Creating a Safe Practice

First impressions count.

Do you know what is the first impression patients have of your practice? Does it include safety? Hopefully your office appearance says well-organized, efficient, and safety centered. As a challenge, the next time you enter your office, walk in the front door and visualize the space as a patient, potential new employee or even an OSHA or public health inspector. Now, ask yourself the following questions:

• Is the waiting area clean and organized?
• Do the silk plants have dust bunnies?
• Is the carpet in good repair?
• How old are the magazines?
• Are the clinical areas filled with items not in use?
• Are the counters free of clutter so surface disinfection can easily occur?
• Are sharps containers overfilled?
• Is the sterilization area clean and well organized?

Perhaps you can see where this is going. There are some compliance basics that go along with appearance and overall, wellbeing of your physical location. When defining compliance, we will look at it from two different perspectives: employee safety and patient safety.

Employee safety standards are often referred to as OSHA standards. The following are some examples of safeguards which must be in place to ensure employees are provided a safe work environment.

• Training is essential for employees to understand safety measures in place in their work environment. Annual training is not only a best practice, bloodborne pathogen training is required by law on an annual basis.
• Written plans on exposure control and hazardous communication must be available at all times to employees. Each employee should know where to locate the written plan as well as where to locate Safety Data Sheets (SDS) for all chemicals they work with.
• Appropriate documentation of hepatitis B vaccination or vaccination declination.
• Personal protective equipment (PPE) provided by the employer at no cost to the employee. Employers must also provide laundering of reusable PPE. Employees should not take contaminated PPE home for cleaning.
• Availability and use of engineering controls was mandated by the Needlestick Safety and Prevention Act of 2001. Examples of engineering controls include sharps containers, safety scalpels, safety needles, and safety IV access devices.
• Written cleaning schedule outlining surfaces to be disinfected, frequency, and product to be used.

Walk through the practice and check for the following items.

• GFIC outlets in restrooms and outlets where there is the potential for splash or splatter of water.
• Clearance of at least three feet around breaker boxes and all breakers with appropriate labeling.
• Fire extinguisher visual checks monthly and annual maintenance by outside source to ensure proper functioning if needed.
• Sharps containers in direct areas of use.
• When transporting contaminated, reusable, sharps ensure employees are placing the sharps in a container that is leak proof on sides and bottom, closable and labeled.

Patient safety is provided in part by following established standards for infection control. The CDC issued multiple guidelines to address specific areas such as handwashing, disinfection, and sterilization. By following the established guidelines, overall risk from acquiring infection through the delivery of patient care can be reduced. Each practice should have an infection control plan which is thoroughly implemented.

Key items to review in your practice include:

• Clearly identified process for cleaning of instruments focusing on reduction in actual handling of soiled instrumentation, i.e., use of ultrasonic cleaner instead of scrubbing by hand. The use of heavy-duty utility gloves during this process should be an expectation for all employees.
• Proper monitoring of the sterilization process which includes the use of internal and external indicators in every package and performance of spore testing on a weekly basis for each sterilizer in use.
• Attention to the sterilization cycle focusing on appropriate loading of the unit, and removal of instrument packages at the end of the dry cycle. Packages should be dry when removed from the sterilizer. If packages are continually wet, there may be an issue with appropriate use of the equipment, overloading of the chamber, or an issue with the drying element.
• Single use devices must be discarded, not disinfected, or sterilized after use. Following the manufacturer’s directions is imperative from a risk management perspective. Single dose medications must be discarded after patient use even if solution remains.
• Is hand washing a top priority for all personnel? Research has proven this is a challenge in all health care environments, yet it is the one thing which will consistently reduce the likelihood of spread of infection.
• Is there a designated point person for oversight of the infection control program?

So, how did you do? If there are opportunities for improvement start now to ensure your practice reflects a strong culture of both patient and worker safety.

Over the next several issues we are going to focus specifically on several of these topics including the role of the safety officer, proper sterilization of instruments and safe injection practices. Follow along to identify safety strategies that will create a safer workplace and a safe place for patients to receive care.