Safety Issues for the Veterinary Hospital Staff
Philip J. Seibert, Jr., CVT
If you're like most people, you've chosen this career because you love animals. What better way to combine the love for animals with the desire to help them. There are may rewards in working in the veterinary community. Sometimes the rewards are very personal and sometimes they're shared with others, but they're the reason we're all here.
With every reward comes responsibility. One of your responsibilities is safety: the safety of yourself, your patients, and your co-workers. If you are hurt on the job, the injury goes well beyond the physical pain and disability. The hospital is affected not only financially, but organizationally as well: the health care delivery team is incomplete and others have to work harder to cover the shortage. Finally, your patients and clients are affected by less than a full team providing their care.
As a staff member in a veterinary hospital, you are exposed to may hazards in your day-to-day routine, and a whole host of others during the non-routine functions that always seem to occur. Hazards can be diseases, exposure to chemicals or radiation, as well as the obvious physical dangers. The good news is that these hazards, when properly identified, can be controlled and your risk of injury minimized.
It's the practice leadership's responsibility to provide a safe and healthful work environment, to comply with the laws and regulations pertaining to safety and health, to establish emergency procedures for reacting to accidents, and to provide adequate safety training to you and your co-workers.
It's your responsibility to learn and apply the safety rules and working practices for the jobs in the hospital, to cooperate in keeping the hospital safe and clean, and to promptly report hazardous conditions, unsafe acts, incidents that could have resulted in injury or damage, and all accidents or injuries to your supervisor.
By participating in this training, you have taken the first step in controlling your risk of an accident or illness: you are becoming aware of potential problems. Some things will seem very obvious, while others will seem more obscure, but remember that all the issues discussed in this manual are very real possibilities for a veterinary health care worker. Some of you may have very limited exposure to these challenges, but awareness of the hazards faced by other members of the team will only strengthen the understanding and morale within your team.
Everyone is responsible for safety. No matter what your position in the organization, you should know where the Hospital Safety Manual is located and take time to become familiar with it. Memorize the "do's and don'ts" of the hospital and always follow the safety rules. No one can protect you from an injury or illness better than you can protect yourself!
Never operate machinery or equipment without all the proper guards in place; equipment like fans and dryers have moving parts that can severely hurt or even sever a finger. Long hair should be tied back or up to prevent it from getting caught in fans, or other moving parts. Always wear appropriate clothing and footwear for the job at hand. Excessive jewelry, very loose-fitting clothing, or open-toed shoes should not be worn. If you become aware of an unsafe or hazardous condition, report it to your supervisor immediately.
You can reduce the chances of personal injury from slips and falls by wearing slip-proof shoes and using non-slip mats or strips in wet areas. Be especially cautious walking on uneven or wet floors. Never run inside the hospital or on uneven footing.
When lifting patients, supplies or equipment, remember to keep your back straight and lift with your legs. Never bend over to lift an object. Without a motorized lift table, get help when lifting patients over 40 pounds. Remember to follow sound ergonomic principles when positioning or restraining, especially when working with horses or food animals.
Some injuries are caused by cluttered or dirty work areas. Cleanliness and organization are good business standards, especially in a healthcare facility. Always clean up spills as soon as they happen. Always clean and return equipment to the proper storage place immediately after use. At least daily, remove all trash from your work area. Organize drawers, cabinets and counters so that items can be found easily and "clutter" is reduced. Keep hallways and stairs free from obstructions.
Always store supplies and equipment properly. Store heavy supplies or equipment on the lower shelves to prevent unnecessary strains. Never use stairways as storage areas. Do not overload shelves or cabinets. Store liquids in containers with tight-fitting lids. When possible, store chemicals on shelves that are at or below eye level. This will minimize the possibility of accidentally spilling the chemical on you when getting or replacing a container. Never climb into or on cabinets, shelves, chairs, buckets or similar items. Use an appropriate ladder or step to reach high locations.
The potential for illness from ingestion of pathogens or harmful chemicals is definitely present in most veterinary situations. Only eat or drink in areas free of toxic and biologically harmful substances. This also applies to the preparation of foods and beverages: make sure your staff coffee pot and utensil area is well away from sources of possible contamination such as the lab or treatment/bathing tub. Ensure the cabinets above a coffee or food area contain no hazardous chemicals or supplies that could spill onto the area. Store food, drinks, condiments and snacks in a refrigerator free from biological or chemical hazards; vaccines, drugs and laboratory samples are all potential contamination sources.
When using equipment like autoclaves, microwave ovens, cautery irons or other heating devices, be sure to understand the proper rules for safe operation. Burns, especially from steam, are painful and serious, and almost always can be prevented. Autoclaves also present a danger from the pressure that is used for proper sterilization. When opening the autoclave, first release the pressure with the "vent" device and keep your hands and face away from the steam. Let the steam rise completely before opening the door fully. Be careful when removing the packs because they are still hot. Always assume cautery devices and branding irons are hot and use the insulated handle whenever you handle them. Never place heated irons on any surface where they could overheat and start a fire, or where someone may accidentally touch them.
Become familiar with the locations and use of the eye wash stations. Always use safety glasses, and other personal protective equipment when required. By law, this equipment must be provided by your employer, but the primary reason it's there is for your protection. Remember, in every state and territory of the United States, an employee can be legally disciplined, including termination, for failure to follow the safety rules of the business.
Many procedures performed on a daily basis require the use of electricity. Although new equipment and wiring have many safety features built-in, you must be conscious of avoiding a situation which could cause a fire or physical harm to yourself, another person or a patient.
Do not remove light switch or electrical outlet covers. Always keep circuit breaker boxes closed. Only persons trained to perform maintenance duties should repair electrical outlets, switches, fixtures or breakers.
If you must use a portable dryer or other electrical equipment in a wet area, it must be properly grounded and only plugged into a ground-fault circuit interruption (GFCI) type outlet.
Extension cords will only be used for temporary supply applications and should always be of the 3-conductor, grounded type. Never run extension cords through windows or doors which may close and damage the wires. Extension cords must never be run across aisles or floors where a tripping hazard may be created. When an extension cord is necessary, it should be adequate for the electrical load. Generally, extension cords longer than 4 feet should not be used for loads greater than 6 amps @ 120v AC or 3 amps @ 240v AC.
Equipment with grounded plugs must never be used with adapters or non-grounded extension cords. Never alter or remove the ground terminals on plugs. Appliances or equipment with defective ground terminals or plugs should not be used until repaired.
When changing light bulbs (especially flourescent bulbs), be careful to remove and replace the bulb without breaking it. Inoperable bulbs should be disposed of directly into the exterior dumpster or inside of a rigid container that will prevent injury if the bulb breaks.
Fire & Evacuation
The potential for dramatic loss of life (human and animal) and the destruction of property make a hospital fire one of the most feared accidents imaginable. Fortunately, this danger can be significantly reduced by practicing a few simple precautions.
Always store flammables properly; materials like gasoline, paint thinner and ether should never be stored inside the hospital except in an approved flammable storage cabinet. Some components of specialty dental and large animal acrylic repair kits are also very flammable. Very small amounts of these components are usually not a problem, but always ensure they are stored and used in an area with good ventilation and free from flames or sparks.
Be alert for situations which could cause a fire. A common cause of fires is improper storage of materials. Flammable items, particularly newspapers, boxes, and cleaning chemicals must always be stored at least three feet away from an ignition source such as a water heater, furnace or stove. Always use extra care when using portable heaters. Never leave them unattended, and always make sure they are placed no closer than 3 feet from any wall, furniture or other flammable material.
Know where the fire extinguishers are and how to use them. Most veterinary hospitals are equipped with dry chemical type fire extinguishers. Before you decide to use a fire extinguisher make sure the alarm has been sounded, everyone has left the building (or is in the process of leaving) and the fire department has been called.
The National Fire Protection Association recommends you NEVER attempt to fight a fire if any of these conditions are true:
if the fire is spreading beyond the immediate area where it started, or is already a large fire.
if the fire could block your escape route.
if you are unsure of the proper operation of the extinguisher.
if you are in doubt that the extinguisher you are holding is designed for the type of fire at hand, or is large enough to suppress the fire.
Know where the designated emergency exits are. Make sure emergency exits are always unlocked and free from obstructions. If you must work in a building during non-operational hours (when security warrants the doors be locked), make sure you have at least two clear exits form the building which can be opened without a key.
Many hospitals have work areas that are located in basements or other "isolated" places. If you must work in one of these areas, make sure there are two ways of escape, preferably arranged so as to minimize the possibility that both may be blocked by a fire or other emergency.
Know the emergency warning system in your hospital. If the facility is equipped with an electronic alarm system, be sure you know how to activate it manually. In the absence of an electronic alarm system, a verbal alarm is very effective. Use the telephone intercom feature to alert everyone that there is a fire in the building. In very small buildings, simply yelling in a loud clear voice will get the message out.
Know your duties in the event of a fire. Remember, your first responsibility is to notify others about the fire and then to get out of the building safely. However, if the situation is not immediately life-threatening, and safe evacuation of patients or disconnection of oxygen, natural gas or electrical systems can be accomplished, attempt to perform the duties assigned to you by the hospital emergency plan. Your hospital should practice the plan and have fire drills regularly; the only way to know if it will really work is to test it.
If you have had to evacuate the building, immediately report to the designated assembly area for accountability. This is very important since others will assume you are still in the building if you are not present at the assembly area.
Just as in any occupation, the risk of injury from accidents not directly related to the job is certainly present in the veterinary fields. Vehicle accidents, personal assault, robbery, and even natural disasters have resulted in veterinary hospital employees being injured while on duty. Although no one can prevent every possible scenario, preparation can certainly help and sometimes will minimize the injury. When outside of the hospital, be aware of your environment. Be alert for things or people that don't belong. Avoid placing yourself in a situation that could go bad.
Workers in emergency or 24-hour practices should utilize the "barriers" that are usually available. Things like buzzers to control access from the front door, and one-way locks on the remaining doors (to let you out in case of an emergency, but keep the door locked from the outside) are almost essential in these environments.
In any practice, the potential for robbery is present also. In any situation where someone demands money or drugs while threatening your personal safety - DO NOT ATTEMPT TO WITHHOLD THE THINGS THEY DEMAND. Cooperate with the demands, but do not go with the person, even to the parking lot. Attempt to remember every detail of the person's appearance and demeanor. This will greatly enhance the ability of the police to locate the person. As soon as safely possible, let everyone else know of the situation. You should attempt to contact the police if it can be safely done without the person's knowledge, otherwise do it immediately after the person has left.
If you can do it without placing yourself in danger, attempt to see the vehicle (and ideally a license number) the person used to escape. Take note of the color, model, distinguishing features of the vehicle and the direction of travel.
You may not think of it, but many products you use every day can be hazardous. Every chemical, even common things like cleaning supplies have the potential to cause harm to someone. Some chemicals can contribute to health problems while others may be flammable and pose a fire threat. The most common chemicals in use in the veterinary profession are insecticides, medications and cleaning agents.
Prior planning and training are the keys to safely handling any chemical. Every business, including your practice must follow the guidelines of OSHA's Right To Know Law. This law requires you to be informed of all chemicals you may be exposed to while doing your job. The Right to Know Law also requires you to wear all safety equipment that is prescribed by the manufacturer when handling a chemical. The safety equipment must be provided to you at no cost to you, but it is not optional - you must wear what is prescribed.
A key component of the Right to Know Law is the hazardous materials plan. This plan will describe the details of the practice's MSDS filing system, the secondary container labeling system, and the person responsible for ensuring all employees have received the necessary safety training. You have a right to review any of these materials, so ask your supervisor where your plan is located.
Part of the planning process includes knowing exactly what chemicals are present. There must be an up-to-date list of chemicals known to be in the hospital. It surprises some people to learn that the average veterinary hospital has over 200 hazardous chemicals present at any one time.
When you receive a supply of chemicals from the distributor, every bottle will be identified with a label containing directions and any appropriate warnings. You should always read, understand and follow all the directions and warnings printed on the label. Whenever possible, you should keep this label intact and readable. Sometimes it is necessary to dilute chemical or just place them in smaller bottles for use. These smaller bottles are known as secondary containers. Always make sure to label secondary containers with the contents. If anyone else will have access to these secondary containers, you must also include any appropriate safety warnings on the label. Your hospital should have a specified format so that all secondary container labels are easily recognized.
Some containers are difficult to label in traditional ways. For shampoo and lubricant bottles (and other slippery containers) use a tag or color coded system instead of adhesive labels. Be sure to make a "key" so that everyone else knows the system also.
More detailed information about every chemical can be found on the associated Material Safety Data Sheet (MSDS). The manufacturer is required by law to prepare and distribute an MSDS for every chemical produced. Your practice is required to keep an MSDS file for the chemicals that you use. Ask your supervisor where your hospital's MSDS file is located and take the time to review the ones you use frequently.
Material Safety Data Sheets may look complicated at first glance, but the information that is important to you is easy to find. You should review the health, protective equipment and disposal sections for every chemical which you regularly use.
Always remember to replace the cap on chemical bottles. Working bottles of chemicals should always have tight fitting, screw-on lids. You should always store chemical bottles in a closed cabinet; this will help prevent animals from injury if they escape while unattended. The cabinet (or shelf within a cabinet) should be at or below eye level. This will minimize the chances of someone spilling some of the chemical in their face if the cap is not secure. Never store or use chemicals near food or beverages.
You should be very cautious when mixing or diluting chemicals. Always wear latex gloves and protective goggles. Never mix any chemicals unless directed to do so on the label or MSDS. When two chemicals are mixed together the result is seldom a simple mixture. It is often a new, sometimes very different and very dangerous chemical. When making solutions from a concentrate, always start with the correct quantity of water then add the concentrate. Never add the water to the concentrate because the chemical may splash or react differently.
Minor spills of most chemicals can be cleaned up with paper towels or absorbent (like kitty litter) and disposed of in the trash or sanitary sewer; however, some very dangerous chemicals, like formaldehyde or ethylene oxide require special procedures. BEFORE you use a new chemical, review the MSDS and learn the procedures you must follow for cleaning up a spill. When cleaning up any spill, remember to wear latex gloves and any other protective equipment required on the MSDS. Keep other people and animals away from the spill until it is safe. Unless prohibited by the instructions on the MSDS, wash the spill site and any contaminated equipment with a detergent soap and water.
You should know where the emergency eye wash station(s) are located and how to use them.
Ethylene Oxide - Many hospitals use gas sterilization for items that would be damaged by other procedures. Electrical drills, rubber products, and sharps are commonly exposed to Ethylene Oxide (EtO) as a sterilization agent in human and veterinary medicine. This method has distinct advantages, but since EtO is a potent human carcinogen, special precautions must be maintained:
read the MSDS carefully
store in a safe place
only use approved devices to perform the procedure
read, understand and follow all the written procedures and safety precautions
know the emergency procedures
be aware of monitoring levels
EtO is very flammable! Keep away from flames and sparks.
In light of the extensive requirements for safe use of this chemical, many veterinary hospitals have found that it is more convenient to have their gas sterilization completed by the local community hospital's Central Sterile Supply department.
Formalin - Historically, formalin has been used for tissue preservation, diagnostic tests (knotts), and even sterilization. Liquid or gaseous formaldehyde and formalin are serious health hazards in veterinary hospitals. Since formaldehyde is a known human carcinogen, OSHA takes it's use very seriously. The standards for use of formaldehyde are very similar to the standards for use of ethylene oxide:
read the MSDS carefully
store supplies safely, include museum jars
use only with good ventilation, avoid breathing vapors
wear gloves and goggles, avoid skin & eye contact
Hospitals who still use formalin for diagnostic laboratory tests (knotts, etc.) should seriously consider switching to some of the newer, less hazardous methods of testing.
Since most hospitals can not discontinue the use of formalin as tissue fixative agents for histology samples, veterinarians are encouraged to keep the quantities on hand to a bare minimum. Whenever possible, order formalin in small, pre-measured containers so that the potential for exposure above the PEL is minimized. Very often the laboratory will supply pre-labeled vials at no charge.
We can't forget that the overriding purpose of a veterinary practice is the care and treatment of patients. Sometimes, handling our patients can be a hazard, but this one just cannot be eliminated! Anyone who has worked with animals under stress or pain will relate personal accounts of injuries from patients. In fact, insurance statistics reveal that animal connected accidents are the most common injury of workers in veterinary related fields. With this in mind, certain safety rules must be followed when attempting to capture, restrain, treat, feed or exercise animals.
The first rule when working around animals is to stay alert! Animals sometimes react to situations unexpectedly. Sudden noises, movements or even light can be the stimulus that would cause an animal to react. If you are the primary restraint person, keep your attention focused on the animal's reactions and not on the procedure. You should learn the proper restraint positions for each of the species of patients you handle regularly.
Make use of any available capture/restraint equipment; sometimes, just a piece of rope to hobble a leg or a piece of gauze for a hasty muzzle will make all the difference. Wear exam gloves and mask when handling a stray, wild or unvaccinated animal. Maintain an appropriate distance to the work, e.g., don't put your face very close to the mouth of the animal. (also see zoonosis section) Dogs, cats and smaller animals can bite, scratch or cause you to lose your balance & fall. Wear protective (leather) gloves when the animal is fractious.
Dogs will inevitably bark, and barking dogs can be a serious concern, especially in indoor kennels. Noise levels in dog wards can reach 110 decibels! Although relatively short duration exposure to these noise levels, like going into the kennel to retrieve a patient, poses no serious damage to your hearing, excessive, or long-term exposure can contribute to hearing loss. When working in noisy areas for extended periods of time (e.g., cleaning of cages), you must wear personal hearing protectors. It doesn't matter what style or type of hearing protectors you use (ear plugs or muffs), as long as they are rated to filter the noise by at least 20 dB (the package will indicate the rating).
Large animals like horses and cattle, simply because of their size, can severely injure or even kill you just by trying to escape the restraint. Never put your hand, leg or any other part of your body between the animal and the side of the enclosure or chute; use a hook or pole to pass ropes or belts through the chute. If you have to enter a stall or paddock with a large animal, stay on the side of the animal nearest the door, so that you can escape if the situation becomes hazardous.
If you have to handle exotic or non-domestic animals, remember that they all have their own unique methods of defense. You should know and understand their possible reactions before you attempt to restrain or treat them.
Unless absolutely necessary, avoid entering a dog run, stock trailer, stall, or other enclosure with an unknown, mean, fractious or wild animal. If you must capture a fractious animal from a cage or pen, make sure there is another person present that could assist you if you get in trouble.
Exposure to potentially hazardous agents can occur by several means: respiratory, contact, oral, ocular and inoculation. There is a real potential for contacting these agents in a veterinary medical environment; therefore, particular attention to personal hygiene and sanitary work practices is essential.
When you handle materials like feces, laboratory samples, or other animal exudates, wear protective gloves and always wash your hands immediately after completing the procedure. Normally, accidents with these types of materials can be cleaned up with paper towels soaked in appropriate disinfecting solution. Gloves should be worn and disposed of with the cleaned-up materials.
When treating patients with potentially infectious diseases (infectious to people or other animals) wear a protective apron, exam gloves, and if appropriate, eye protection. Thoroughly wash your hands with a disinfecting agent like chlorhexadine or povidone-iodine scrub at the completion of the treatment. Any clothing that has been contaminated should be changed immediately.
Potential zoonotic diseases which can be contracted by veterinary workers include:
Rabies is a very serious, usually fatal viral disease that can affect any warm-blooded animal (including man). The virus is spread by contact with an infected animal's saliva. Usually, an infected animal bites another, non-infected animal, but the disease has been transmitted by saliva (even the residue left on a dog's bowl after eating) coming in contact with an open wound or the mucous membranes. It is also known that several humans have contracted rabies by inhaling the virus while exploring bat caves!
Although the disease is ever present in the wild animal population, in recent years, many states (primarily on the eastern seaboard) have confirmed record high numbers of animal rabies in domestic species like cats, dogs, horses and cattle. In 1994, there were two cases in the United States of humans contracting rabies from animals; in both cases, the patient died. There was also a very publicized episode of several kittens adopted from a New Hampshire pet shop later diagnosed with rabies. One of those kittens could show up at your hospital for an exam and vaccinations!
The best protection you can have as a veterinary health care worker is an understanding of the reality that rabies is still a threat in the United States. The primary barrier between the wild animal population and humans is the vaccination of pets and domestic animals. When you must handle an unvaccinated, wild, or stray animal, always wear protective (rubber or latex) gloves, and maybe even protective gowns and goggles in some cases.
There is a very safe and effective human vaccine that can be administered to people who work with animals. Ask your hospital administrator about the availability of this vaccine at your practice.
Bacterial infections are certainly possible in the veterinary environment. Aside from the common bacteria that all animals harbor naturally, injury and disease can expose you to some serious pathogens like pasteurella spp., e.coli, or pseudomonas spp. Bacteria is most commonly transferred by direct contact with the animal or it's exudates, especially if you have any cuts or open sores. Some bacteria are easily "aerosolized" or released in the air where they can be inhaled and absorbed through your mucous membranes. The best protection from exposure to bacteria is simply good personal hygiene. Always follow the personal hygiene rules discussed earlier.
Contrary to its name, ringworm is not a parasite or worm. Animals and people can be infected with a fungus know as Microsporum canis. Ringworm is very easily passed between animals and humans. Cats and horses are particularly susceptible to ringworm infestations. Again, the most effective protection from ringworm infestations is to wear gloves when handling or treating animals diagnosed with the condition and to practice good personal hygiene. Be especially careful about preventing contamination of your clothing when treating patients with m. canis because it is believed that the fungal spores can be carried to other locations (like home) and infect other animals or humans also.
When the eggs of common internal parasites like roundworms and hookworms infect humans, they usually do not mature into adult parasites, but they do cause other problems. Roundworm larvae can migrate to virtually any organ in the body and develop into a cyst-like growth known as visceral larval migrans. These "cysts" are usually not noticeable, but if they develop in a vital organ like the eye, it can cause severe problems.
Another parasite, hookworms , can cause similar problems in humans by a condition known as cutaneous larval migrans. This condition particularly affects children who play in areas where pets defecate frequently. Unlike the visceral "cysts" from roundworms, the cutaneous migrans are relatively easy to visualize. Usually occurring on the lower extremities (legs), small red lines appear near the foot and "migrate" up towards the body.
Recently, Lyme disease has become a more serious concern for pets and people. When an infected deer tick bites a host (animal or person) during feeding, the bacteria Borrelia burgdorferi is transferred to the host. Lyme disease in humans is characterized by aches in the joints, fever, and a host of other "flu-like" symptoms. The best defense against this disease is to check yourself daily for ticks, and remove them promptly. If you work in a large or mixed animal practice, it's also very advantageous to use an insect repellant on you and your clothes if you must go out into fields or woods to work or treat animals.
Although the common dog mange, demodex , is rarely contagious to humans, animals with sarcoptic mange can easily infect people. Only microscopic identification of the mite can positively determine which form of mange is present. When treating animals with mange, always wear gloves and a protective gown and wash your hands thoroughly with disinfecting soap immediately after the procedure.
Infestation with a common feline parasite, toxoplasma catti, is known as toxoplasmosis . Although it is usually not harmful to healthy humans, it can cause serious problems in pregnant women by causing abnormalities in the developing child. Ideally, pregnant women should avoid cleaning cat litter pans. It that's not possible, wear protective gloves and clean the pans every day (the eggs need a few days to become "infectious"). As always, good personal hygiene is expected.
Normally, vaccine and biological agent vials are not considered hazardous unless the agent is capable of infecting humans. Regular vaccine and medication vials are not usually considered a hazard, but vials containing materials biologically hazardous to humans (like brucellosis bacterin) must be treated as potentially infectious during and after use.
Inherent to medicine is the necessity to "see inside the body." In veterinary medicine, the method of choice in most cases is diagnostic radiography. Although modern machines have many safeguards integrated in the design, there still exists the possibility of injury if these tools are misused.
Short duration, infrequent exposure to radiation, such as having radiographs taken of yourself, is accepted as an insignificant variable in your overall health. However, long term exposure to low doses of radiation has been linked to genetic, cutaneous, glandular, and other disorders. High dose exposure can cause skin changes, cell damage, and gastrointestinal and bone marrow disorders that can be fatal. Fortunately, much is known about the properties of x-rays, and ways to protect ourselves. By following some very simple safety precautions, you can utilize radiographs in your practice with complete confidence.
When you are involved in the use of radiographic equipment, you must never place any part of your body in the primary beam (even gloved hands) and always wear the appropriate protective equipment - lead aprons and gloves must be worn. Thyroid collars and lead glasses are recommended if available.
Machines in use today must meet strict federal and state guidelines for safety. Often, the state regulatory agency will inspect machines to ensure they are working properly, but only the operator can use them safely. Before you use an x-ray machine, make sure you know where all the controls are located and the function of every individual knob or button. Make sure you always use the collimator to restrict the primary beam to smaller than the size of the cassette - in other words, isolate the area to be radiographed and minimize the scatter.
Always follow the written operational or safety procedures from the hospital or the manufacturer. If you haven't already done so, make an exposure chart so that you can replicate the best techniques for various studies. By following a proven technique chart and positioning the patient correctly the first time, you'll have fewer "retakes."
Portable machines, like those used in large animal and mobile practices, can be particularly dangerous because of their multi-purpose abilities. These machines can be "aimed" in any direction, and because of their limited "power" they must utilize longer exposure times to produce diagnostic images. When using a portable machine, always make sure no one is in the path of the primary beam (even at a distance). Never hold a cassette with your hands, gloved or not; always utilize a holding pole. Remember to wear a lead apron and gloves.
Everyone who is involved with radiation on the job must have and utilize an individual dosimetry badge. This badge must always be worn during radiographic procedures, not as protection, but as a measurement of any scatter radiation you may receive during the procedure. You should always return the badge to the designated storage location (outside the x-ray area) when not in use. Unless you are taking radiographs, never wear your badge outside because exposure to sunlight will result in false readings.
Your supervisor or hospital administrator will regularly advise you of the results from your personal dosimetry badge. Depending on the system in place, the reports may be made monthly or quarterly. These reports, required by law, are designed as a warning system to alert you and your supervisor if your exposure to radiation increases. In the veterinary profession, due to the relatively low numbers of radiographs taken, the newer, safer machines, and the use of good protective equipment, most workers receive very little, if any, occupational exposure to radiation.
Radiographic developing chemicals (developer and fixer) can be very corrosive to materials and human tissues. Take extreme care when mixing, transferring, agitating, or transporting these chemicals, and only do this in a well ventilated area - this means always using the exhaust fan in the darkroom. Use protective gloves and goggles when mixing or pouring the chemicals. For manual processing tanks, before use, stir the chemicals with care but avoid splashing them. After handling radiographic developing chemicals, always wash your hands.
These chemicals also react dangerously with other chemicals, so NEVER pour other chemicals into a sink or drain where developing chemicals are used. Some liquid drain openers, when mixed with developer and fixer, can produce toxic gases and others will produce an ectothermic (extremely high temperature) reaction that could damage pipes.
Anesthesia is as common to medicine as is antiseptic wound care. Exposure to waste anesthetic gasses (WAGs) is probably the most misunderstood area of hospital safety. Only recently have the dangers from occupational exposure to anesthetic gasses become known, or at least taken seriously. The National Institute of Occupational Safety & Health (NIOSH) estimates that over 250,000 U.S. workers are at risk from exposure to the gas not metabolized by the patient. Recent discoveries in the types of gasses used in veterinary medicine have produced safer agents for the patients and the workers, but since no chemical is without risk, we must still take precautions to protect ourselves.
More hospitals are choosing isoflurane over halothane or methoxyflurane as their anesthetic of choice for all patients, but exposure to any chemical can be dangerous. Long term exposure to waste anesthetic gases (WAGs) has been linked to congenital abnormalities in children, spontaneous abortions, and even liver and kidney damage. OSHA has set the safe exposure limit for ALL halogenated anesthetic agents (including the three mentioned above) at 2 parts per million (ppm).
According to some sources, as much as 90% of the anesthetic gas levels found in the room during a procedure can be attributed to leaks in anesthesia machines, so always perform a leak check of the machine prior to use. Also make sure you use the proper size hoses and rebreathing bags and inflate the endotracheal tube cuff before connecting the patient to the machine. You should start the flow of anesthetic after connecting the patient to the machine and maintain the flow of oxygen, before disconnecting the patient, until the circuit has been flushed through the scavenging system.
A proper scavenging system will capture the excess gasses directly at the source and transport them to a safe exhaust port, usually outside the building. This is the single most effective means of reducing exposures of WAGs in the workplace. There are three general methods of WAG removal currently in use: active scavenging, passive exhaust and absorption. Each has a place, but rarely does one method fit all circumstances. Regardless of the system your practice uses, make sure it is connected to the machine before use. If you use the absorption canisters, ensure the time or weight limit not been exceeded.
When refilling the anesthetic machine vaporizer, move the machine to a well ventilated area. Use a pouring funnel and avoid overfilling the vaporizer or spilling the anesthetic. If you accidentally break a bottle of anesthetic, immediately evacuate all people from the area. The windows should be opened and all exhaust fans turned on. Control the liquid with a spill kit absorbent or a generous amount of kitty litter. Pick up the absorbed liquid and kitty litter with a dust pan and place it in a plastic garbage bag. Seal the bag tightly and dispose of it in an outside trash can. Leave the exhaust fans on and the windows open until you are sure the gas level has been reduced to a safe level.
Some procedures, like masking or tank induction, defy collection of waste gasses. In those instances, make sure the ventilation in the room is good. Exhaust fans for evacuating room air to the outside are recommended. Be conscious of air handling systems that recirculate the air; exposure of others may be the result. Induction chambers can be connected to the scavenging system or absorption canisters to reduce the levels of escaping gasses.
When monitoring patients during recovery, you should avoid close facial contact and keep the number of recovering patients to an acceptable number for the size of the area and ventilation system. When practical, allow the patient to partially recover while still connected to the anesthetic machine (oxygen only) and scavenging system. When moving the patient, avoid close facial contact.
When changing the soda lime (carbon dioxide absorbent) in anesthetic machines, wear rubber or latex gloves. When the soda lime is wet, as it often is from humidity in the patient's breathing, it can be very caustic to tissues and some metals. Place the used soda lime granules in a plastic trash bag and dispose of it in the regular trash.
If you are a woman and become pregnant, discuss the risk with your physician as soon as possible and notify your supervisor immediately.
The most serious hazard from sharps in a veterinary medical environment is from the physical trauma (and possible bacterial infection) that is caused by a puncture or laceration.
To prevent accidents from punctures or lacerations, always keep sharps, needles, scalpel blades and other sharp instruments capped or sheathed until ready for use. Whenever practical, the needle or sharp should be placed in a red "sharps container" immediately after use. Whenever possible, do not attempt to recap the needle unless the physical danger from sticks or lacerations cannot be avoided by any other means.
When necessary, needles may be recapped by using the "one-handed" method: place the cap on a flat surface (like the table or counter) then, with one hand, "thread" the needle into the cap. The cap may then be firmly seated using both hands. The needle should not be removed from the syringe, but the entire unit should be disposed of in the red sharps containers. When full, the sharps containers must be sealed and disposed of following the hospital's prescribed policy.
Ordinary milk containers are not appropriate sharps collection containers: try pushing a 22 gauge needle through one. The containers made for this specific purpose (usually red with biohazard symbol) are the most effective and are usually very economical.
The cutting of needles prior to disposal increases the potential for aerosolization and collecting sharps in a smaller container and transferring them to a larger container for disposal places someone at an increased risk of exposure; neither practice is recommended.
Never throw needles or sharps directly into regular trash containers, regardless of whether or not they are capped. Never open a used sharps container or stick your fingers into one for any reason.
In human medicine, transfer of HIV (or the AIDS virus) and hepatitis-B between the patients and the workers is a real threat. Since our patients are currently incapable of transmitting these two serious diseases to our staff, the strict rules of OSHA's Bloodborne Pathogens Standard are not necessary. Although the term "bloodborne pathogen" is usually reserved for human infectious agents, the principles of good clinical hygiene must still be followed. From a practical standpoint, typical organisms found in or on an animal could cause problems in people. Some of these organisms include most bacteria, some parasites, viruses (rabies) and similar organisms.
The best way to deal with this hazard is to take simple precautions like wearing protective equipment and practicing good personal hygiene. Always wash your hands after treating or handling a patient. When the treatment or procedure is likely to be extensive or "messy" it's a goo idea to wear a pair of exam gloves to minimize your exposure to pathogens. Procedures like high speed or ultrasonic dental scaling will often aerosolize the pathogens, so additional protection like goggles and a surgical mask are necessary. Some literature suggests that common pathogens in an animal's mouth (like pasturella spp.) can cause cardiac problems in people!
By understanding the way in which job-related accidents or illnesses occur we can take the preventive steps necessary to enjoy a career as a veterinary technician or assistant. Although there are many safety regulations and rules to follow, you can successfully incorporate those procedures into your daily routines and make them "second nature." Remember, no one can protect you better than you can, and using your head is the best way to do that.
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