incident Commander, as directed. 3. In the CEO s absence, assume the role of incident commander. (for fire events at free standing centers, follow department specific guidelines). ORGANIZATIONAL MANAGERS (INPATIENT SERVICES) 1. When SoutheasternHealth s Fire Marshall and/or Engineering and Facility Management personnel are on duty, report to the scene of fire to direct nursing personnel. 2. When SoutheasternHealth s Fire Marshal and/or Engineering and Facility Management personnel are not on duty, assume the duties of this position until relieved. 3. Account for all staff (collect ID tags from SoutheasternHealth s first responders) and patients at fire scene. 4. Cooperate with fire fighters, as needed. (for fire events at free standing centers, follow department specific guidelines) MANAGERS AND DIRECTORS Remain in your department to monitor your staff s response. If needed elsewhere, someone will contact you from the command center (for fire events at free standing centers, follow department specific guidelines). ENGINEERING DEPARTMENT 1. Report to scene of fire and leave your name tag with the senior person on scene. 2. Report to nursing station in affected area. 3. Determine if all air handling systems should be turned off or converted to handle smoke. 4. At SoutheasternHealth s main campus, set up elevators for fire service as directed by Incident Command or Lumberton Fire Department. (for fire events at free standing centers, follow department specific guidelines

8 ENVIRONMENTAL SERVICES 1. Supervisory personnel shall report to scene of fire and leave your name tag with the senior person on scene. 2. Housekeepers in the affected building will respond to the scene of the fire, leave your name tag with the senior person on the scene and await instructions. 3. All other personnel should remain in their regularly assigned area and assist in clearing halls and closing doors and windows. 4. Do not alarm patients, if asked about what is happening. Simple state: We continually train to respond to all kinds of alarms. (for fire events at free standing centers, follow department specific guidelines) ADMINISTRATIVE ASSISTANTS 1. Stay in own department and await further instructions from Incident Command. FIRE MARSHALL (Safety Director) 1. Responsible for the fire safety program. 2. Report to the scene of all fire emergencies, when notified. 3. Responsible for identifying on-scene responders, (name tags collected and returned after the incident) 4. Assume responsibility for containing the fire until relieved by Fire Department personnel. 5. Assume authority for ordering evacuation. 6. Keep Incident Command informed of the fire situation (use radio channel 2) 7. Investigate and submit a written report for each fire event. 8. Cooperate with Engineering and Facility Management to assure the readiness of firefighting equipment in SRMC facilities. NURSE IN CHARGE OF UNIT 1. Reassure your patients. 2. Close all doors, windows and clear halls. 3. Be prepared to evacuate patients, as needed. 4. If oxygen must be turned off, be ready to move patients requiring O2 into the closest section of the building where oxygen is available. Portable oxygen is safe to use during evacuation. (for fire events at free standing centers, follow department specific guidelines) COMMUNICATIONS 1. Follow established department protocol.

9 RESPONDING TO A FLOW SWITCH ALARM Wherever flow-switch alarms are installed, they are connected to the automatic alarm system. When activated, first responders (Engineering, Safety and Security) shall proceed to the location as indicated by the alarm system description. IF YOU ARE TRAPPED 1. Close all doors to the corridor. 2. Plug any leaks with wet blankets or other water soaked material(s). 3. Open an outside window (break window, if necessary) (if on ground level and safety permits, escape through a window) 4. If escape through a window is not possible, hang a sheet, blanket or towel out of the window to attract attention. The majority of fire fatalities are caused by asphyxiation and smoke inhalation. Normally, the safest air to breathe is closest to the floor. ALL CLEAR SIGNAL In facilities with overhead announcement capabilities, an all-clear signal will be sounded over the public address system when the danger of fire has been eliminated. At facilities without public address systems, do not enter the building until given the OK by the local Authority Having Jurisdiction (fire department, law enforcement and/or responsible SRMC personnel). EXAMPLE: The building emergency code has been cleared, you may return to your normal activity. OR Code Red All Clear, Code Red All Clear, Code Red All Clear when you hear this announcement, you may return to your normal activities. RECOVERY Due to the uniqueness of each potential event, SoutheasternHealth uses HEICS to identify the appropriate individuals responsible for re-establishing normal operations. The ultimate responsibility for establishing and maintain daily operations lies with SoutheasternHealth s President/CEO or designee.

10 FIRE DRILLS All SoutheasternHealth s personnel must be aware of their duties and responsibilities in case of fire. Initiating a correct response to fire events must be second nature. To ensure our personnel can respond as expected, SoutheasternHealth conducts periodic fire drills at all facilities. Drills are conducted at least once a shift per calendar quarter in healthcare occupancies (SoutheasternHealth, Woodhaven and Hospice) and at least once per year in business occupancies. The Safety Manager is responsible for conducting drills. A written critique of each drill is performed to evaluate SoutheasternHealth s response and to look for opportunities for improvement. The results of the drill are reported to Environment of Care Key Function Team. Individual units or departments are expected to perform monthly fire safety in-services building alarms will not be activated for unit base drills. A report of these drills shall be submitted to Environmental Services. A facility drill conducted by the Safety Office may be initiated by a general alarm, stating a fire scenario or by the use of a flashing red light and a display reading Fire Drill. Personnel will be evaluated on their response to the situation and their ability to walk through the fire emergency process using RACE and PASS. If coaching is required, the drill rating is considered not adequate. If any coaching or coaxing is needed by an employee when responding to an actual event or a drill, their performance is not meeting expectations and remedial education and training are required. Remedial education may be applicable to the individual, the department and/or both.

11 FIRE EXTINGUISHING AIDS 1. ABC (Halon, dry chemical or equivalent) extinguishers are located throughout the hospital. ABC extinguishers are also called universal extinguishers because they may be used on any common small fire. 2. Carbon Dioxide (CO2) extinguishers are located in the Operating Room, Delivery Suites, Laboratory and other areas that may have electrical fires or liquid fires. 3. Halon extinguishers (ABC) are located throughout the hospital around sensitive electronic equipment. Halon is a colorless, odorless, electrically non-conductive gas. This extinguisher is used to protect valuable or irreplaceable materials and equipment, that maight be damaged or destroyed by conventional extinguishing methods. The halon system works by inhibiting the chemical reaction of fuels and oxygen. It is a clean agen and leaves no residue to damage equipment or to be cleaned up. 4. K extinguishers are located in the kitchen areas within the hospital (Food Services), Woodhaven and Hospice House. The extinguishers are used for fires involving combustible cooking media, such as vegetable or animal oils and fats. 5. Pressurized water extinguishers are located in the Psychiatric Unit, Recovery Room, Intensive/Intermediate Care Units and the Security office. These extinguishers are used for wood, textiles and paper or rubbish fires. DO NOT USE ON ELECTRICAL OR LIQUID FIRES. 6. Special non-magnetic, non-conductive water extinguishers are available in the MRI suites.

12 SECURITY IDENTIFICATION CARDS all people who have a working relationship within SoutheasternHealth are required to display appropriate identification while on duty. Employees are issued picture ID badges. Volunteers, chaplains and others, such as contractors, will be issued ID badges with a color designation for their category of service. Human Resources personnel issue the badges. A fee is charged as a deposit until the badges are returned at the end of employment. (Do not charge volunteers) A replacement fee is charged for lost, stolen or unusable badges. (Do not charge volunteers). For personnel who work for the Corporation, but are not hospital employees, the badges are issued the same as for hospital employees. Follow hospital rules for display of the badges. If your official duty brings you to the hospital, display your ID as required of other hospital employees. The proper wearing of the badge where required is must be worn mid-chest or above with name and picture visible at all times while on duty as outlined in the SoutheasternHealth Personnel Policy Manual. SECURITY SERVICES Main campus (SoutheasternHealth) Security provides around the clock security service. The inside officers provide roving patrol of departments and nursing units 365

13 days a year. Special emphasis is placed on the Emergency Department area and to service calls. The inside officer may be reached by pager using the internal phone by dialing , listen to the operator ask you the phone extension number where you are calling from, enter that number on the keypad, so Security will be able to call you back. SoutheasternHealth has security service in the parking deck, as needed. The officers assigned to the outside or bicycle duty patrol SoutheasternHealth and the surrounding area including all SoutheasternHealth and affiliated parking lots, the grounds and parking decks and associated properties within the city limits of Lumberton NC. Mobile Unit SoutheasternHealth provides a Security vehicle 24 hours a day. The mobile unit provides off campus patrol for the area immediately adjacent to SoutheasternHealth (about a one block area) and to our off campus facilities. The patrolling of off-site facilities is done randomly and is more frequent at night. The motor office provides Security for scheduled department needs and is available for emergency services, such as blood bank transport(s). Security service to off campus facilities is limited to Lumberton NC. The service provided to off-site facilities usually consists of security survey or education on request, transport or escort as needed, alarm response and random patrolling. If you need to discuss safety or security issues, feel free to contact any security officer. Their phone number is X If your need is urgent, use the paging system by dialing , listen for the tone and speak your message. Security may also be contacted by dialing 0 from any inside phone. The operators can contact Security for you too. Please remember your response from security may be delayed by going through the Communications Center, since they may be handling a large volume of calls. SoutheasternHealth will send Security to any of our Lumberton locations to provide escort service AS NEEDED and requested. Please use the paging service as described above. Please allow 5 15 minutes for the officer to arrive or respond by phone. If there is no response after 15 minutes, repeat the page or contact the hospital operator. Please do not jeopardize your safety by a lack of patience. Security responds to calls on a priority basis and may be busy when you call. In emergencies when life or property is at risk, dial The Communications Center will answer your call and dispatch Emergency Medical, Fire or Police assistance, as needed. LOST and FOUND is operated by Patient Care Services. Call the in-house supervisor (Organizational Manager) or drop off items at their office near the Customer Relations office on the Human Resources hallway. EMERGENCY MEDICAL SERVICES are accessed by off campus facilities by dialing from a hospital extension or by dialing 911 from a direct line. The hospital

14 provides an Employee Health Nurse at extension 5162, for on-the-job accidents and illnesses of a non life threatening nature. After normal business hours, weekends and holidays, please report injuries and illnesses to the in-house supervisor. Employees of Home Health/Hospice have their own EHN. The hospital Emergency Services Department is accessed via 29 th Street. SAFETY, SECURITY and ENVIRONMENTAL SERVICES The Safety Manager is the safety officer for the corporation. Our safety and security professionals are concerned with your workplace health and safety. If you have special training needs in safety or security or wish to report safety or security hazards, please call extension SAFETY/SECURITY OFFICER Jerry Ratajczak at INFECTION CONTROL PERSPECTIVE All hospital professionals and employees/volunteers shall become involved in achieving the goal of a clean and microbiologically safe hospital, focusing on the individual roles of the various hospital departments. THE OBJECTIVE OF THE INFECTION CONTROL PROGRAM will be to minimize the probability of transmissions of infections employing 4 principles: 1. keeping harmful microorganisms (germs) out of critical areas. 2. killing the ones that get in anyway.

15 3. preventing the multiplication of those that get in and are not killed. 4. controlling the vehicles and the vectors of transmission. SOUTHEASTERNHEALTH INFECTION CONTROL Definition of Nosocomial Infection The nosocomial or hospital associated infection is an infection that appears to have developed during the hospitalization stay OR is not known to have been incubating at the time of admission. An infection present on admission can be classified as nosocomial, but only if it is directly related to OR is the residual of a previous admission. The definition of nosocomial infection is quite broad, since its determination is essentially a matter of symptoms supported by clinical judgment and many of the infections are borderline. Nosocomial infections include potentially preventable infections as well as some infections that may be regarded as inevitable. ALL physicians are requested to report to the Infection Committee any patients that return to their office with a nosocomial infection. WHY DO INFECTIONS OCCUR IN HOSPITALS? Many people are sick and treated in close quarters. Many microorganisms that can cause harm are present

16 1. bacteria 2. fungi 3. viruses 4. parasites Frequent contacts are made between people who have or can spread illness and people who are weak and vulnerable to infections. Large amounts of contaminated waste, equipment and supplies must be handled and processed. Some procedures that save lives may increase the risk of infection. Who can get infections? Catheterization inserting a tube into the body to drain or deliver fluids, opens a pathway through which bacteria can enter. Inhalation Therapy uses moisture which may encourage the growth of harmful bacteria. Antibiotics have (sometimes) caused the development of drug resistant bacteria which are harder to destroy. Surgery requires cutting the skin one of the body s most important defenses against infection. ANYONE!!! However, some groups are especially vulnerable Certain patients have low resistance: 1. newborns, especially premature babies 2. very elderly 3. surgical patients 4. seriously ill patients (those with burns, in ICU/IMU, etc.) 5. patients in poor physical or nutritional health 6. patients hospitalized for long periods 7. people receiving certain kinds of drugs (antibiotics, immune-suppressive) Certain hospital personnel are routinely exposed to infection 1. nurses and nursing personnel who have direct contact with many patients. 2. workers in the Laundry, Housekeeping and Central Supply, who handle germ-laden linens, wastes and surgical supplies. 3. laboratory workers who handle infectious specimens, blood, etc.

17 How are infections spread? The development of any infectious disease is dependent of a sequence of factors often referred to as a cycle. Breaking this cycle is vital in the prevention and control of infection. The factors involved in the infectious process are as follows: 1. the microbial or infectious agent that lives and multiplies 2. the source or reservoir in which it develops 3. its escape through the portal of exit 4. its transmission by various modes 5. its entry into the new source through the appropriate portal of entry 6. its maturation and multiplication in the new source INFECTION CONTROL HANDWASHING IS THE SINGLE MOST IMPORTANT MEANS OF PREVENTING THE SPREAD OF INFECTION IN THE HOSPITAL

18 SOUTHEASTERNHEALTH TUBERCULOSIS CONTROL PLAN Since 1985, the Centers for Disease Control and Prevention (CDC) have reported a resurgence of mycobacterium tuberculosis (TB). Homeless shelters, substance abuse centers, hospitals and correctional facilities have been hit hardest. TB is transmitted through the air and spreads easily in these overcrowded, sometimes poorly ventilated places. Outbreaks of TB have become a serious concern. Although TB has been cured with anti-tubercular drugs for years now, new strains of drugresistant TB are appearing. These TB strains do not respond to certain medications. One strain multi-drug resistant TB (MDR-TB) responds to few or none. The transmission of tuberculosis is a recognized risk in health care settings. The CDC has issued guidelines to protect health care workers from the threat of TB and its drug-resistant strains. These guidelines are designed to protect you, if you have prolonged contact with active TB patients. Following these measures will greatly reduce your risk of on-the-job exposure to TB. TUBERCULOSIS Mycobacterium tuberculosis spreads through the air in droplets generated when a person with active TB coughs, sneezes or speaks. These droplet nuclei are so small, regular air currents within a building keep them airborne for hours. You can become infected with TB if you inhale droplet nuclei. When inhaled, the bacteria may establish itself in your lungs and can spread through your body. One of the simplest

19 ways to control the spread of droplets is for patients and staff to cover all coughs and sneezes with a tissue. Most people s immune system will fight off TB after initial exposure. These two factors increase a person s chances of contracting TB: 1. Immunosuppression 2. Frequent exposure to active TB As a caregiver, you are at risk, because you may be exposed to TB. TB Infection vs. Active TB Tuberculosis infection is not the same as active TB. Of those infected with TB, ten percent will progress into a contagious case of active TB. If you are infected, but have not progressed on to active TB You will have no symptoms You will not be contagious You will not know you are infected, unless you have a positive Mantoux skin test It may take months or years before you progress into active TB If you progress into active pulmonary or laryngeal TB:

20 Your symptoms will be prolonged coughing for 3 weeks or more, fatigue, fever, weight loss and night sweats. You will be contagious You will need to take medication High Risk Groups You should know which patients may be potential TB carriers in order to take precautionary measures. The groups with highest incidence of TB are: HIV positive patients Other immunosuppressed patients like chemotherapy patients and patients with diabetes, silicosis and malnutrition. Economically and socially depressed people like the homeless, alcoholics, drug users and current or past prisoners. Foreign-born people from regions where TB is widespread. DRUG-RESISTANT TB Drug-resistant tuberculosis does not respond to the usually anti-tubercular drug therapies. MDR-TB develops when people stop taking their medication before the treatment is completed. Some reasons for this may include the following: The medication schedule is very strict, consisting of meticulous pill taking for a minimum of six months. The medications clear up all outward symptoms of TB after just a few weeks. Poor access to health care. This partial treatment is worse than none. Bacteria that is still active can become immune or resistant to these anti-tubercular drugs. People who cultivate these drug-resistant strains are as contagious to others as are people with regular TB. It is estimated that 25 percent of new TB cases are resistant to at least one standard anti-tubercular drug. At least 10 percent of new TB cases are multi-drug resistant. The more drugs a person is resistant to, the harder it is to find a medication or combination of medications that will work to cure TB.

21 RESPIRATORY PROTECTION Regardless of how good ventilation is in your workplace, you need extra protection when you share immediate breathing space with TB patients. Wearing a respirator will maximize your protection. 1. Disposable High Efficiency Particulate Air (HEPA) Respirators It is recommended that disposable HEPA s be used. HEPA S offer significantly more protection than standard surgical masks. If worn properly, HEPA s are designed to filter out 1 to 5 micron-sized TB droplets. 2. When you should wear a respirator You are advised to wear a respirator in active TB patient isolation rooms, during procedures that generate airborne secretions, when caring for undiagnosed patients suspected of having active TB and during vehicle transport of contagious TB patients. NOTE: Patients should wear a surgical mask during transport. 3. Respirator use Respirators are only effective, if the seal around your nose and mouth is tight. Glasses, facial hair and even missing dentures will create gaps in the seal that will let in harmful air. For your protection, your employee is required to provide you with training on how to properly fit, use and maintain your respirator.

22 KEYS TO INFECTION CONTROL PERSONAL TIPS to keep you from transmitting germs and to protect you from receiving them. 1. Get immunizations that are required or recommended. The specific kind will depend on your job, age, sex and health history. Ask the Employee Health Nurse. Examples: Hepatitis B, Tetanus and Flu. 2. Have periodic tests as required for tuberculosis, hepatitis and other infections you might pick up and pass on. 3. Report any illness such as a cold, flu or infected cut to your supervisor. What is minor to you, could be serious or fatal for a patient. Do not report to work, if you are sick! 4. Maintain good health with a balanced diet, regular exercise and enough sleep. You will be less likely to get infections and transmit them to others. 5. Follow good health habits and personal hygiene bathe or shower every day, keep your hair clean, cover or wear a restraint for long hair while at work, keep nails trimmed and clean, wear a clean uniform/smock every day to work/volunteer and leave your jewelry at home.

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24 SOUTHEASTERNHEALTH s disaster response is divided into 3 phases: Please look in the red safety manual and see what your duties are for your position. This manual is located in the Patient Representative Office, across from the volunteer and patient placement offices. CODE TRIAGE PHASES Code Triage Stand-by Phase I this is a limited response to increased patient load in the Emergency Services Department that can be managed by on-duty and on-call personnel. Code Triage Stand-by Phase II This response extends the personnel recalls to include selected individuals with skills required either because of large numbers of patients or special types of casualties.

25 Code Triage is the all-out hospital response due to major disasters with sudden influx of large numbers of patients with total mobilization with all hospital personnel and logistical support. General Guidelines Phase I prepare for incoming patients. Make sure staffing is adequate. Insure adequate supplies are on the patient care units and in your department to take care of the patients needs. The Emergency Department may request assistance transporting patients to floors. Contact your supervisor to see what help may be needed. Phase II Continue Phase I duties. Certain individuals may be called in for additional assistance. Phase III An all-out hospital response requiring many staff to come in and assist additional patient holding areas may be set up. Staff from units may have to assist with patient care in holding areas. Nursing staff designated to respond, should go to the morgue viewing area in the Emergency Department with a wheelchair, stretcher, IV Pole, BP cuff and stethoscope for an assignment. Hospital Codes There are several codes that you may hear called within our facility. It is essential for volunteers to also be aware of these codes and know your function and responsibility when each one is called. Some you may hear more than others. Code Blue means Life or Death - stay out of the Code Blue team s way. Code Red means Fire stay in your work area, close all doors and windows, do not use elevators, use the stairs, do not go to another floor, do not open fire doors. Code Pink means Infant Abduction keep your eyes on all exits in your area, report any suspicious behavior to security immediately, do not attempt to approach a suspicious person.

26 Code Triage means External Disaster you will be called in to set up comfort stations, answer phone calls, take messages or any other assistance needed. Report to volunteer office, if called in. Code Grey means Combative Person may be unruly or agitated. Do not get involved. Trained staff will be dispatched to deal with this situation. FLOODS May occur in almost any area and may happen slowly or suddenly. If the water rises slowly, there is usually time to evacuate patients/staff to higher ground. What to do Obtain flashlights for use in event of electrical power outage Fill bathtubs and other containers with water for non-drinking purposes Collect and fill large, clean containers with drinking water as the water supply may become contaminated HURRICANES Hurricanes are wind and rain storms usually occurring between June and November and are most common in the southern and eastern parts of the country. The strong winds can cause major damage. If there is enough warning, maintenance may cover the windows with boards. Staff should put away or secure outdoor furniture or objects. EARTHQUAKES Most earthquakes occur beneath the ocean. They mostly occur in the western part of the country, but can occur almost anywhere. Earthquakes come without warning and range from slight tremors to major quakes. If one does occur, be prepared for aftershocks, which can also cause severe damage. What to do Move as many patients/staff as possible to areas that have additional structural strength Watch for and report signs of fire due to broken gas and electrical lines. Report any broken gas, electric or water lines Obtain flashlights/batteries

27 Fill clean containers with water for drinking purposes as water lines may become contaminated. Fill bathtubs and other containers with water for non-drinking purposes. OTHER SAFETY MEASURES Use the tube system properly to prevent it from failing. You should not: Overload the carrier Remove the carrier from the sending mechanism once you have pushed the send button Send the carrier unless it is properly latched Put your arm up into the tube system If you have a gas or vacuum monitor in your area and an alarm sounds, you should call 7777 to report it. (call nursing supervisor, if after hours). If you have medical gas shut off valves in your department, only designated staff (respiratory therapist) may turn them off. Never pour hazardous wastes down the drain. If you are not sure if something should be poured down the drain, ask your supervisor or call If you are experiencing low water pressure in your department, call SRMC has boilers to produce steam. The steam is used to sterilize equipment, cook food and produce heat for the building. If you see a steam leak, stay away from it to prevent getting burned and call If you have problems with any utilities, contact the work request center at X If you have problems with computers or printers, call Help Desk at X 5006; telephone problems, call Communications at X 5099.

28 Side Rails Safety sides are used on both hospital beds and stretchers. They are of various shapes and sizes and are usually made of metal. Intravenous Rods these can be poles or stands) usually made of metal, support intravenous (IV) infusion containers, while fluid is being administered to a client. Some hospital units have overhead hanging rods on a track for IV s.

29 MAKING BEDS Preparing hospital beds in different ways for specific purposes. PRACTICE GUIDELINES FOR BED-MAKING Wash hands thoroughly after handling a patient s bed linens Linens and equipment that have been soiled with secretions and excretions harbor microorganisms that can be transmitted to others directly or by the nurse s hands or uniform Hold soiled linen away from uniform Linens for one patient is NEVER placed on another patient s bed Place soiled linens directly in a portable linen hamper or tucked into a pillow case at the end of the bed before it is gathered up for disposal Do not shake soiled linen in the air because shaking could disseminate secretions and excretions and the microorganisms they contain When stripping and making a bed, conserve time and energy by stripping and making up one side as much as possible before working on the other side To avoid unnecessary trips to the linen supply area, gather all linens before starting to strip a bed

30 THE IMPORTANCE OF A WELL MADE BED Patients spend a lot of time in bed. Some are out of bed part of the day and some must be in bed all the time. Meals are eaten in bed and some patients are bathed in bed. Some cannot get out of bed to use the bathroom. Many procedures are done with the patient in bed. Bed making is an important part of your job. A clean, neat bed helps make your patient more comfortable. Think of how nice it is to get into a freshly made bed at home. How does it feel getting into an unmade bed that does not have the sheets and blankets tucked in? Linens are straightened, if they become loose and wrinkled during the day. Check linens to make sure everything is as it should be. Be sure and change linens, if they become wet, soiled or damp, at any time. LINENS Special attention is given to the care and use of linens. The rules of medical asepsis are followed when handling linens and making beds. Your uniform is considered dirty, so you must always hold linens away from your body and uniform. NEVER shake linens in the air. Clean linens are placed on a clean surface always. NEVER put dirty linens on the floor. Clean linens are collected in the order they will be used. Bring only what you need. Do not bring unneeded/extra linens to a patient s room. It is considered contaminated and cannot be used for another patient. Linen order: 1. Bottom sheet (fitted or contour sheet) 2. Cotton draw sheet 3. Linen savers (optional-used if incontinent/risk of soiling bed) 4. Top sheet (flat sheet) 5. Blanket 6. Bedspread 7. Pillowcase 8. Bath towel 9. Hand towel 10. Washcloth Use one arm to hold the linens and the other hand to pick them up. The item to be used first is at the bottom of your stack. (bottom sheet first)

31 Removing dirty linen roll the linens away from you. The side that touched the person is inside the roll. The side that has not touched the person is outside. When a person is discharged, remove all linens and make a closed bed. Making a closed bed (should always be assisting staff when doing this) 1. Wash your hands 2. Collect clean linens (remember the order they should be in) 3. Place linens on a clean surface 4. Raise the bed to an appropriate level for good body mechanics 5. Move the mattress to the head of the bed 6. Put the bottom sheet on unfold it lengthwise and place the center crease in the middle of the bed 7. Pick the sheet up from the side and open it. Fanfold it towards the other side of the bed. 8. Go to the head of the bed and tuck the top of the sheet under the mattress 9. Open the cotton draw sheet and fanfold it towards the other side of the bed 10. Tuck the cotton draw sheet under the mattress. 11. Go to the other side of the bed 12. Pull the bottom sheet tight, so there are no wrinkles and tuck in the sheet. 13. Pull the drawsheet tight, so there are no wrinkles 14. Go back to the other side of the bed 15. Put the top sheet on the bed, unfold it lengthwise and place the center crease in the middle. Place the large hem at the top, even with the top of the mattress. Open the sheet and fanfold the extra part towards the other side. Face the hem stitching outward. DO NOT tuck the bottom in yet. Never tuck top linens in on the sides 16. Place the blanket on the bed. Unfold it so the center crease is in the middle. Put the upper hem about 6 8 inches from the top of the mattress. Open the blanket and fanfold the extra part towards the other side 17. Place the bedspread on the bed (if using one). Unfold it so the center crease is in the middle. Place the upper hem even with the top of the mattress. Open the bedspread and fanfold the extra part towards the other side. Make sure the bedspread facing the door is even and covers all top linens 18. Tuck in top linens together at the foot of the bed. They should be smooth and tight Make a mitered corner (next page). 19. Go to the other side 20. Straighten all top linens, working from the head of the bed to the foot 21. Tuck in the top linens together. Make a mitered corner 22. Turn the top sheet down over the bedspread. Hem stitching is down 23. Place the pillow on the bed 24. Open the pillowcase, so it is flat on the bed

32 25. Put the pillowcase on the pillow. 26. Place the pillow on the bed, so the open end is away from the door. 27. Attach the signal light to the bed 28. Lower the bed to its lowest position 29. Put towel, washcloth and gown on bedside stand (if needed). 30. Wash your hands Making an open bed (should always be assisting a staff member) 1. Wash your hands 2. Collect linens for a closed bed 3. Make a closed bed 4. Fanfold top linens to the foot of the bed 5. Attach the signal light to the bed 6. Lower the bed to its lowest position 7. Put towels, washcloth and gown on bedside stand (if needed). 8. Wash your hands The occupied bed is made when a person cannot get out of bed because of illness or injury. You must keep the person in good body alignment. You must know about restrictions or limitations in the person s movement or positioning. Explain each step of the procedure to the person before it is done. The surgical bed (recovery, postoperative or anesthesia) is a form of the open bed. Top linens are folded for transferring the person from a stretcher to the bed. The term surgical bed and its other names imply the person had surgery. This bed is used for person who arrive on a stretcher. If the bed is made for a postoperative (surgical) patient, a complete linen change is done. What is this? A disposable linen pad is a small sheet placed over the middle of the bottom sheet. It goes between the bottom sheet and cotton drawsheet. It helps keep the mattress and bottom sheet clean and dry. It is disposable and protects the mattress and bottom sheet from dampness and soiling. The cotton drawsheet protects the person from contact with the plastic and absorbs moisture. Sometimes, discomfort and skin breakdown may occur. The pad retains heat and plastic drawsheets are hard to keep tight and wrinkle free.

33 Key Terms 1. Bath blanket a thin, lightweight cotton blanket used to cover the patient during a bath or other procedure 2. Drawsheet a small sheet placed over the middle of the bottom sheet; it helps keep the mattress and bottom linens clean and dry and it can be used to turn and move patients in bed 3. Mitered corner a way of tucking linens under the mattress to help keep them straight and smooth 4. Closed bed one that is not being used; top linens are not folded back 5. Open bed one that is being used by a patient; top linens are folded back, so the patient can get into bed 6. Occupied bed a bed that is made with a patient in it 7. Asepsis the absence of pathogens How to make a Mitered Corner on a hospital bed Mitered corners (hospital corners) give a neat, finished look to the bed, which adds to a clean and polished look to the hospital room. 1. Make the bed with the fitted sheet. Fit the elasticized corners to the mattress corners on one side of the bed, while person on other side of bed, does the same. 2. Unfold the flat sheet and position the center fold of the sheet close to the center of the mattress. Bring the top part of the sheet up toward the top of the mattress, straighten it out on both sides of the bed and smooth it out flat. 3. Putt the bottom part of the sheet toward the bottom of the mattress and straighten it out on both sides of the bed. Make sure the sheet is even on both sides of the bed. Make any needed adjustments and tuck the end in at the foot of the mattress. 4. Lift the bottom corner of the sheet and pull it up from the mattress. Hold the corner up so the sheet folds down into a triangle. Hold the corner of the triangle with one hand and pull on the corner of the sheet, so you make the triangle even and smooth.

34 5. Place the triangle portion of the sheet onto the mattress. Tuck the corner of the sheet hanging down in between the mattress and the box springs. Bring the triangle portion of the mattress down to the side of the mattress and let it fall naturally. Tuck it in between the mattress and box springs. Person on other side needs to be doing the same. 6. Finish making the bed by placing blankets on top of the sheet (if necessary). 7. Mitered corners secure the flat sheet to the bottom of the mattress. Standard Precautions Clean hands upon entering patient room before and after patient contact after removing gloves before exiting room after contact with patient environment and equipment Clean & disinfect equipment between patient uses Use gloves for contact with blood or body fluids, excretions and secretions Anticipate need for protective barriers (gown, mask, etc.) according to patient condition Universal Precautions- These are measures you can take to prevent the spread of infectious diseases, from the common diseases, such as colds, flu, mumps, chickenpox, tuberculosis and food poisoning, to more life-threatening diseases like AIDS and hepatitis. Wear latex gloves when there is a chance of being in contact with body fluids (except sweat), wash your hands carefully with soap and water before putting on the gloves and immediately after taking them off, wash your hands before and after you go to the bathroom, prepare food, personal care and housecleaning tasks. Avoid handling sharp objects that may have come in contact with blood or body fluids. Wash most soiled laundry in hot water and dry in hot, when acceptable with manufacturer s instructions on how to clean. Do not eat or drink where exposure to blood or other body fluids is possible. Wash dishes and utensils in hot, soapy water. Rinse in very hot water and let them air dry. Notify those around you, if you are ill or have a condition that may be contagious.