www.rejinpaul.

com
VIVEKANANDHA
COLLEGE OF TCHNOLOGY FOR WOMEN
ELAYAMPALAYAM, TIRUCHENGODE – 637 205, NAMAKKAL Dt., TAMIL NADU, INDIA
Phone : 04288-234064, Fax : 04288-234134, Website :www.vctw.ac.in,E-mail:principal@vctw.ac.in
VIVEKANANDHA

DEPARTMENT OF COMPUTER SCIENCE AND ENGINEERING

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III CSE (A & B) - FIFTH SEMESTER

OMD552 - HOSPITAL WASTE MANAGEMENT

UNIT I

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HEALTHCARE HAZARD CONTROL AND UNDERSTANDING ACCIDENTS

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Healthcare Hazard Control: Introduction, Hazard Control: Management & Responsibilities,
Hazard Analysis, Hazard Correction, Personal Protective Equipment, Hazard Control
Committees, Accident Causation Theories, Accident Reporting, Accident Investigations,
Accident Analysis, Accident Prevention, Workers‟ Compensation, Orientation, Education, and
Training.
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PART - A
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1.What are the main ways to control a hazard?
The main ways to control a hazard include:
• Elimination (including substitution): remove the hazard from the workplace, or
substitute (replace) hazardous materials or machines with less hazardous ones.
• Engineering Controls: includes designs or modifications to plants, equipment,
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ventilation systems, and processes that reduce the source of exposure.

• Administrative Controls: controls that alter the way the work is done, including timing
of work, policies and other rules, and work practices such as standards and operating
procedures (including training, housekeeping, and equipment maintenance, and personal
hygiene practices).
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• Personal Protective Equipment: equipment worn by individuals to reduce exposure

such as contact with chemicals or exposure to noise

2. What is meant by elimination?

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Elimination is the process of removing the hazard from the workplace. It is the most
effective way to control a risk because the hazard is no longer present. It is the preferred way to
control a hazard and should be used whenever possible.
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3.What are examples of systems that increase awareness?

Systems that increase awareness are methods that help the worker to detect if a hazard is
present. Examples of these hazard controls include warning systems, visual or audible alarms,
warning signs, or other indicators that alert the worker to a situation
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4.What are examples of administrative controls?
Administrative controls limit workers' exposures by scheduling shorter work times in
contaminant areas or by implementing other "rules". These control measures have many
limitations because the hazard itself is not actually removed or reduced. Administrative controls
are not generally favoured because they can be difficult to implement, maintain and are not a
reliable way to reduce exposure. When necessary, methods of administrative control include:
• Restricting access to a work area.
• Restricting the task to only those competent or qualified to perform the work.
• Scheduling maintenance and other high exposure operations for times when few workers

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are present (such as evenings, weekends).
• Using job-rotation schedules that limit the amount of time an individual worker is
exposed to a substance.
• Using a work-rest schedule that limits the length of time a worker is exposure to a hazard.

5.What should I know about personal protective equipment (PPE) as a hazard control

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method?
Personal protective equipment (PPE) includes items such as respirators, protective
clothing such as gloves, face shields, eye protection, and footwear that serve to provide a barrier
between the wearer and the chemical or material.

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It is the final item on the list for a very good reason. Personal protective equipment should never
be the only method used to reduce exposure except under very specific circumstances because
PPE may "fail" (stop protecting the worker) with little or no warning. For example:
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"breakthrough" can occur with gloves, clothing, and respirator cartridges.

6.What is a hazard control program?

A hazard control program consists of all steps necessary to protect workers from
exposure to a substance or system, the training and the procedures required to monitor worker
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exposure and their health to hazards such as chemicals, materials or substance, or other types of
hazards such as noise and vibration. A written workplace hazard control program should outline
which methods are being used to control the exposure and how these controls will be monitored
for effectiveness.
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7. What are the types of hazard analysis?

• Change analysis
• Creative hazard analysis
• Risk analysis
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• Phase hazard analysis

• Process hazard analysis
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• Job hazard analysis

8. Define hazard analysis?

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It collects the information regarding hazard surveys, inspections, hazard reports and
accident investigation. Effective analysis take the snap shots and create viable pictures of hazards
and accident causal factors.
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9. List out the effective information provided to the team in creative hazard analysis?
• Known hazards
• Related technologies
• Operational procedures
• Equipment design issues
• Instrumentation controls

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• Necessary historical information

10. What is the need of job hazard analysis?

It permits the examination of job related tasks, operations and process to discuss and
correct inherent risks and hazards. It can help tools, machines and materials used to perform a
job.

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11. What type of correctional program is used to plan the best way to control or prevent
hazards?

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• Engineering Controls.
• Administrative Controls.
• Personal Protective Equipment (PPE)
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• Systems to Track Hazard Correction.
• Preventive Maintenance Systems.
• Emergency Preparation

12. How do you manage hazards?

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In order to control workplace hazards and eliminate or reduce the risk, you should take the
following steps:
• identify the hazard by carrying out a workplace risk assessment;
• determine how employees might be at risk;
• evaluate the risks;
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• record and review hazards at least annually, or earlier if something changes

13. What are the types of hazards?

Hazards generally fall into one of six groups:
• Physical – Slippery floors, objects in walkways, unsafe or misused machinery, excessive
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noise, poor lighting, fire.

• Chemical – Gases, dusts, fumes, vapours and liquids.
• Ergonomic – poor design of equipment, workstation design, (postural) or workflow,
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manual handling, repetitive movement.

• Radiation – Microwaves, infra-red, ultraviolet, lasers, X-rays and gamma rays.
• Psychological – Shiftwork, workload, dealing with the public, harassment,
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discrimination, threat of danger, constant low-level noise, stress.

• Biological – Infection by bacteria, virus, fungi or parasites through a cut, insect bite, or
contact with infected persons or contaminated object.
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14. Mention the three types of controls in hazard.
• Engineering controls
• Administrative controls
• Work place controls

15. What is the difference between engineering controls and administrative controls?

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This involves a change in the physical features of the workplace. When engineering
solutions are not feasible, administrative controls offer methods to reduce the
exposure of workers to the identified hazard. ... They are considered less effective
than engineering controls in that they do not usually eliminate the hazard.

16. What is an example of an administrative control?

Administrative controls are training, procedure, policy, or shift designs that lessen the

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threat of a hazard to an individual. Administrative controls typically change the behavior of
people (e.g., factory workers) rather than removing the actual hazard or providing personal
protective equipment (PPE).

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17. Who controls the administration?
Administrative controls (or work practice controls) are changes in work procedures
such as written safety policies, rules, supervision, schedules, and training with the goal of
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reducing the duration, frequency, and severity of exposure to hazardous chemicals or situations.

18. What does engineering control mean?

Engineering controls eliminate or reduce exposure to a chemical or physical hazard
through the use or substitution of engineered machinery or equipment.
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19. What engineering controls are in the hospital?
Engineering controls isolate or remove the bloodborne pathogen hazard from the
workplace. These controls are sharps disposal containers, self-sheathing needles, safer
medical devices such as sharps with engineered sharps injury protections, and needleless systems
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20. What are the 4 types of PPE?

Types of personal protective equipment
• Respiratory protection - for example, disposable, cartridge, air line, half or full face.
• Eye protection – for example, spectacles/goggles, shields, visors.
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• Hearing protection – for example, ear muffs and plugs.

• Hand protection – for example, gloves and barrier creams
• Foot protection – for example, shoes/boots
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• Head protection – for example, helmets, caps, hoods, hats

• Working from heights - for example, harness and fall arrest devices
• Skin protection – for example, hats, sunburn cream, long sleeved clothes
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21. What are 3 examples of PPE and when should they be used?
Personal protective equipment, commonly referred to as “PPE”, is equipment worn to
minimize exposure to a variety of hazards. Examples of PPE include such items as gloves,
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foot and eye protection, protective hearing devices (earplugs, muffs) hard hats, respirators
and full body suits.

22.What are the functions of safety committee?

The main functions of the health and safety committee are to: facilitate co-operation in
developing and carrying out measures to improve the safety of workers. help develop health
and safety standards, rules and procedures.

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23.What type of control eliminates exposure to a hazard?
Elimination (including substitution): remove the hazard from the workplace, or substitute
(replace) hazardous materials or machines with less hazardous ones. Engineering Controls:
includes designs or modifications to plants, equipment, ventilation systems, and processes that
reduce the source of exposure.

24.What are three responsibilities of the health and safety committee?

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Functions of a Health and Safety Committee are:
• Assist in developing standards, rules and/or procedures relating to health and
safety to improve and ensure workers health and safety at the workplace.
• Comply with functions prescribed by regulations.

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• Carry out any other functions agreed between the PCBU and the HSC.

25.Why is a safety committee important?

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• A health and safety committee can be an important way to improve conditions on the
job.
• An effective committee can help prevent injury and illness on the job;
• Increase awareness of health and safety issues among workers, supervisors, and
managers;
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• Develop strategies to make the work environment safe and healthy.

26.What is accident causation theory?

The theory posits that injuries result from a series of factors, one of which is an accident.
The accident/incident theory of accident causation is an extension of the human
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factors theory. It introduces such new elements as ergonomic traps, the decision to err, and
systems failures.

27.What is accident causation?

Accident causation refers to the factors that are the primary reasons behind anaccident.
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For occupational health and safety professionals, determining causationfactors in any workplace
injury or accident is key.
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28.What is the domino theory of accident causation?

A theory of accident causation and control, developed by H.W. Heinrich, that purports
that all accidents, whether in a residence or a workplace environment, are the result of a chain of
events.
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29.What is the theory of multiple causation?

Multiple Causation Theory is an outgrowth of the Domino Theory, but it postulatesthat
for a single accident there may be many contributory factors, causes and sub-causes, and
that certain combinations of these give rise to accidents
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30.List out accident causation theories.
• Henni Heinrich’s five factor accident
• Multiple causation theory
• Biased liability theory
• Energy transfer theory and The “symptoms Vs Causes” theory

31.What is Heinrich theory?

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The relationship was first proposed in 1931 by Herbert William Heinrich in his Industrial
Accident Prevention: A Scientific Approach. Heinrich was a pioneer in the field of workplace
health and safety. ... Heinrich's theory also suggested that 88% of all accidents were caused by a
human decision to carry out an unsafe act

32.What is Heinrich domino theory?

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Heinrich's Domino Theory. According to Heinrich, an "accident" is one factor in a
sequence that may lead to an injury. • The factors can be visualized as a series of dominoes
standing on edge; when one falls, the linkage required for a chain reaction is completed.

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33. Define Biased liability theory.
Biased liability theory is based on the view that once a worker is involved in an accident,
the chances of the same worker becoming involved in future accidents are either increased or
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decreased as compared to the rest of workers.

34. What is accident triangle or pyramid?

The accident triangle, also known as Heinrich's triangle or Bird's triangle, is a theory
of industrial accident prevention. It shows a relationship between serious accidents, minor
accidents and near misses and proposes that if the number of minor accidents is reduced then
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there will be a corresponding fall in the number of serious accidents.
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35. What are the effective risk assessment methodologies that prevent fatalities?
• System based approach
• Hazard based approach
• Task based approach
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36.What is accident reporting and investigation?
An accident is unplanned or undesired occurrence which may or may not result in injury
to person(s) and or damage to property. ... Accident reporting and investigation is a legal
requirement of the General Applications Regulations 2007 and the Safety, Health & Welfare at
Work Act 2005.

37.What is the purpose of accident investigation and reporting?

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Accident Investigation & Reporting. The prime objective of accident investigationis
prevention. Finding the causes of an accident and taking steps to control or eliminate it can help
prevent similar accidents from happening in the future.

38. How do you prepare for an accident investigation report?

Writing any incident report involves four basic steps.
• Respond Immediately

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• Find the Facts
• Analyze
• Complete Corrective Action Plan

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39.Why should all incidents and accidents be reported?
That is why getting injuries treated when they occur is so important. Beyond the need for
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immediate medical treatment, there is another equally important reason to report all
accidents and injuries. Accidents must be investigated and their causes found to prevent the same
injuries from happening again to someone else.

40. What is the main aim of accident investigation?

When incidents are investigated, the emphasis should be concentrated on finding the root
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cause of the incident so you can prevent the event from happening again. The purpose is to find
facts that can lead to corrective actions, not to find fault. Always look for deeper causes.

41.What type of accidents need to be reported?

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Deaths and injuries. If someone has died or has been injured because of a work-related
accident this may have to be reported. Not all accidents need to be reported, other than for
certain gas incidents.

42.What is the process for accident investigation?

An investigation will involve an analysis of all the information available, physical (the
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scene of the incident), verbal (the accounts of witnesses) and written (risk
assessments, procedures, instructions, job guides etc), to identify what went wrong and
determine what steps must be taken to prevent the adverse event .
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43.How long do I have to report an accident at work?

You must report within 10 days of the incident. Over-seven-day injuries must be reported
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within 15 days of the incident. Diseases should be reported as soon as a registered medical
practitioner (RMP) notifies you in writing that your employee suffers from a reportable work-
related disease
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44. What is accident analysis and prevention?
Accident Analysis & Prevention provides wide coverage of the general areas relating
to accidental injury and damage, including the pre-injury and immediate post-injury phases.

45. Write down the categories of accident analysis.

• Causal analysis (root cause Analysis)
• Expert Analysis
• Organizational Analysis

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46. How to record accidents and near misses?
• Keep simple
• Clear communication
• Review for injuries and locations
• Goal should always be the prevention of further incidents

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47. How is root cause analysis done?
Root cause analysis (RCA) is a systematic process for identifying “root causes” of
problems or events and an approach for responding to them. RCA is based on the basic idea that

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effective management requires more than merely “putting out fires” for problems that develop,
but finding a way to prevent them

48.What are the root cause analysis tools?

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Cause analysis tools are helpful tools for conducting a root cause analysis for a problem
or situation. They include: Fishbone (Ishikawa) diagram: identifies many possible causes for an
effect or problem and sorts ideas into useful categories.

49. What is root cause analysis?

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• Root cause analysis (RCA) is the process of discovering the root causes of problems in
order to identify appropriate solutions.
• RCA assumes that it is much more effective to systematically prevent and solve for
underlying issues rather than just treating ad hoc symptoms and putting out fires.
• Root cause analysis can be performed with a collection of principles, techniques, and
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methodologies that can all be leveraged to identify the root causes of an event or trend.

50. How does the workers compensation work?

• Workers' compensation is a type of insurance program that insures employees for
illnesses and injuries that arise out of the job.
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• Injured employees receive a certain portion of their wages while they are off work for the
treatment of such injury or illness, depending on state rules.
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51. What does workers compensation pay for?

Workers' comp does pay hospital and medical expenses that are necessary to diagnose
and treat your injury. But it also provides disability payments while you are unable
to work (typically, about two-thirds of your regular salary)
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52. What is a return to work policy?

• Company or organization strives to assist employees to return to work at the earliest
possible date following an injury or illness.
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• The policy only applies to regular full- and part-time employees who are on leave as a
result of injury or illness and who are receiving workers' compensation benefits.

53. What is the purpose of the return to work after injury policy?
Workers' compensation. : Return to work refers to helping injured workers with
their recovery and getting back to work. Legislation in this area provides for the safe and durable
return to work of an injured worker as early as possible allowing for their injury.

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54. Define modified duty position.
• Modified duty is also sometimes called light duty.
• An employee assigned to modified duty may perform a portion of the duties of her
regular job or a completely different job.
• Modified duty is intended to allow employees to earn a salary and perform
productive work while they continue to recover.

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55.What is the difference between light duty and modified duty?
• Light Or Modified Duty: If you are injured on the job and your doctor gave you a
note with restrictions, your employer may offer you light duty work.

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• Light (or Modified Duty) work means that your employer will place you in a less
physically demanding job until you are healed.

56. Can an employee refuses modified duty?

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If your employee refuses modified duty while she is collecting workman's compensation
payments for a work-related illness or injury, part or all of her workman's comp payments
may be withheld.

57. What does education and training do?

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Education and training. You'll be using your communication skills and knowledge to help
people develop and learn in many of these jobs. Whether you like working with children
or training people in sports, this is a sector where you can use your knowledge and skills to help
others.
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58. How do you conduct employee orientation?

• Give employees a tour of the building/workplace.
• Introduce them to key colleagues and supervisors/managers.
• Get them set up with necessary equipment.
• Review their schedule.
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• Review initial projects and expectations.

• Conduct a team-building exercise.
• Introduce them to your employee handbook.
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59. Why education and training is important?

1. Most employees have some weaknesses in their workplace skills.
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2. A training program allows you to strengthen those skills that each employee needs
to improve.
3. A development program brings all employees to a higher level so they all have
similar skills and knowledge.
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60. What are the types of training methods?
• Technology-Based Learning. Common methods of learning via technology
• Simulators. Simulators are used to imitate real work experiences.
• On-The-Job Training.
• Coaching/Mentoring.
• Lectures, Management Games, Group Discussions & Tutorials and Role Playing.

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PART-B

1. Explain about healthcare hazard control.

• Hazard control effectiveness impacts both the overt and covert cultures of any healthcare
organization. The safety culture of healthcare organizations must be recognizable by

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those served.
• Healthcare organizations seeking to maintain revenues, minimize losses, serve their
communities, and meet regulatory or accreditation requirements need effective safety

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functions.
• Rates of occupational injury to healthcare workers have risen over the past decade. Safety
issues facing healthcare organizations include needle sticks, back injuries, slips and falls,
laser hazards, chemical exposures, biological hazards, workplace violence, and
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community safety issues.
• An increased emphasis on topics such as emergency management, indoor air quality, and
patient safety indicates that safety will remain a key function in healthcare organizations.

• Effective healthcare hazard control management continues to be overlooked despite the

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number of workers employed in healthcare-related occupations.

• Advances in medical technology and clinical treatment techniques expose workers and
patients to a variety of potential hazards.
•
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The Occupational Safety and Health Administration (OSHA) continues to highlight the
importance of safety and health for all healthcare organizations including hospitals,
nursing homes, surgery centers, and physician practices

OSHA Comparative (Nonfatal)

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Incidence Rates for 2011

Industry Rate under Various ratio,Such as,
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 Private industry 3.5

 Construction 3.9
 Manufacturing 4.4
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 Health services 8.2

 Hospitals 8.5
 Nursing facilities 12.7
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1.1 INTERNATIONAL BOARD FOR CERTIFICATION OF SAFETY MANAGERS

• The International Board for Certification of Safety Managers (IBFCSM), founded in

1976 as a not-for-profit credentialing organization, operated for some time as the Board
of Certified Hazard Control Management (BCHCM).

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• The board offers qualified working healthcare professionals an opportunity to earn their
Certified Healthcare Safety Professional (CHSP), Certified Healthcare Emergency
Professional (CHEP), or Certified Patient Safety Officer (CPSO) credential.

• Many healthcare professionals hold more than one credential. The board offers CHSP
and CHEP credential holders with the opportunity to add the healthcare Fire Safety

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Management (FSM) designation to their primary certification.

• The board now offers a registration credential for frontline environmental services
personnel. The registered healthcare safety technician-environmental services (RHST-

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EVS) designation fills a vital need for a credential for those responsible for cleaning and
disinfecting healthcare facilities.

• The board also offers qualified candidates the opportunity to earn their Certified Hazard
Control
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• Manager (CHCM), Certified Hazard Control Manager-Security (CHCM-SEC), or
Certified Product Safety Manager (CPSM) credential. The IBFCSM motto, Individual
Credentials—The Key to Upgrading the Profession, reflects the impact that individual
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certifications have on improving organizational safety and hazard control functions.

1.2 HAZARD CONTROL

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IBFCSM defines a hazard as “any solid, gas, or liquid with the potential to cause harm
when interacting with an array of initiating stimuli including human-related factors.”
• The scope of a hazard can include any activity, behavior, error, event, incident,
occurrence, operation, process, situation, substance, or task with potential to cause human
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harm, property damage, risk to the environment, or a combination of all three.

• The board defines hazard closing as the process of two or more hazards or causal factors
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attempting to occupy the same space at the same time. Some hazard control professionals
refer to this interaction of causal factors as the accident generation cycle. Accidents,
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mishaps, and hazardous exposures can result in injuries, illnesses, property damage, and
work interruptions.
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• Companies, businesses, and institutions must make hazard control a priority
organizational function. Proactive hazard control can improve operational efficiency,
organizational effectiveness, and the bottom line.
• The hazard control profession should focus on using management, leadership, and
improvement principles to prevent accidents, injuries, and other losses.
• Senior leaders must ensure that organizational members promptly report accidents,

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hazards, close-call incidents, and unsafe behaviors.
• Organizations can unknowingly promote activities that do little to improve safety-related
behaviors or encourage continuous learning processes.
• Passive hazard control efforts can communicate a general awareness about the

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importance of working safely.
• Most organizations must comply with a number of safety and environmental standards.

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However, making compliance the centerpiece of hazard control efforts can send the
wrong message to many organizational members.
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2. Describe in detail about hazard control management.

• Using the phrase of hazard control management does not diminish the importance of
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safety and other disciplines such as risk management, occupational health, or
industrial hygiene.
• Hazard control management must focus on developing processes or systems that can
help prevent harm and loss. An uncorrected hazard or hazardous situation could
contribute to an event resulting in property damage, job interruption, personal harm,
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or adverse health effects.

• The process of controlling hazards may require development of written policies,
plans, or procedures. Never consider hazard control as a program but as a function of
the organization.
• The hazard control function must connect with organizational structures and
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operational philosophies

2.1 SEVEN VALUES OF HAZARD

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• Never-ending process
• People focused
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• Leadership driven
• Operational priority
• Benefits everyone
• Reduces organizational losses
• Prevents human harm
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2.2 PROGRAM OR FUNCTION

• Program comes from the French word programme, which means agenda or public notice.
We can also refer to the Greek word graphein, which means to write.

• When used with the prefix pro, it became prographein, which means to write before.
Many organizations develop written safety programs to satisfy organizational mandates

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or to demonstrate visual compliance with regulatory requirements.

• Written plans, policies, and procedures should direct the hazard control function. The
word function, first used in the early sixteenth century, denotes the concept of
performance or execution. A function can relate to people, things, and institutions.

• A function can refer to serving a designated or defined role in some manner. A function

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can also relate to participation in an ongoing cultural or social system.

• Considering hazard control as a function of the organization elevates its priority in the

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minds of everyone.

Proactive versus Reactive Hazard Control

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Proactive
Anticipates, recognizes, and identifies
hazards
Analyzes and determines risks
Controls hazards to reduce accident
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potential
Educates and encourages safe behaviors
Focuses in preventing losses
Analyzes to determine root causes
Operates to open and hidden cultures
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Reactive
Evaluates and investigates past incidents or
accidents
Uses risk management to control losses
Satisfied with reducing accident recurrence
Disciplines unsafe actions and behaviors
Accepts some losses if not too severe
Documents errors and primary causes
Responsive to formal culture expectations

Involves leaders in hazard control Leaders delegate responsibilities to others

2.3 TRADITIONAL HAZARD CONTROL ASSUMPTIONS

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• Hazard control manager retains responsibilities for solving all safety-related problems.
• Senior leaders view hazard control as a necessary expense.
• Training and education focuses on documentation and not human performance.
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• Organizational efforts focus on hazards with minimum emphasis on unsafe behaviors.

2.4 HAZARD CONTROL IS GOOD BUSINESS

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• Liberty Mutual, in its 2007 Workplace Safety Index, estimated that in 2005, employers
paid almost $1 billion per week in direct compensation costs for disabling workplace
injuries and illnesses.
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• Senior leaders must make hazard control a priority function. Proactive efforts can help
reduce workers’ compensation premiums, injury costs, and lost productivity.
• Liberty Mutual sent a survey to hundreds of chief financial officers in 2005. More than
60% of those responding to the survey indicated that they could document a return on
investment (ROI) for money allocated to hazard control– related initiatives.
• OSHA reports that the average work site participating in the OSHA Voluntary Protection
Program (VPP) documented days away, restricted, or transferred (DART) rates of 52%
below the national average for their industrial classification.

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• Organizational leaders making hazard control part of a good business initiative must
understand accidents impact their organization in the terms of cost, time, performance,
and morale. Proactive hazard control can also help achieve compliance with the myriad
of regulatory requirements placed businesses today.

2.5 HAZARD CONTROL RESPONSIBILITIES

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• Many organizations with high accident or injury rates fail to outline specific hazard
control responsibilities in their plans, procedures, directives, and job descriptions. The
concept of responsibility relates to a person’s obligation to carry out assigned duties in an

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efficient, effective, and safe manner.
• Senior leaders must ensure that managers and supervisors understand the importance of
their assigned hazard control responsibilities. Senior leaders must ensure that job
descriptions address hazard control responsibilities inherent with each position or task.
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• Hazard control efforts will yield results when leaders encourage participation and hold
key managers accountable.
• Senior leaders and hazard control managers must learn to focus on the hazards,
behaviors, and risks that pose the most potential harm.
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2.5.1 Senior Management Responsibilities

• Develop, sign, and publish an organizational hazard control policy statement.

• Describe key expectations related to accomplishing hazard control objectives.
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• Ensure that all organizational members can explain the major objectives.
• Develop methods to track progress and provide feedback to all organizational members.
• Require managers and supervisor to visibly support established objectives.

2.6 HAZARD CONTROL MANAGER RESPONSIBILITIES

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• An effective hazard control manager serves as a consultant and adviser to managers at all
operational levels. Hazard control managers must persuade management action rather
than attempt to correct every hazardous situation.
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• The need for improving hazard control efforts must remain proportional to the need for
improving other organizational functions.
• Hazard control objectives must focus on accident prevention, reducing operating costs,
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and efficiently using human and other organizational resources.

• Hazard control managers learn to compile and disseminate important safety-related
information to managers throughout the organization. Hazard control managers must
teach others about accident prevention principles and solicit their input. When seeking
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senior leader’s approval for hazard control expenditures, use a well-prepared cost–benefit
analysis document.
• Hazard control managers should anticipate opposition from certain segments within their
organization. When dealing with opposition, use effective human relation and
communication skills to persuade others to support hazard control objectives.
• Hazard control managers should know what they know and acknowledge the things they
don’t know. However, they must know where to go to find answers. Hazard control
managers must acknowledge that many operational managers and supervisors face issues

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beyond their control. Understanding this important concept can help hazard control
managers gain their respect. Conducting periodic perception surveys can reveal what
people in the organization truly think or believe about hazard control efforts

2.6.1 Hazard Control Manager Responsibilities

• Guide development of hazard control training and educational sessions.

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• Serve as the hazard control consultant and information center.
• Provide hazard control–related technical assistance as necessary.
• Provide information about legal and compliance requirements affecting safety and health.

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• Evaluate overall hazard control performance as related to established objectives or goals.
• Maintain communication with regulatory agencies and professional safety organizations.
• Oversee accident investigations, hazard analysis, and preparation of reports or summaries.
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• Monitor progress of corrective actions required to address hazards or other safety deficiencies.

2.7 SUPERVISOR INVOLVEMENT

• Supervisors must possess the knowledge and experience to provide hazard control
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guidance to those they lead. First-line supervisors occupy a key hazard control position in
many organizations.
• This position of trust can require supervisors to conduct area inspections, provide job
training, ensure timely incident reporting, and accomplish initial accident investigations.
Supervisors in many organizations possess little control over factors such as hiring
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practices, working conditions, and equipment provided to them.

• Supervisors must understand the role that human factors can play in accident prevention
and causation.
• They must ensure that each person they supervise understands the behavior expectations
of the job. Some organizations require employees to sign a safe work agreement. Such an
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agreement requires the individual to commit to working safely and adhere to

organizational policies or procedures. Supervisors must ensure that their subordinates can
access all hazard control plans, policies, and procedures.
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2.7.1 Supervisor Responsibilities

• Enforce work rules and correct unsafe or at-risk behaviors.

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• Implement hazard control policies, procedures, and practices in their areas.

• Provide job or task-related training and education.
• Immediately report and investigate all accidents in their work areas.
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• Conduct periodic area hazard control and safety inspections.
• Ensure proper maintenance and servicing of all equipment and tools.
• Lead by example and personally adhere to hazard control requirements.
• Conduct safety and hazard control meetings on a regular basis.
• Work with organizational hazard control personnel to correct and control hazards.
• Ensure all personnel correctly use required PPE.

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3.List out hazard analysis. Explain it.

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• Organizations can use a variety of processes to analyze workplace hazards and accident
causal factors. Hazard evaluations and accident trend analysis can help improve the
effectiveness of established hazard controls.
•

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Routine analysis enables an organization to develop and implement appropriate controls
for hazardous processes or unsafe operations. Analysis processes rely on information
collected from hazard surveys, inspections, hazard reports, and accident investigations.
• This analysis process can provide a snapshot of hazard information. Effective analysis
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can then take the snapshots and create viable pictures of hazards and accident causal
factors.

3.1 CHANGE ANALYSIS

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• Change analysis helps hazard control personnel identify hazards inherent in new
processes and job related tasks. Change analysis actually works as a proactive problem-
solving technique. To solve a problem, hazard control personnel must look at situations
using some type of logic process.
• Change analysis must attempt to identify all anticipated hazards and concerns generated
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by the change. Begin by defining a problem or concern. Attempt to determine what

happened. Next, determine the norm or standard.
• Attempt to identify, locate, and describe the change by focusing on what, where, when,
and to some extent how. Describe exactly the things impacted and things not affected by
the change. Identify distinctive features of any change and list all possible causes.
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• Finally, select and validate all causes before continuing with corrections or controls.

3.2 CREATIVE HAZARD ANALYSIS

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• Creative hazard analysis combines innovation with human expertise to identify, discover,
and analyze hazards of a process, operation, or system. Ensure the analysis team
understands the problem statement. Provide the team with sufficient information such as
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known hazards, related technologies, operational procedures, equipment design issues,

instrumentation controls, and necessary historical information.
• As the team works through each step of the hazard process, it should collectively
generate a list of what or why questions related to hazards. After completing this list of
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probing questions, the team must systematically answer each question. This process can
provide answers that can help achieve consensus. The answers can also generate
additional questions that seek to clarify important information. The use of intuitive
questions and answers provides insight for all team members.
• The team then works to achieve a consensus on each question and answer. The answers
that achieve consensus form the foundation for developing recommendations or dictating
the requirement for additional action or study. The team then can make recommendations
to reduce operational hazards.

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3.3 RISK ANALYSIS

• Risk analysis helps hazard control personnel assess the probability that an uncontrolled
hazard could contribute to an accident event with resulting organizational losses.
• Risk assessments must also consider the potential severity associated with an adverse
event occurrence. Analysis personnel should use available empirical data when

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attempting to determine probability of a risk-related event.
• Severity consideration should become the controlling issue when other factors indicate a
low probability of an event. Risk personnel can consider hazards with acceptable risks as

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safe and those with unacceptable risks as unsafe.
• The phrase “safety first” makes a great sounding slogan and many organizations use it.
Taken literally, the slogan implies that safety becomes the primary objective and not job
or task accomplishment. However, in many very hazardous jobs and operations, a more
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appropriate slogan should read, “accomplish the job with safety.”

3.4 PHASE HAZARD ANALYSIS

• Phase hazard analysis processes work very well for construction projects and other
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settings with rapidly changing work environments. Consider phase hazards as a new or
unique set of hazards not present during operations.
• Prior to transitioning to a new phase, conduct an analysis to identify and evaluate new or
potential hazards. Use the information gained through analyses to develop action plans
that can ensure implementation of appropriate controls.
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3.5 PROCESS HAZARD ANALYSIS

• The OSHA Process Safety Management standard requires completion of a process hazard
analysis for any activity involving the use of highly hazardous chemicals. The OSHA
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standard applies to entities using, storing, manufacturing, handling, or on-site moving of

highly hazardous chemicals.
• Process hazard analysis permits employers to accomplish detailed studies to identify
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every potential hazard. The analysis must include all tools and equipment, each chemical
substance, known hazards, and every job-related task.
• The analysis must show that each element of the process poses no hazard, poses an
uncontrolled hazard, or poses a hazard controllable in all foreseeable circumstances.
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Recommend using process hazard analysis during the design and development phases of
any hazardous project or operation under development.
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3.6 JOB HAZARD ANALYSIS

• Job hazard analysis (JHA) permits the examination of job-related tasks, operations, and
process to discover and correct inherent risks and hazards. Supervisors and other
experienced personnel can perform the process by working sequentially through the steps
of a job process or task.
• JHA can help tools, machines, and materials used to perform a job. JHA does require an
understanding of potential job hazards. Personnel conducting the analysis must possess

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knowledge of hazard control including use of PPE. A well-developed JHA can also serve
as an effective teaching tool.
• Organizations should develop a JHA for all tasks, processes, or phase-related jobs.
Conduct and update a JHA when a process changes or an accident occurs. Recommend
that each organization develops standardized procedures and formats for conducting the
analysis.
• An effective analysis provides the basis for developing and implementing appropriate

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control measures. Post analysis results at appropriate workstations and other job or
process locations

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3.6.1 Job Hazard Analyses

Step A: Break the job down—Examine each step in the process for hazards or unsafe conditions
that could develop during job accomplishments.
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Step B: Identify hazards—Document process hazards, environmental concerns, and any
anticipated human issues.
Step C: Evaluate hazards—Assess identified hazards and behaviors to determine their potential
roles in an accident event.
Step D: Develop and design hazard controls—Develop or design the best hazard control based
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on evaluating each hazard. Coordinate implementation of all feasible controls
Step E: Implement required controls—Coordinate and obtain management approval for
implementation
Step F: Revise and publish the JHA information—Update the JHA and then communicate
implementation actions with the organizational members
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3.7 JOB DESIGN

• Creating well-designed jobs, tasks, and processes can help reduce worker fatigue, reduce
repetitive motion stress, isolate hazardous tasks, and control human factor hazards. The
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concept of job design refers primarily to administrative changes that help improve
working conditions.
• Designing safe work areas must address workstation layout, tools and equipment, and the
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body position needed to accomplish the job.

• Safe work area design reduces static positions and minimizes repetitive motions and
awkward body positions. Consider the importance of human factor issues when designing
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work processes.
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4.Explain the concept of hierarchies of controlling hazard in hazard control and correction.

• Organizations must use the concept known as hierarchy of controls to reduce, eliminate,
and control hazards or hazardous processes. Hazard controls can also include actions
such as using enclosure, substitution, and attenuation to reduce human exposure risks.
An enclosure keeps a hazard physically away from humans.
• For example, completely enclosing high-voltage electrical equipment prevents access by

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unauthorized persons. Substitution can involve replacing a highly dangerous substance
with a less hazardous one.
• Attenuation refers to taking actions to weaken or lessen a potential hazard. Attenuation
could involve weakening radioactive beams or attenuating noise to safer levels.
• The use of system safety methods, traditional hazard control techniques, and human
factors must begin at the initial stages of any design process.

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4.1 HAZARD CORRECTION MONITORING SYSTEM

• Implement a system to report and track hazards correction actions.

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• Establish a timetable for implementing hazard controls.
• Prioritize hazards identified by inspections, reporting, and accident investigations.
• Require employees to report hazards using established processes.
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• Provide quick feedback about the status of hazard correction.
• Delegate responsibility for correcting and documenting completion actions.
• Permit supervisors and experienced employees to initiate hazard correction actions.

Passive hazard controls would not require continuous or even occasional actions from
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system users. Active controls would require operators and users to accomplish a task at some
point during the operation to reduce risks and control hazards

• Obstacles preventing the safe movement of people, vehicles, or machines

• Blocked or inadequate egress routes and emergency exits
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• Unsafe working and walking surfaces

• Using worn or damaged tools and equipment or misusing tools
• Failing to identify hazards and provide proper equipment including PPE
• Operating equipment with guards removed or bypassed
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• Permitting the presence of worn, damaged, or unguarded electrical wiring, fixtures, or cords
• Lack of or inadequate warning, danger, or caution sign in hazardous areas
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4.2 ENGINEERING CONTROLS

• Seek to eliminate hazards by using appropriate engineering controls. Make the
modifications as necessary to eliminate hazards and unsafe conditions. The design of
machine guards, automobile brakes, traffic signals, pressure relief valves, and ventilation
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demonstrates engineering controls at work.

• For example, proper ventilation can remove or dilute air contaminants in work areas. Air
cleaning devices can also remove contaminants such as particulates, gases, and vapors
from the air.
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• Using engineering, design, and technical innovation remains the top priority for
controlling or eliminating hazards. Establishing preventive and periodic maintenance
processes can help ensure tools and equipment operate properly and safely.
• Preventive maintenance must also address engineered hazard controls and emergency
equipment. If needed, schedule shutdowns to address preventive and predictive
maintenance issues. Ensure the preventive maintenance addresses safety and hazard
control issues as well as operational or production requirements.

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4.3 ADMINISTRATIVE CONTROLS
• Use administrative controls such as scheduling to limit worker exposure to many
workplace hazards such as working in hot areas. However, OSHA prohibits employee
scheduling to meet the requirement of air contaminant exposure limits.
• The scheduling of maintenance and other high exposure operations during evenings or
weekends can reduce exposures. Use job rotation to limit repetitive motion tasks or
reduce the exposure time to occupational noise hazards. Use a work–rest schedule for

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very hazardous or strenuous tasks.

4.4 WORK PRACTICE CONTROLS

• These controls can reduce hazard exposure through development of standard operating

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procedures (SOPs). Another important work practice relates to conducting training and
education about the safe use of tools and equipment.
• Practices can also include knowing emergency response procedures for spills, fire
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prevention principles, and dealing with employee injuries.
• Job-related education and training helps individuals work safely and minimize hazard
exposure risks. Work practice controls must address task accomplishment and ensure
workers understand all job-related hazards.
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4.5 HIERARCHIES FOR CONTROLLING HAZARDS
• Engineering and technological innovation remains the preferred type of hazard control.
• Substitution results in using a less hazardous substance or piece of equipment.
• Isolation moves either workers or hazardous operations to reduce risks.
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• Work practices such as policies or rules can reduce human exposure to the hazard.
• Administrative controls limit human exposures through the rotation and scheduling.
• Consider PPE when other controls prove inadequate.
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5.Discuss about Personal Protective Equipment (PPE) with tools.

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• Consider the use of appropriate PPE and clothing when engineering, administrative, and
work practice controls fail to provide adequate or mandated protection for individuals
exposed to hazards and unsafe conditions. OSHA can require PPE to protect the eyes,
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face, head, and extremities.

• Examples can include protective clothing, respiratory devices, protective shields, and
barriers. When employees provide their own PPE, the employer must ensure its
adequacy, including proper maintenance, and sanitation. Employers must assess the
workplace to determine hazards that would require the use of PPE.
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• Employers must select and require the use of PPE that will protect from the hazards
identified in the PPE hazard assessment. OSHA requires the employer to verify
completion of the assessment through a written certification that identifies the workplace,
certifying person, and assessment date. Never permit use of defective or damaged PPE.
• Train employees on the proper selection and use of PPE. Employees must demonstrate
the ability to use PPE properly before using it on the job. Provide retraining whenever
employees fail to demonstrate an understanding of proper PPE use.
• Never use PPE as a substitute for engineering, work practice, or administrative controls.

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• Consider PPE as all clothing and other work accessories designed to create a hazard
protection barrier. PPE should comply with applicable American National Standards
Institute (ANSI) standards.
• Using PPE can create hazards such as heat disorders, physical stress, impaired vision, and
reduced mobility. Review PPE policies at least annually. The review should include
evaluation of accident and injury data, current hazard exposures, training effectiveness,
and documentation procedures.

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• The employer must verify that affected employees receive and understand required
training through a written certification that contains the name of each employee, dates of
training, and topics covered.

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• Employers in most situations must provide PPE mandated by OSHA at no cost to
employees. OSHA does not require employers to pay for non specialty safety-toe
footwear including steel-toe shoes or boots and non specialty prescription safety eyewear
if employees wear them away from job site.
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• The employer must pay for replacement PPE, except when the employee loses or
intentionally damages PPE. When employees provide their own PPE, employers may
permit use. OSHA does not require reimbursement to the employee for that equipment.
Employers cannot require employees to provide their own or pay for PPE.
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5.1 EYE AND FACE PROTECTION
• Refer to 29 Code of Federal Regulations (CFR) 1910.133 for OSHA standards covering
eye and face protection requirements. Employers must provide suitable eye protection
when flying particles, molten metal, liquid chemicals, acids or caustic liquids, chemical
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gases or vapors, potentially injurious light radiation, or any combination hazard exists in
the workplace.
• Protective eye and face devices must comply with ANSI Z-87, Occupational and
Educational Eye and Face Protection.
• Eye protectors must prove adequate against particular hazards with a reasonably
comfortable fit when worn under designated conditions. Protectors must demonstrate
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durability and fit snugly without interfering with the movements or vision of the wearer.
Finally, keep eye protectors disinfected and in good repair.
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5.2 HEAD PROTECTION

• Refer to 29 CFR 1910.135 for information about OSHA head protection. Ensure workers
wear appropriate head protection that can resist penetration and absorb the shock of
blows. Evaluate the need for using protective hats to protect against electric shock.
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• OSHA requires head protection hats to meet the requirement of ANSI Z-89.1, Industrial
Head Protection, and Z-89.2, Requirements for Industrial Protective Helmets for
Electrical Workers.
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• Each type and class of head protector must provide protection against specific hazardous
conditions. An understanding of these conditions will help in selecting the right hat for
the particular situation.

5.3 FOOT PROTECTION

• Refer to 29 CFR 1910.136 for OSHA standards addressing foot protection. Select safety
shoes made of sturdy materials with impact-resistant toes. Some shoes contain metal
insoles that protect against puncture wounds.
• Additional protection in the form of metatarsal guards can provide additional protection.

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Today’s safety shoes come in a variety of styles and materials.
• Classification of safety shoes relates directly to their ability to meet requirements of
compression and impact tests.
• Protective footwear must comply with the requirements found in the ANSI Z-41.1
Standard.

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5.4 ARM AND HAND PROTECTION
• Refer to 29 CFR 1910.137 for OSHA standards addressing arm and hand protection.
Employers must provide appropriate protection when hazard assessments reveal

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engineering and work practice controls cannot eliminate injury risks.
• Potential hazards can include skin absorption of harmful substances, chemical or thermal
burns, electrical dangers, bruises or abrasions, cuts or punctures, fractures, and
amputations. pa
• Protective equipment can include gloves, finger guards, arm coverings, and elbow-length
gloves. Employers must evaluate the use of engineering and work practice controls
before requiring glove use.
• The nature of the hazard and the operations involved will affect the selection of gloves.
Require employees to use gloves designed for the specific hazards and tasks.
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5.5 BODY AND TORSO PROTECTION
• Certain hazards may require the use of body protection clothing or equipment. For
example, exposure to address biohazards or chemical hazards during the mixing of
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dangerous drugs would require body protection.

• However, other hazards that could pose a risk to the body include heat sources, hot metal
exposures during welding operations, hot liquids, and radiation exposures.
• Body protection clothing can vary and could include gowns, vests, jackets, aprons,
coveralls, and full bodysuits.
• Refer to manufacturer or supplier selection guides for information on the effectiveness of
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specific materials against specific hazards.

• Inspect clothing to ensure proper fit and function.
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6.Describe the accident causation theories.

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• Accidents are defined as unplanned occurrences which result in injuries, fatalities,

loss of production or damage to property and assets.
• Preventing accidents is extremely difficult in the absence of an understanding of the
causes of accidents. Many attempts have been made to develop a prediction theory of
accident causation, but so far none has been universally accepted.
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• Researchers from different fields of science and engineering have been trying to
develop a theory of accident causation which will help to identify, isolate and
ultimately remove the factors that contribute to or cause accidents

6.1 ACCIDENT CAUSATION THEORIES

The domino theory

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According to W.H. Heinrich (1931), who developed the so-called domino theory, 88% of
all accidents are caused by unsafe acts of people, 10% by unsafe actions and 2% by “acts of
God”. He proposed a “five-factor accident sequence” in which each factor would actuate the next
step in the manner of toppling dominoes lined up in a row. The sequence of accident factors is as
follows:
 ancestry and social environment
 worker fault

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 unsafe act together with mechanical and physical hazard
 accident
 damage or injury.

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In the same way that the removal of a single domino in the row would interrupt the sequence of
toppling, Heinrich suggested that removal of one of the factors would prevent the accident and
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resultant injury; with the key domino to be removed from the sequence being number 3.
Although Heinrich provided no data for his theory, it nonetheless represents a useful point to
start discussion and a foundation for future research.

Multiple causation theory

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Multiple causation theory is an outgrowth of the domino theory, but it postulates that for a single
accident there may be many contributory factors, causes and sub-causes, and that certain
combinations of these give rise to accidents. According to this theory, the contributory factors
can be grouped into the following two categories:
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 Behavioural. This category includes factors pertaining to the worker, such as improper
attitude, lack of knowledge, lack of skills and inadequate physical and mental condition.

 Environmental. This category includes improper guarding of other hazardous work

elements and degradation of equipment through use and unsafe procedures.
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The major contribution of this theory is to bring out the fact that rarely, if ever, is an accident the
result of a single cause or act.
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The pure chance theory

According to the pure chance theory, every one of any given set of workers has an equal chance
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of being involved in an accident. It further implies that there is no single discernible pattern of
events that leads to an accident. In this theory, all accidents are treated as corresponding to
Heinrich’s acts of God, and it is held that there exist no interventions to prevent them.

Biased liability theory

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Biased liability theory is based on the view that once a worker is involved in an accident, the
chances of the same worker becoming involved in future accidents are either increased or
decreased as compared to the rest of workers. This theory contributes very little, if anything at
all, towards developing preventive actions for avoiding accidents.

Accident proneness theory

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Accident proneness theory maintains that within a given set of workers, there exists a subset of
workers who are more liable to be involved in accidents. Researchers have not been able to
prove this theory conclusively because most of the research work has been poorly conducted and
most of the findings are contradictory and inconclusive. This theory is not generally accepted. It
is felt that if indeed this theory is supported by any empirical evidence at all, it probably accounts
for only a very low proportion of accidents without any statistical significance.

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The energy transfer theory

Those who accept the energy transfer theory put forward the claim that a worker incurs injury or
equipment suffers damage through a change of energy, and that for every change of energy there

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is a source, a path and a receiver. This theory is useful for determining injury causation and
evaluating energy hazards and control methodology. Strategies can be developed which are
either preventive, limiting or ameliorating with respect to the energy transfer.
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Control of energy transfer at the source can be achieved by the following means:
 elimination of the source
 changes made to the design or specification of elements of the work station
 preventive maintenance.
The path of energy transfer can be modified by:
 enclosure of the path
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 installation of barriers
 installation of absorbers
 Positioning of isolators.
The receiver of energy transfer can be assisted by adopting the following measures:
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 limitation of exposure
 Use of personal protective equipment.

The “symptoms versus causes” theory

The “symptoms versus causes” theory is not so much a theory as an admonition to be heeded if
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accident causation is to be understood. Usually, when investigating accidents, we tend to fasten

upon the obvious causes of the accident to the neglect of the root causes. Unsafe acts and unsafe
conditions are the symptoms—the proximate causes—and not the root causes of the accident.
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6.2 STRUCTURE OF ACCIDENTS

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The belief that accidents are caused and can be prevented makes it imperative for us to study
those factors which are likely to favour the occurrence of accidents. By studying such factors, the
root causes of accidents can be isolated and necessary steps can be taken to prevent the
recurrence of the accidents. These root causes of accidents can be grouped as “immediate” and
“contributing”.
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The immediate causes are unsafe acts of the worker and unsafe working conditions. The
contributing causes could be management-related factors, the environment and the physical and
mental condition of the worker. A combination of causes must converge in order to result in an
accident.

The structure of accidents, including the details of immediate causes, contributing causes, types
of accidents and results of accidents. This accounting is not exhaustive by any means. However,

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an understanding of the “cause and effect” relation of the accident-causing factors is required
before continuous improvement of safety processes can be undertaken.

7.How can prevent the fatal events. Explain.

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Here are six ways prevent accidents in the workplace:

1. Always be alert. There’s a reason why many workers insist upon that morning coffee.

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Being awake and alert isn’t just important in order to complete tasks adequately, but it also
helps to keep both you and your co-workers out of harm’s way. According to Julian Hall
on Character-Training.com, “most of the people who become involved with accidents at
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work are those who feel sleepy while working.”

2. Don’t rush your work. In many workplaces, time is of the essence. Employees are given
deadlines that they must meet, so there is often a sense of urgency when it comes to
completing certain tasks. It’s important, however, to take the appropriate amount of time to
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perform your duties safely. On Arbill.com, it is explained that “it’s natural to want to get the
job finished on schedule — or even ahead of time — but with a ‘get it done quick’ attitude,
accidents happen.”

3. Wear required safety gear. Many jobs require uniforms. But the jobs that require the
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wearing of safety equipment are the ones where dress codes are the most important. “A
person who works in a factory has a greater chance of being involved in an accident at
work,” reminds Hall, “Thus, he should be more vigilant about the wearing of proper
uniforms and other protective garments when working. Never take safety to chance so
always go to work with the proper dress code.”
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4. Follow instructions to a tee. Sometimes, workers get complacent. It’s easy to fall into
the trap of assuming that you’re an expert at your job, so you don’t need to follow every last
instruction. However, paying attention to detail can help you to avoid making mistakes that
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can lead to injury. “Don’t take shortcuts,” insists Arbill.com, “stick to the instructions and
work with diligence and awareness of your surroundings.”
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5. Pay attention to and follow emergency drills. Workers also tend to take safety drills for
granted. If they’re not “the real thing”, they often go through the motions carelessly.
However, participation in such drills couldn’t be more important. As Hall points out, these
emergency drills are conducted for the purpose of teaching employees what to do in the
event of an emergency and so that they can avoid accidents.
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6. Insist upon proper training. This is especially important if you plan on taking on a job
that may present a number of risks. Knowing exactly what you’re in for and how to react
during emergency situations is imperative for your safety. “It is stupid for anyone to take on
a high-risk job especially if he has not been trained for the job,” states Arbill.com, “Imagine
an untrained person doing the job of a fireman? Doing this will not only expose you to a
great danger but will expose other people to danger as well.”

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8.Explain about accident investigation and prevention.

An accident is defined as "an undesired, unplanned event resulting in physical injury or

damage to property." A near miss is defined as "an event that doesn’t result in injury or damage,

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but has the potential to do so."

Investigating the cause of accidents and/or near misses is one tool in a comprehensive
accident-prevention program. If an effective accident investigation is conducted, lessons can be

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learned and similar incidents can be avoided in the future.

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The basic elements of an effective accident-investigation program include:

 Immediately reporting all accidents and near misses to the company

 Having an effective accident-reporting form
 Assigning responsibilities for conducting the accident investigation and reporting the
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findings to the company
 Determining root cause(s)
 Identifying corrective actions and ensuring they are completed
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The 1st element – Immediately Reporting All Accidents – is vital for your company to have an
effective accident investigation program because common sense tells us that an accident has to
be reported before it can be investigated. Any delay in reporting an accident may hinder the
investigation because evidence at the scene of the accident can become disturbed and witnesses'
memories can fade over time.
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The 2nd element – Having an Effective Accident-Reporting Form – helps ensure proper
information is collected during the investigation. Sample forms can be obtained from your
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agribusiness risk management consultant at Nationwide or by contacting Vickie Kilgore directly.

The 3rd element – Assigning Accident Investigation Responsibilities – helps ensure the accident
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investigation is conducted by someone who’s knowledgeable in the business and understands

accident prevention. It also helps ensure all necessary personnel are involved in obtaining all
pertinent information. As with any task or responsibility, if it’s not clearly assigned, it’s unlikely
to be completed.
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The 4th element – Determining Root Cause(s) – is perhaps the most critical element of an
effective accident-investigation program. Also known as Root Cause Analysis (RCA), this
element requires the investigator to not just look for the direct cause(s) of the accident, but to dig
a little deeper and also determine any indirect cause or causes. In other words, RCA helps the
investigator look beyond the employee who was "not paying attention," to see if there are other
reasons/causes for the incident. Using RCA, the investigator will be in fact-finding mode, instead
of the typical "fault-finding mode."

The 5th element - Determining the root cause is as simple as asking the question "Why?" at least

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5 times. Typically, the root cause will surface after the 5th time the question is asked.
Understanding why an event occurred is the key to developing effective recommendations for
corrective action.

An example of how RCA may be used in an accident investigation.

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Incident: Henry received a steam burn to his arm and shoulder.
Root Cause Analysis: Ask “why” 5 times. Start with the question, “Why did this incident
happen?” For every answer to that question, ask “why” again. Do this 5 times and you will have
an enormous number of possibilities.

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1. Why did Henry receive a steam burn to his arm and shoulder?
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Because the gasket blew out on a flange coupling near where he was working.

2. Why did the gasket blow out on the flange coupling near him?
Because the safety valve did not release the excess pressure in the steam line.
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3. Why did the safety valve fail to release?
Because it had not been inspected.

4. Why was the safety valve not inspected?

Because there was no procedure to periodically inspect the valve.
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5. Why was there no procedure to periodically inspect the safety valve?

Because no one thought it was important.

Solution: Develop a procedure to require safety valves to be periodically inspected, which

should greatly reduce the potential for the exposure.
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As this example shows, going beyond the obvious cause of the accident — gasket failure —
results in determining the underlying causes that can increase the chance of preventing a
recurrence of this incident.
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The 6th and final element – Identifying and Ensuring the Completion of Corrective Actions – is
vital to preventing repeat accidents and helping employees feel safe and respected within your
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organization. The worst thing that can happen when trying to establish a safety culture is to
conduct the accident investigation and NOT complete the corrective actions or NOT ensure they
stay in place. This is why it’s important to assign responsibility for corrective actions and to
track the progress of their completion.
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9. Discuss the categories of accident analysis.

• Accident analysis is carried out in order to determine the cause or causes of an accident
(that can result in single or multiple outcomes) so as to prevent further accidents of a
similar kind. It is part of accident investigation or incident investigation.
• These analyses may be performed by a range of experts, including forensic

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scientists, forensic engineers or health and safety advisers.
• Accident investigators, particularly those in the aircraft industry, are colloquially known
as "tin-kickers". Health and safety and patient safety professionals prefer using the term
"incident" in place of the term "accident"

9.1 ACCIDENT ANALYSIS IS PERFORMED IN FOUR STEPS:

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1. Fact gathering: After an accident happened a forensic process starts to gather all
possibly relevant facts that may contribute to understanding the accident.

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2. Fact Analysis: After the forensic process has been completed or at least delivered some
results, the facts are put together to give a "big picture." The history of the accident is
reconstructed and checked for consistency and plausibility.
3. Conclusion Drawing: If the accident history is sufficiently informative, conclusions can
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be drawn about causation and contributing factors.

4. Counter-measures: In some cases the development of counter-measures is desired or

recommendations have to be issued to prevent further accidents of the same kind.
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9.2 BASIC METHODS OF ACCIDENT ANALYSIS:

9.2.1.Causal Analysis(Root cause Analysis)

It uses the principle of causality to determine the course of events. Though people
casually speak of a "chain of events", results from Causal Analysis usually have the form
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of directed a-cyclic graphs – the nodes being events and the edges the cause-effect relations.
Methods of Causal Analysis differ in their respective notion of causation.
A root cause is defined as a factor that caused a nonconformance and should be
permanently eliminated through process improvement.
Root cause analysis is defined as a collective term that describes a wide range of
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approaches, tools, and techniques used to uncover causes of problems.

9.2.2 Approaches To Root Cause Analysis

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 Events and causal factor analysis: Widely used for major, single-event problems,
such as a refinery explosion, this process uses evidence gathered quickly and
methodically to establish a timeline for the activities leading up to the accident. Once
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the timeline has been established, the causal and contributing factors can be identified.

 Change analysis: This approach is applicable to situations where a system’s

performance has shifted significantly. It explores changes made in people, equipment,
information, and more that may have contributed to the change in performance.
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 Barrier analysis: This technique focuses on what controls are in place in the process
to either prevent or detect a problem, and which might have failed.

 Management oversight and risk tree analysis: One aspect of this approach is the use
of a tree diagram to look at what occurred and why it might have occurred.

 Kepner-Tregoe Problem Solving and Decision Making: This model provides four

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distinct phases for resolving problems:

• Situation analysis
• Problem analysis
• Solution analysis
• Potential problem analysis

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Root Cause Analysis

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1. Expert Analysis relies on the knowledge and experience of field experts. This form of
analysis usually lacks a rigorous (formal/semiformal) methodological approach. This
usually affects falsify-ability and objectivity of analyses. This is of importance when
conclusions are heavily disputed among experts.
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2. Organizational Analysis relies on systemic theories of organization. Most theories

imply that if a system's behaviour stayed within the bounds of the ideal organization then
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no accidents can occur. Organizational Analysis can be falsified and results from
analyses can be checked for objectivity. Choosing an organizational theory for accident
analysis comes from the assumption that the system to be analysed conforms to that
theory.
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9.3 MODELS:

1. Camera matching: Camera matching uses accident scene photos that show various
points of evidence. The technique uses CAD software to create a 3-dimensional model of
the accident site and roadway surface. All survey data and photos are then imported into
a three dimensional software package like 3D Studio Max. A virtual camera can be then
be positioned relative to the 3D roadway surface. Physical evidence is then mapped from
the photos onto the 3D roadway to create a three dimensional accident scene drawing.

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2. Photogrammetry: Photogrammetry is used to determine the three-dimensional geometry
of an object on the accident scene from the original two dimensional photos. The
photographs can be used to extract evidence that may be lost after the accident is cleared.
Photographs from several viewpoints are imported into software like PhotoModeler. The
forensic engineer can then choose points common to each photo. The software will
calculate the location of each point in a three dimensional coordinate system.

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3. Rectification: Photographic rectification is also used to analyze evidence that may not
have been measured at the accident scene. Two dimensional rectification transforms a

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single photograph into a top-down view. Software like PC-Rect can be used to rectify a
digital photograph.
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10. How workers compensation is maintained. Explain the concept of return to work and
modified duty positions.
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 Workers' compensation is a form of insurance providing wage replacement and medical
benefits to employees injured in the course of employment in exchange for mandatory
relinquishment of the employee's right to sue their employer for the tort of negligence.
 The trade-off between assured, limited coverage and lack of recourse outside the worker
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compensation system is known as "the compensation bargain".

 One of the problems that the compensation bargain solved is the problem of employers
becoming insolvent as a result of high damage awards.
 The system of collective liability was created to prevent that, and thus to ensure security
of compensation to the workers. Individual immunity is the necessary corollary to
collective liability.
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10.1 RETURN TO WORK PRACTICES

Employees injured on the job must return to work as soon as medically allowed. Written
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work restrictions from a medical provider outline the physical limitations for an employee’s
return to work. Restrictions are in place until the treating physician or independent medical
examiner indicates the employee has modified restrictions, or until the employee has reached a
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plateau in their healing process or “end of healing”.

Every employee who has to take days off due to a workplace injury must be notified by
their supervisor that they will be expected to return to work within restrictions prescribed by the
treating physician or independent medical examination. Each supervisor must provide a
welcoming environment for the injured employee returning to work. Supervisors will remain in
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contact with injured employees who cannot come back to work so as to maintain a positive
employer–employee relationship.
Employees returning to work after a work place injury will be assigned job tasks within
the prescribed restrictions. With the assistance of the institution risk management team (risk
manager, safety officer, worker’s compensation coordinator), human resources, and supervisor,
the institution will take the necessary steps to find work for the injured employee within the
restrictions.

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The following progression will be used for prioritizing the placement of an employee
returning to work following a workplace injury:

1. Job tasks within the injuring department

2. Job tasks within another department at the institution
3. Job tasks at another state agency or in the community

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The wages for the injured employee will be funded by the employee’s current employer at
the institution regardless of restricted duty placement location.
Workers compensation coordinators (in cooperation with UW System Administration senior
workers compensation examiners) will be in regular communication with the treating physicians

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about when the employee may return to work, the employee restrictions, any modifications over
time, and when the employee has reached an end of healing. If at any time there are questions or
concerns regarding the treating physician’s diagnosis, this team will also determine if an
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independent medical examination is needed.
The institution safety officer may be called upon to perform a job task analysis to assure the
assigned duties are within the prescribed restrictions identified by the treating physician or
independent medical examination. Job tasks may change as restrictions are modified. The safety
officer will work with the supervisor and human resources representative to identify the physical
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demands of the essential job functions. Some tasks may have to be redesigned for the return to
work to prevent further injury.
A representative from Human Resources may be called upon to assist in placement
opportunities, address benefits and other related human resource issues. Human Resources will
provide resources for seriously injured employees. Human Resources will address all
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interrelationships of the Americans with Disabilities Act, Family Medical Leave Act and
workers compensation return to work programs.
There may be unique circumstances for not bringing the employee back to work which would
require the approval of the Chief Business Officer.
productive work while they continue to recover.
This policy covers a number of scenarios relating to an Employee’s ability to return to work
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after experiencing an Injury, personal Sickness or Disability.

10.1.1 The scenarios include but are not limited to:

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• Returning to work on a regular schedule with no restrictions;

• Returning to work on a regular schedule with restrictions and receiving a Modified Duty
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Assignment, if available;
• Returning to work on a reduced schedule basis with or without restrictions and potentially
being placed in a Modified Duty assignment, if applicable.
• Inability to return to work.
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Employees who are released to return to work on a regular or reduced schedule basis but with
temporary job restrictions, as supported by medical evidence documented on the “Physician’s
Release to Return to Work” form, may be eligible for a Modified Duty assignment.
The goal of this program is to enable Employees to continue using skills and abilities
temporarily limited by Injury, Sickness or Disability when modified duty positions are available.
This shall apply to any Employee who has a temporary Injury, Sickness or Disability, that
prevents him/her from performing his/her full duties or meeting the minimum standards
established for his/her position.

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An Employee must adhere to any restrictions noted on the “Physician’s Release to Return to
Work” form even if the Employee has not missed any work.

10.1.2 Return to Work with Regular Hours and No Restrictions:

The Employee obtains the completed “Physician’s Release to Return to Work” form from
his/her Physician noting no restrictions and the ability to work his/her regularly scheduled hours.
This form must be presented to the Supervisor and Human Resources upon the Employee’s

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return to work.

10.1.3 Return to Work with Restrictions:

Restrictions noted by the Physician on the “Physician’s Release to Return to Work”

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form may be:
 Restricted duties (For example, limitations on lifting, walking, stooping, bending, etc.),
and/or Return to Work/Inability to Return to Work Policy .
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 Restricted number of hours worked per day or per week, with or without limitations on
the duties performed.

10.1.4 Inability to Return to Work:

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• If the Employee is unable to return to work, with or without restrictions, as noted on the
“Physician’s Release to Return to Work” form or the “Certification of Health Care
Provider” form, the Employee must notify Human Resources as soon as possible, and
may be required to provide periodic updates from his/her Physician every 30 days.
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• In conjunction with such review, the Employee may be required to submit to a periodic
physical examination as a condition of continued leave.
• While off work, it is the responsibility of the Employee to supply Human Resources with
a current telephone number (listed or unlisted), email address and a mailing address
where the Employee can be reached.
•
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The Employee will notify Human Resources as soon as practicable of all changes in
medical condition.
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10.2 MODIFIED DUTY POSITIONS

 Modified duty is also sometimes called light duty. An employee assigned to modified
duty may perform a portion of the duties of her regular job or a completely different job.
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 Modified duty is intended to allow employees to earn a salary and perform If restrictions
as noted on the Physician’s Release to Return to Work form or “Certification of Health
Care Provider” form are determined to be permanent, the Employee is not eligible for a
Modified Duty assignment.
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 Modified Duty is an assignment which is for a specified and limited period and fulfills a
necessary job function, appropriate to the Employee’s skills and level of experience as
determined by the Employer, and which the Employee can perform without violating any
medical restriction imposed as a result of a temporary Disability, Sickness or Injury, for
which the Employee is compensated at his or her normal rate of pay and benefits.

 Modified duty assignments are not a matter of right. The number, availability and

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duration of such assignments are limited by departmental needs as defined by the
department head or designee.

10.2.1 Limitation of Modified Duty Assignment:

The Modified Duty assignment ends on the earliest of:

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1. The date the Employee is released to his/her regular schedule with no restrictions as
evidenced on the Physician’s Release to Return to Work form;
2. The date the Physician determines the Employee has permanent restrictions;

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3. The date the Maximum Assignment Period ends;
4. The date the Employee fails to take a required medical examination, without good cause.
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10.2.2 Maximum Assignment Period:

For full-time employees, no Modified Duty assignment may last for a cumulative period
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exceeding 1,560 work hours excluding any hours charged to over-time on on-call pay. For part-
time benefited employees, no Modified Duty assignment may last for a cumulative period
exceeding work hours equivalent to the hours the employee would normally be scheduled to
work in a 39 work week period.
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For part time non-benefited and temporary employees, no Modified Duty assignment may last
for a cumulative period exceeding such as

1) the duration of the employee’s appointment, or

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2) 90 calendar days.

 Assignment to a Modified Duty assignment does not in any way create a right for
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the Employee to occupy that or any other position on a regular basis.

 At the end of the Modified Duty assignment, if an Employee is unable to return to
work without restrictions, he/she may be placed on the appropriate leave.
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11.Illustrate about Orientation, education and training.

Education and training are important tools for informing workers and managers about
workplace hazards and controls so they can work more safely and be more productive. Another
role of education and training, however, is to provide workers and managers with a greater
understanding of the safety and health program itself, so that they can contribute to its
development and implementation.

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Education and training provides employers, managers, supervisors, and workers with:

 Knowledge and skills needed to do their work safely and avoid creating hazards that
could place themselves or others at risk.
 Awareness and understanding of workplace hazards and how to identify, report, and
control them.

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 Specialized training, when their work involves unique hazards.

Additional training may be needed depending on the roles assigned to employers or

individual managers, supervisors, and workers. For example, employers, managers, and

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supervisors may need specific training to ensure that they can fulfill their roles in providing
leadership, direction, and resources for the safety and health program. Workers assigned specific
roles in the program (e.g., incident investigation team members) may need training to ensure
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their full participation in those functions.

Effective training and education can be provided outside a formal classroom setting. Peer-to-peer
training, on-the-job training, and worksite demonstrations can be effective in conveying safety
concepts, ensuring understanding of hazards and their controls, and promoting good work
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practices.
OET is an important tool for informing workers and managers about workers and
managers about workplace hazards and controls so they can work more safely and be more
production. It provides workers and managers with a greater understanding of the safety and
health program itself, so that they can contribute to its development and implementation.
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An orientation at the very beginning of their employment is an important tool in helping

new staff members understand and adjust to the organization and their jobs, and to become
effective as soon as possible.

•
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Provide adequate sessions

• Training and hazard control
• Training methods
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• Off-the-job safety education

• Instructional system design
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11.1 PROVIDE ADEQUATE SESSIONS

• It provide program awareness training

• Provide training to all Managers, supervisors, and workers and contractor, sub contractor
and temporary agency.
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• The session must provide:
 Safety and health policies, goals and procedures.
 Functions of safety and health program
 How to report hazards, injuries, illnesses and close calls/near misses.
 Whom to contact with questions and answers.
 What to do in an emergency
 The employer’s responsibilities under the program.
 Worker’s rights under the Occupational Safety and Health Act (OSHA)

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Provide information on the safety and health hazards of the workplace. Ensure that training is
provided in the comfortable languages.

 Conducting learning sessions outside of the office: Offer employees taster

sessions of your virtual resources which can be accessed from anywhere – even at
home.

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 Using gamification: Training sessions can be dull but there’s no reason why you
can’t be playful. It suggests “Depending on your budget you can help employees
study for a test in a digital game”.
 Introducing competition: If you’re sending large groups for training try

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gamifying through an escape room where small teams compete against one another to
answer questions to escape the room in the fastest time.
 Making sure they’re heard: Allow your employees to show their feedback in the
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office. “It can be an empowering reminder that their development is a top priority for
the organisation,” says the report.
 Allow your employees to ask ‘stupid’ questions and giving them the platform
in which to do so (discreetly): Some may say that there is no such thing as a stupid
question. And you’d rather a staff member asks than to be too embarrassed to do so
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and get the task wrong. If you do, however, have some shy staffers then let them
submit questions anonymously, suggests the report.

11.2 TRAINING AND HAZARD CONTROL

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Providing workers with an understanding of hazard recognition and control and actively
involving them in the process can help to eliminate hazards before an incident occurs.
How to accomplish it
• Train workers on techniques for identifying hazards, such as job hazard analysis
• Train workers so they understand and can recognize the hazards they may encounter
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in their own jobs, as well as more general work-related hazards.

• Instruct workers on concepts and techniques for controlling hazards, including the
hierarchy of controls and its importance.
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• Train workers on the proper use of work practice and administrative controls.
• Train workers on when and how to wear required personal protective equipment.
• Provide additional training, as necessary, when a change in facilities, equipment,
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processes, materials, or work organization could increase hazards, and whenever a

worker is assigned a new task.
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11.2.1 Off-the-job safety education
Additional training may be needed to ensure that workers can incorporate any assigned
safety and health responsibilities into their daily routines and activities.
How to accomplish it
• Instruct workers on how to report injuries, illnesses, incidents, and concerns. If a
computerized reporting system is used, ensure that all employees have the basic computer
skills and computer access sufficient to submit an effective report.
• Instruct workers assigned specific roles within the safety and health program on how they

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should carry out those responsibilities, including:
o Hazard recognition and controls
o Participation in incident investigations
o Program evaluation and improvement
• Provide opportunities for workers to ask questions and provide feedback during and after
the training.

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• As the program evolves, institute a more formal process for determining the training
needs of workers responsible for developing, implementing, and maintaining the
program.

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11.2.2 Instructional system design

Employers, managers, and supervisors are responsible for workers' safety, yet sometimes
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have little training on safety-related concepts and techniques. They may benefit from specific
training that allows them to fulfill their leadership roles in the program.
How to accomplish it
• Reinforce employers, managers, and supervisors' knowledge of their responsibilities
under the Occupational Safety and Health Act and the workers' rights guaranteed by
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the Act.
• Train employers, managers, and supervisors on procedures for responding to workers'
reports of injuries, illnesses, and incidents, including ways to avoid discouraging
reporting.
• Instruct employers, managers, and supervisors on fundamental concepts and
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techniques for recognizing hazards and methods of controlling them, including the
hierarchy of controls
• Instruct employers, managers, and supervisors on incident investigation techniques,
including root cause analysis.
11.2.3 Methods of Training: On-the-job Training Method and Off-the-Job Methods!
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 Management development is a systematic process of growth and development by which

the managers develop their abilities to manage. It is concerned with not only improving
the performance of managers but also giving them opportunities for growth and develop-
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ment.
 There are two methods through which managers can improve their knowledge and skills.
One is through formal training and other is through on the job experiences. On the job
training is very important since real learning takes place only when one practices what
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they have studied.

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11.3 ON-THE-JOB TRAINING (OJT) METHODS:

This is the most common method of training in which a trainee is placed on a specific job
and taught the skills and knowledge necessary to perform it.

The advantages of OJT are as follows:

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1. On the job method is a flexible method.
2. It is a less expensive method.
3. The trainee is highly motivated and encouraged to learn.
4. Much arrangement for the training is not required.

11.3.1 On-the-job training methods are as follows:

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1. Job rotation:
This training method involves movement of trainee from one job to another gain knowledge and
experience from different job assignments. This method helps the trainee understand the
problems of other employees.

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2. Coaching:
Under this method, the trainee is placed under a particular supervisor who functions as a coach in
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training and provides feedback to the trainee. Sometimes the trainee may not get an opportunity
to express his ideas.

3. Job instructions:
Also known as step-by-step training in which the trainer explains the way of doing the jobs to the
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trainee and in case of mistakes, corrects the trainee.

4. Committee assignments:
A group of trainees are asked to solve a given organizational problem by discussing the problem.
This helps to improve team work.
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5. Internship training:
Under this method, instructions through theoretical and practical aspects are provided to the
trainees. Usually, students from the engineering and commerce colleges receive this type of
training for a small stipend.
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11.3.2 Off-the-job Methods:

On the job training methods have their own limitations, and in order to have the overall
development of employee’s off-the-job training can also be imparted. The methods of training
which are adopted for the development of employees away from the field of the job are known as
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off-the-job methods.

The following are some of the off-the-job techniques:

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1. Case study method:

Usually case study deals with any problem confronted by a business which can be solved by an
employee. The trainee is given an opportunity to analyse the case and come out with all possible
solutions. This method can enhance analytic and critical thinking of an employee.
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2. Incident method:
Incidents are prepared on the basis of actual situations which happened in different organizations
and each employee in the training group is asked to make decisions as if it is a real-life situation.
Later on, the entire group discusses the incident and takes decisions related to the incident on the
basis of individual and group decisions.

3. Role play:

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In this case also a problem situation is simulated asking the employee to assume the role of a
particular person in the situation. The participant interacts with other participants assuming
different roles. The whole play will be recorded and trainee gets an opportunity to examine their
own performance.

4. In-basket method:
The employees are given information about an imaginary company, its activities and products,

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HR employed and all data related to the firm. The trainee (employee under training) has to make
notes, delegate tasks and prepare schedules within a specified time. This can develop situational
judgments and quick decision making skills of employees.

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5. Business games:
According to this method the trainees are divided into groups and each group has to discuss
about various activities and functions of an imaginary organization. They will discuss and decide
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about various subjects like production, promotion, pricing etc. This gives result in co-operative
decision making process.

6. Grid training:
It is a continuous and phased programme lasting for six years. It includes phases of planning
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development, implementation and evaluation. The grid takes into consideration parameters like
concern for people and concern for people.
7. Lectures:
This will be a suitable method when the numbers of trainees are quite large. Lectures can be very
much helpful in explaining the concepts and principles very clearly, and face to face interaction
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is very much possible.

8. Simulation:
Under this method an imaginary situation is created and trainees are asked to act on it. For e.g.,
assuming the role of a marketing manager solving the marketing problems or creating a new
strategy etc.
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9. Management education:
At present universities and management institutes gives great emphasis on management
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education. For e.g., Mumbai University has started bachelors and postgraduate degree in
Management. Many management Institutes provide not only degrees but also hands on
experience having collaboration with business concerns.
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10. Conferences:
A meeting of several people to discuss any subject is called conference. Each participant
contributes by analyzing and discussing various issues related to the topic. Everyone can express
their own view point.
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12. Explain about Hazard Prevention and Control.
Effective controls protect workers from workplace hazards; help avoid injuries, illnesses,
and incidents; minimize or eliminate safety and health risks; and help employers provide workers
with safe and healthful working conditions. The processes described in this section will help
employers prevent and control hazards identified in the previous section.

To effectively control and prevent hazards, employers should:

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 Involve workers, who often have the best understanding of the conditions that create
hazards and insights into how they can be controlled.
 Identify and evaluate options for controlling hazards, using a "hierarchy of controls."
 Use a hazard control plan to guide the selection and implementation of controls, and
implement controls according to the plan.
 Develop plans with measures to protect workers during emergencies and nonroutine

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activities.
 Evaluate the effectiveness of existing controls to determine whether they continue to
provide protection, or whether different controls may be more effective. Review new
technologies for their potential to be more protective, more reliable, or less costly.

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Action item 1: Identify control options
Action item 2: Select controls pa
Action item 3: Develop and update a hazard control plan
Action item 4: Select controls to protect workers during non routine operations and emergencies
Action item 5: Implement selected controls in the workplace
Action item 6: Follow up to confirm that controls are effective
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Action item 1: Identify control options

A wealth of information exists to help employers investigate options for controlling

identified hazards. Before selecting any control options, it is essential to solicit workers' input on
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their feasibility and effectiveness.

How to accomplish it
Collect, organize, and review information with workers to determine what types of hazards may
be present and which workers may be exposed or potentially exposed. Information available in
the workplace may include:
 Review sources such as OSHA standards and guidance, industry consensus standards,
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National Institute for Occupational Safety and Health (NIOSH) publications, manufacturers'
literature, and engineering reports to identify potential control measures. Keep current on
relevant information from trade or professional associations.
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 Investigate control measures used in other workplaces and determine whether they would be
effective at your workplace.
 Get input from workers who may be able to suggest and evaluate solutions based on their
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knowledge of the facility, equipment, and work processes.

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Action item 2: Select controls

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Employers should select the controls that are the most feasible, effective, and permanent.

How to accomplish it
• Eliminate or control all serious hazards (hazards that are causing or are likely to cause
death or serious physical harm) immediately.
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• Use interim controls while you develop and implement longer-term solutions.
• Select controls according to a hierarchy that emphasizes engineering solutions
(including elimination or substitution) first, followed by safe work practices,
administrative controls, and finally personal protective equipment.
• Avoid selecting controls that may directly or indirectly introduce new hazards.
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Examples include exhausting contaminated air into occupied work spaces or using
hearing protection that makes it difficult to hear backup alarms.
• Review and discuss control options with workers to ensure that controls are feasible
and effective.
• Use a combination of control options when no single method fully protects workers.
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Action item 3: Develop and update a hazard control plan

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A hazard control plan describes how the selected controls will be implemented. An
effective plan will address serious hazards first. Interim controls may be necessary, but the
overall goal is to ensure effective long-term control of hazards. It is important to track progress
toward completing the control plan and periodically (at least annually and when conditions,
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processes or equipment change) verify that controls remain effective.

How to accomplish it
 List the hazards needing controls in order of priority.
 Assign responsibility for installing or implementing the controls to a specific person or
persons with the power or ability to implement the controls.
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 Establish a target completion date.
 Plan how you will track progress toward completion.
 Plan how you will verify the effectiveness of controls after they are installed or
implemented.

Action item 4: Select controls to protect workers during nonroutine operations and
emergencies
The hazard control plan should include provisions to protect workers during nonroutine

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operations and foreseeable emergencies. Depending on your workplace, these could include fires
and explosions; chemical releases; hazardous material spills; unplanned equipment shutdowns;
infrequent maintenance activities; natural and weather disasters; workplace violence; terrorist or
criminal attacks; disease outbreaks (e.g., pandemic influenza); or medical emergencies.
Nonroutine tasks, or tasks workers don't normally do, should be approached with particular
caution. Prior to initiating such work, review job hazard analyses and job safety analyses with
any workers involved and notify others about the nature of the work, work schedule, and any

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necessary precautions.

How to accomplish it

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 Develop procedures to control hazards that may arise during nonroutine operations (e.g.,
removing machine guarding during maintenance and repair).
 Develop or modify plans to control hazards that may arise in emergency situations.
 Procure any equipment needed to control emergency-related hazards.
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 Assign responsibilities for implementing the emergency plan.
 Conduct emergency drills to ensure that procedures and equipment provide adequate
protection during emergency situations.

Action item 5: Implement selected controls in the workplace

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Once hazard prevention and control measures have been identified, they should be
implemented according to the hazard control plan.

How to accomplish it
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 Implement hazard control measures according to the priorities established in the hazard
control plan.
 When resources are limited, implement measures on a "worst-first" basis, according to
the hazard ranking priorities (risk) established during hazard identification and
assessment. (Note, however, that regardless of limited resources, employers have an
obligation to protect workers from recognized, serious hazards.)
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 Promptly implement any measures that are easy and inexpensive—e.g., general
housekeeping, removal of obvious tripping hazards such as electrical cords, basic
lighting—regardless of the level of hazard they involve.
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Action item 6: Follow up to confirm that controls are effective

To ensure that control measures are and remain effective, employers should track
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progress in implementing controls, inspect and evaluate controls once they are installed, and
follow routine preventive maintenance practices.
How to accomplish it
 Track progress and verify implementation by asking the following questions:
 Have all control measures been implemented according to the hazard control plan?
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 Have engineering controls been properly installed and tested?
 Have workers been appropriately trained so that they understand the controls, including
how to operate engineering controls, safe work practices, and PPE use requirements?
 Are controls being used correctly and consistently?
 Conduct regular inspections (and industrial hygiene monitoring, if indicated) to confirm
that engineering controls are operating as designed.
 Evaluate control measures to determine if they are effective or need to be modified.

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Involve workers in the evaluation of the controls. If controls are not effective, identify,
select, and implement further control measures that will provide adequate protection.
 Confirm that work practices, administrative controls, and personal protective equipment
use policies are being followed.
 Conduct routine preventive maintenance of equipment, facilities, and controls to help
prevent incidents due to equipment failure.

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UNIT-II

BIOMEDICAL WASTE MANAGEMENT

Biomedical Waste Management : Types of wastes, major and minor sources of biomedical
waste, Categories and classification of biomedical waste, hazard of biomedical waste, need for
disposal of biomedical waste, waste minimization, waste segregation and labeling, waste

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handling and disposal.
PART-A

PART - A

1. What is the meaning of bio medical waste?

Biomedical waste is any kind of waste containing infectious (or potentially infectious)

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materials. Biomedical waste is generated from biological and medical sources and activities,
such as the diagnosis, prevention, or treatment of diseases.

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2. What are the four major types of medical waste?
The Four Types of Medical Waste
• Generally, there are four major types of medical waste. What are they and how are they
handled? ... pa
• General Medical Waste. General medical waste is the lion's share of medical waste in a
facility and is not typically considered hazardous. ...
• Infectious Medical Waste. ...
• Hazardous Medical Waste. ...
• Radioactive Medical Waste
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3. Define “Waste”.
Waste means any useless, unwanted or discarded substance or material, whether or not
such substance or material has any other future use and includes any substance or material that is
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spilled,leaked,pumped,poured,emitted,emptied or dumped onto the land or into the water or

ambient air.

4. What are the four major types of medical waste?

The Four Types of Medical Waste
• Generally, there are four major types of medical waste. What are they and how are they
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handled? ...
• General Medical Waste. General medical waste is the lion's share of medical waste in a
facility and is not typically considered hazardous. ...
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• Infectious Medical Waste. ...

• Hazardous Medical Waste. ...
• Radioactive Medical Waste
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5.What are some examples of hazardous waste?

The most common examples of hazardous waste found within the home include paints,
batteries, solvents, cleaning agents and pesticides
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6.What are the four types of waste?
There are 5 types of waste, do you know them all?
• Liquid Waste. Liquid waste is commonly found both in households as well as in
industries. ...
• Solid Rubbish. Solid rubbish can include a variety of items found in your household
along with commercial and industrial locations. ...
• Organic Waste. Organic waste is another common household. ...
• Recyclable Rubbish. ...

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• Hazardous Waste.

7.List out the biomedical waste.

• Infectious
• Pathological
• Sharps
• Pharmaceutical

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• Genotoxic
• Chemical
• Radioactive

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8. List out the places where waste is produced.
• Medical wards
• Operation theaters and surgical wards
• Immunization ward
• Other healthcare wards
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• Laboratories
• Pharmaceutical and chemical stores
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9. Where healthcare wastes are generated?
• General physician’s clinic
• Dental clinics
• Nurse’s Station
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• Home healthcare

10. List out some of the major sources of healthcare waste.

• Hospitals-General and district hospitals
• Other healthcare establishments - Emergency medical care services
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- Obesity and maternity clinics

- Healthcare centers and dispensaries
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11. Catalog about major sources of healthcare waste.

• Physician’s office
• Dental clinics
• Acupuncturists
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• Psychiatric hospitals
• Nursing homes
• Disabled person’s institutions
• Cosmetic body-piercing and tattoo parlors
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12. Objectives of biomedical waste management.
• To prevent transmission of disease from patient to patient, from patient to health
worker and vice versa.
• To prevent injury to the health care worker and workers and workers in support
services, while handling biomedical waste.
• To prevent exposure to the harmful effects of the genotoxic and chemical
biomedical waste.

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13. Map out the categories of biomedical waste (As per BMW Rules, 1998).
• Human anatomical waste
• Animal waste
• Microbiology and biotechnology waste
• Waste sharps
• Discarded medicines and cytotoxic drugs
• Solid waste

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• Liquid waste
• Incineration ash
• Chemical waste

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14. State the color coding for disposal of biomedical waste.

Color Coding
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Type of Container Waste category
• Human anatomical waste
• Animal waste
Yellow Plastic bag • Microbiology and
biotechnology waste
• Solid waste
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• Microbiology and
Red Disinfected container/plastic bag biotechnology waste
• Solid waste
Blue / White Plastic bag / Puncture proof • Waste sharps
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translucent container • Solid waste

• Discarded medicines and
cytotoxic drugs
Black Plastic bag
• Incineration ash
• Chemical waste
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15. File out the types of hazards of biomedical / healthcare waste.

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• Infection
• Physical injuries
• Chemical toxicity
• Radioactivity hazards
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• Genotoxicity and cytotoxicity

• Public sensitivity
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16. What is Biomedical hazard?
Biomedical Hazard. Biological hazards, also known as biohazards, refer
tobiological substances that pose a threat to the health of living organisms, primarily that of
humans. This can include samples of a microorganism, virus or toxin that can affect human
health.

17. How do you dispose of biomedical waste?

In general, there are two recommended ways to handle medical waste fluids:
• Collect fluids in a leak proof container, and solidified for autoclave treatment.

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• Thermally (autoclave) fluids then they be disposed into the sanitary sewer system.

18.Why is safe disposal of biomedical waste is important?

Improper waste management causes environmental problems and health hazards for
humans and animals. ... Medical personnel could significantly reduce disease risk by ensuring
that medical waste is placed into the proper bins and that the facility uses a reputable medical

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waste disposal company to pick up and treat the waste

19.How can biomedical waste be reduced?

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Here are nine ways to reduce medical waste, courtesy of Hoboy:
• Know your state laws. ...
• Develop a formal waste management plan. ...
• When possible, use reusable products in place of single-use products. ...
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• Use small medical waste containers in patient rooms.

20. Where can I dispose of medical waste?

Various local pharmacies, doctors' offices, hospitals, health clinics or many community
organizations provide convenient drop-off points for proper disposal of household medical
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waste. These can be used for the collection of needles or syringes, as well as leftover or outdated
medications.

21.What is the importance of biomedical waste management?

Therefore, the disposal of health care waste and its potential health impact are an
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important public health issue. Effective medical waste disposal is the first and foremost way to
prevent unwanted disease and prevent untoward infection from medical wastes

22.How do I dispose of a sharps box?

You should use a sharps bin to dispose of used needles or sharps. A sharps bin is a
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specially designed rigid box with a lid that's available on prescription (FP10 prescription form)
from your GP or pharmacist. When full, the box can be collected for disposal by your local
authority
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23.What is general waste in a hospital?

Every department in the hospital generates waste and the overall product is waste of
different kinds; healthcare, household and administrative waste. Healthcare waste
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includes infectious, chemical, expired pharmaceutical and radioactive items and sharps. These
items can be pathogenic and environmentally adverse
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24.Can you throw a sharps container in the garbage?
You may be able to drop off your sharps disposal containers at local public household
hazardous waste collection sites. ... whether sharps disposal containers can be thrown away in the
common trash.

25. How do I dispose of used needles?

The FDA recommends a two-step process for properly disposing of used needles and
other sharps.
• Step 1: Place all needles and other sharps in a sharps disposal container immediately after

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they have been used. ...
• Step 2: Dispose of used sharps disposal containers according to your community
guidelines.

26.Which Colour lidded sharps box would you use to dispose of a needle used to take
blood?

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Orange sharps bins can also be used for sharp instruments with no contaminant on them
at all, but are in need of disposal, such as an unwrapped needle or scalpel. Safely dispose of all
sharps including hypodermic syringes, scalpels and all medical sharps.

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27.What is the Colour code for the bin used to dispose needles and syringes?
• Yellow bins are going to be used for most general medical practitioners.
• Red: Inred containers, there should be contaminated waste material that has been in
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contact with hazardous substances. For instance, IV tubes, catheters, tubing, or syringes
(without the needle) can all be collected in red bins

28. What Colour sacks should be used for clinical waste?

Yellow clinical waste bags. Colour coded yellow bags must be used for the storage of
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soft clinical waste contaminated with infectious or potential infectious blood or bodily fluids. To
comply with the regulations, these bags must be UN approved.

29.What are some examples of clinical waste?

What is clinical waste? Clinical waste is the term used to describe waste produced from
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healthcare and similar activities that may pose a risk of infection, for example, swabs, bandages,
dressings etc. or may prove hazardous, for example medicines.

30.What goes in recycling bins?

Things that can go in your brown bin include: glass bottles and jars, plastic bottles (but
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not the lids), tins, cans, tin foil and foil containers, aerosols. Things that can't goin include:
plastic bags, cling film, plant pots, yoghurt pots, plastic toys, bottle tops, plastic food trays.

31.What is non clinical waste?

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'Offensive waste' is non-clinical waste that's non-infectious and doesn't contain

pharmaceutical or chemical substances, but may be unpleasant to anyone who comes into contact
with it. If you've produced less, you can dispose of your municipal offensive waste in your
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mixed municipal waste ('black bag').

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32.What is non infectious waste?
Non infectious clinical waste is commonly known as offensive waste. ... Non-infectious
waste is waste contaminated with bodily fluids from patients with no known or
suspected infection, such as swabs, dressings, nappies or incontinence wastes.

33.How do you dispose of infectious waste?

Transfer non-disposable infectious materials safely to the sterilisation department for
decontamination. You must adhere to the local policy for cleaning the equipment. Always use

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puncture-resistant containers sharps, as they will not leak. Use pierce-proof waste containers and
close them in between use for safety

34.What is meant by waste minimization?

Waste minimisation is a set of processes and practices intended to reduce the amount
of waste produced. By reducing or eliminating the generation of harmful and
persistent wastes, waste minimisation supports efforts to promote a more sustainable society. The

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main sources of waste vary from country to country.

35.What are the waste minimization techniques? (Or) how to do waste minimization?
 Source reduction

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 Resource recovery and recycling methods
 Educating staff
 Composting organic waste pa
36.Why is waste minimization important?
Waste minimization is important because it helps protect the environment and it
makes good business sense. In fact, businesses can simultaneously manage both business
and environmental objectives by focusing on waste minimization.
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37. Define Waste segregation.
It is defined as “separation of different types of wastes by sorting or the systematic
separation of biomedical waste into designated categories.
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38.What is the proper waste segregation?

 "Waste segregation" means dividing waste into dry and wet.
 Dry waste includes wood and related products, metals and glass.
 Waste can also be segregated on the basis of being biodegradable or non-biodegradable.
 Landfills are an increasingly pressing problem.
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39.What are the benefits of waste segregation?

 Proper segregation of waste thus leads to a “circular economy” creating green jobs,
reducing consumption of virgin resources and promoting investments and innovations.
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 Furthermore as waste transportation reduces, emissions reduce; life of the landfill

increases and risk to the ecosystem goes down.
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40.What is the importance of segregation?

Waste segregation is included in law because it is much easier to recycle. Effective
segregation of wastes means that less waste goes to landfill which makes it cheaper and better for
people and the environment. It is also important to segregate for public health.
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41.What are the advantages of segregation?
Even with low levels of inbreeding, selection is stronger on a modifier that promotes
segregation than on a modifier that promotes recombination, suggesting that the benefits of
segregation are more likely than the benefits of recombination to have driven the evolution of
sexual reproduction in diploids.

42. How do you handle waste safely?

 Use cloth bags instead of plastic. This small measure will greatly reduce the amount of

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waste you bring into your house.
 Buy food that has less packaging.
 Do vermin composting.
 Don't use bottled drinks unless you have to.
 Reduce your paper usage.
 Consider making your own household cleaners and detergents

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43. List out the waste handling equipments.
 Gloves
 Aprons,gowns,suits

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 Masks/eye wear/face shields
 Boots/shoes
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44. Why waste must be handled and disposed of correctly?
Proper waste disposal is critical due to the fact that certain types of wastes can be
hazardous and can contaminate the environment if not handled properly. These types
of waste also have the potential to cause disease or get into water supplies
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PART-B
1. Explain the different types of waste.
Waste generated during the diagnosis, testing, treatment, research or production of
biological products for humans or animals (WHO).
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Waste means any useless, unwanted or discarded substance or material, whether or not
such substance or material has any other future use and includes any substance or material that is
spilled,leaked,pumped,poured,emitted,emptied or dumped onto the land or into the water or
ambient air.
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Biomedical waste is any kind of waste containing infectious (or potentially infectious)
materials. Biomedical waste is generated from biological and medical sources and activities,
such as the diagnosis, prevention, or treatment of diseases.
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There are two catagories,such as,

• General waste
• Biomedical waste or hospital waste
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1.2 General waste

- It is nonhazardous waste such as kitchen waste, paper or wrappers, etc.
- It contributes 5 to 90 percent to the total healthcare waste.
- It follows the domestic waste stream as it does not require any special treatment
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- It must separate from infected or hazardous waste.
1.3 Biomedical waste or hospital waste
- It is any waste which is generated during diagnosis, treatment or immunization of
human beings or animals or in research activities pertaining or in the production
or testing biological or in research activities.
- It is also includes the waste origination from “minor” or scattered” sources.
- 75 to 955 of the waste produced by any housekeeping functions and
administration functions of healthcare establishments.

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- General healthcare wastes can be treated or disposed of in a similar. (Municipal
Waste Disposal)
- Remaining 10 to 25% of healthcare waste is regarded as hazardous and may
create a variety of health risks.
 Infectious waste
 Pathological waste
 Sharps

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 Pharmaceutical waste
 Genotoxic waste
 Chemical waste
 Radioactive waste

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1.4 Infectious waste:
It is suspected to contain pathogenic organisms. i.e – bacteria,viruses,parasites or fungi in
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sufficient concentration or quantity to cause disease in suspectable. It includes the following
waste:
 Cultures and stocks of infectious agents from clinical labs
 Waste from surgery and autopsies done on patients suffering from
infectious diseases.(tissues,materials or equipment that have been in
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contact with blood or other body fluids)
 Excreta, dressings from infected surgical wounds, clothes heavily soiled
with human blood or other body fluids. (from infected patients in isolated
wards)
 Dialysis equipment such as tubing and filters, gowns, aprons, gloves,
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disposable towels and lab coats which have been contact with infected
patients undergoing dialysis.
 Always wear gloves to handle contaminated dressings or supplies. Wash
hands immediately if they become contaminated with blood or body
fluids. Take care to avoid splashing any contaminated material onto the
mucous membranes of your eyes, nose or mouth, or into any broken skin
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you may have.

 Highly infectious waste. Highly infectious waste consists in microbial
cultures and stocks of highly infectious agents from Medical Analysis
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Laboratories. They also include body fluids of patients with highly

infectious diseases.
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1.5 Pathological waste:

 Pathological waste is a category of biohazardous waste. The parent category
includes infectious animal bedding/feces, human and/or animal pathogens and
disposable items contaminated with human blood or body fluids.
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 It consists of tissues, organs, body parts, human fetuses (unborn baby tissues) and
animal carcasses (dead body), blood and body fluids.
 Example: Anatomical waste (recognizable human or animal body parts).
1.5 Sharps waste:
 It is a form of biomedical waste composed of used "sharps", which includes any device
or object used to cut,puncture or lacerate the skin. Sharps waste is classified
as biohazardous waste and must be carefully handled. Common medical materials treated
as sharps waste are:

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o Hypodermic needles
o Disposable scalpels and blades
o Contaminated glass and some plastics
o Guidewires used in surgery
 In addition to needles and blades, anything attached to them will also be considered

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sharps waste, such as syringes and injection devices.

1.6 Pharmaceutical waste:

 It includes expired, unused, split and contaminated pharmaceutical products,

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drugs, vaccines.
 Discarded item used in the handling of pharmaceuticals, such s bottles or boxes
with residues, gloves, masks, connecting tube and drugs.
 Pharmaceutical waste is any waste which contains medicinal drugs that are
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expired, unused, contaminated damaged or no long needed. Our waste services
can help with the collection and disposal of the following:
 Cytotoxic waste
 Cytostatic waste
 Pharmaceutical stock which is out of date
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 Pharmaceutical stock which is no longer required
 Controlled drugs destruction kits
 Recalled pharmaceutical stock
 Pharmi bins
 All waste associated with pharmaceutical
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1.7 Genotoxic waste :

 It derives from drugs generally used in oncology or radiotherapy units that have a
high hazardous mutagenic or cytotoxic effect. Faeces, vomit or urine from
patients treated with cytotoxic drugs or chemicals should be considered as
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genotoxic.
 It poses serious safety threats, both inside hospitals and after disposal.
 It has the ability to kill or stop the growth of certain living cells. Due to this
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property they are used in chemotheraphy of cancer.

 The genotoxic substances induce damage to the genetic material in the cells
through interactions with the DNA sequence and structure.
 Sources of genotoxic waste- syringes, needles, ganges, vials, packaging materials.
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 Outdated drugs, excess or leftover solutions, drugs returned from the wards.
 Faeces, Urine and vomit from patients treated with cytostatic drugs.
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1.8 Chemical Waste:
 There are many causes of this type of industrial water pollution, which has both
serious and negative impacts on aquatic and human life. The term “Chemical
Waste” includes harmful chemical by-products from manufacturing facilities and
laboratories and smaller scale chemicals disposed of from businesses and
households.
 It consists of discarded solid, liquid and gaseous chemicals (experimental work
from cleaning, house keeping and disinfection).
 Chemical waste from health care may be:

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 Hazardous – toxic, corrosive, flammable, reactive, genotoxic.
 Non-hazardous – Sugars, amino acid, certain organic and inorganic
salts.
 Chemical used in healthcare:
 Formaldehyde
 Solvents

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 Photographic/radio graphic chemicals
 Organic And Inorganic Chemicals
 Anesthesia gases
 Pressurized containers

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 Ethylene oxide
 Oxygen
 Compressed air
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1.9 Radioactive waste:
It includes solid, liquid and gaseous wastes contaminated with radionuclide from nuclear
medical diagnostic and therapeutic procedures.
 Sealed sources
 Unsealed sources
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o The radioactive waste produced by healthcare and research activities can
be classified as:
• Sealed sources
• Spent radionuclide generators
• Low level solid waste(absorbent, papper, swabs, glassware, syringes,
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vials).
• Waste from spils and from decontamination of radioactive spils.
• Low level liquid waste from washing materials.
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2. Explain the different sources of health-care wastes and how the hospitals handle them.
In a hospitals, every ward produces peculiar composition of waste because of difference
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in materials and methods of treatment of its patient’s. Examples are:

Medical wards – mainly infectious waste such as dressings, bandages, used hypodermic
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needles, intravenous, sets, gloves, disposable medical items, sticking plaster, body fluids and
excreta contaminated packaging, meal scraps.

Operation theatre and Surgical wards – in addition the above mentioned wastes,
anatomical waste such as tissues, organs, body parts including fetuses.
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Immunization Ward – Hypodermic needles and syringes, residual vaccine, cotton swabs
and ampoules etc.

Other healthcare Wards – mostly general waste with a small percentage of infectious
waste.

Laboratories – mainly pathological and high infectious waste, example small pieces of

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tissue, infected animal, carcasses, microbiological cultures, stocks of infectious agents, blood and
other body fluids plus sharps, some radioactive and chemical waste.

Pharmaceutical and chemical stores – only small quantities of pharmaceutical and

chemical wastes, mainly packaging and general waste.

Support Units – only general waste

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Healthcare waste generated at various sources generally has the characteristic
composition, for example:

General physician’s clinics – infectious waste and some sharps.

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Dental clinics – Infectious wastes, sharps, waste with high heavy metal content
(mercury, silver). pa
Nurse’s Station – Infectious waste and many sharps.
Home healthcare – e.g: dialysis, insulin injections: Mainly infectious waste and sharps.

2.1 Major Sources of healthcare Waste:

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Hospitals
o Healthcare teaching institutions and hospitals.
o General hospitals
o District hospitals
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Other healthcare establishments

o Emergency medical care services
o Obstetric and maternity clinics
o Healthcare centers and dispensaries
o Outpatient clinics
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o Transfusion centers
o Military medical services
o Dialysis centers
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o First-aid posts and sick bays

o Long term healthcare establishments and hospitals
o Blood banks and blood collection services
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o Related laboratories and research centers

o Medical and autopsy centers
o Animal research and testing
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2.2 Minor Sources of healthcare Waste:

Small healthcare establishments

• Physician’s offices
• Dental clinics
• Chiropractors

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• acupuncturists
Specialized healthcare establishments and institutions with low waste generation
• Convalescent nursing homes
• Disabled person’s institutions
• Psychiatric hospitals

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Intravenous or subcutaneous intervention activities other than health care
• Cosmetic body-piercing and tattoo parlors
• Illicit drug users

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Ambulance services
Home treatments
Funeral services.
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3.What are the various guidelines given by WHO for safe health-care waste management?
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• Health-care activities lead to the production of waste that may lead to adverse
health effects. Most of this waste is not more dangerous than regular household
waste. However, some types of health-care waste represent a higher risk to health.
• These include infectious waste (15% to 25% of total health-care waste) among
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which are sharps waste (1%), body part waste (1%), chemical or pharmaceutical
waste (3%), and radioactive and cytotoxic waste or broken thermometers (less
than 1%).
• To better understand the problem of health-care waste management, WHO
guidance recommends that countries conduct assessments prior to any decision as
to which health-care management methods be chosen.
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1 - Unsafe health-care waste management leads to death and disability

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• Health-care activities lead to the production of waste that may lead to adverse health
effects. Most of this waste is not more dangerous than regular household waste. However,
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some types of health-care waste represent a higher risk to health.

• These include infectious waste (15% to 25% of total health-care waste) among which are
sharps waste (1%), body part waste (1%), chemical or pharmaceutical waste (3%), and
radioactive and cytotoxic waste or broken thermometers (less than 1%).
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• Sharps waste, although produced in small quantities, is highly infectious. Poorly
managed, they expose health-care workers, waste handlers and the community to
infections. Contaminated needles and syringes represent a particular threat and may be
scavenged from waste areas and dump sites and be reused. WHO has estimated that, in
2000, injections with contaminated syringes caused:
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• 21 million hepatitis B virus (HBV) infections (32% of all new infections);

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two million hepatitis C virus (HCV) infections (40% of all new infections);

• 260 000 HIV infections (5% of all new infections).

Epidemiological studies indicate that a person who experiences one needle-stick injury from
a needle used on an infected source patient has risks of 30%, 1.8%, and 0.3% respectively to
become infected with HBV, HCV and HIV. In 2002, the results of a WHO assessment conducted

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in 22 developing countries showed that the proportion
of health-care facilities that do not use proper waste disposal methods ranges from 18% to 64%.

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2 - Health-care waste management may also represent a risk to health

• Health-care waste management options may themselves leadto risks to health and no
perfect readily achievable solution to manage health-care waste exists.
•
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Health-care waste, whether generated at smaller rural clinics or larger facilities, can
be managed where adequate well-operated infrastructures exist. However, the
volumes of waste generated within large facilities and targeted public efforts (e.g.,
immunization campaigns)
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3 – Balancing risks to make sound policy decisions in health-care waste
management
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• In addition to risks to health from infectious agents, long-term low-level exposure of

humans to dioxins and furans may lead to impairment of the immune system, and
impaired development of the nervous system, the endocrine

• system and the reproductive functions. Short-term high level exposure may result in skin
lesions and altered liver function.
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• The International Agency for Research on Cancer (IARC) classifies dioxins as a “known
human carcinogen”.
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• However, most of the evidence documenting the toxicity of dioxins and furans is based
upon studies of populations that have been exposed to high concentrations of dioxins
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either occupationally or through industrial accidents. There is little evidence to determine

whether

• chronic low-level exposure to dioxins and furans causes cancer in humans. Overall, it is
not possible to estimate the global burden of diseases from exposure to dioxins and furans
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because of large areas of uncertainty. In the last 10 years, the enforcement of stricter
emission standards for dioxins and furans by many countries

4 – Guiding policy principles

• In view of the challenge represented by health-care waste and its management, WHO
activities are oriented by the following guiding principles:

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• preventing the health risks associated with exposure to health-care waste for both health
workers and the public by promoting environmentally sound management policies for
health-care waste;

• supporting global efforts to reduce the amount of noxious emissions released into the
atmosphere to reduce disease and defer the onset of global change;

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• supporting the Stockholm Convention on Persistent Organic Pollutants (POPs);

• supporting the Basel Convention on hazardous and other waste; and reducing the

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exposure to toxic pollutants associated with the combustion process through the
promotion of
• appropriate practices for high temperature incineration.
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5 – Strategy

• To better understand the problem of health-care waste management, WHO

guidance recommends that countries conduct assessments prior to any decision as
to which health-care management methods be chosen.
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• Tools are available to assist with the assessment and decision-making process so
that appropriate policies lead to the choice of adapted technologies. WHO
proposes to work in collaboration with countries through the following
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Some strategies are ,

Short-term

• Production of all syringe components made of the same plastic to facilitate recycling;
•
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selection of PVC-free medical devices; identification and development of recycling

options wherever possible (e.g.: for plastic, glass, etc.); and

• research and promotion on new technology or alternative to small-scale incineration;

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• Until countries in transition and developing countries have access to health-care waste
management options that are safer to the environment and health, incineration may be an
acceptable response when used appropriately.
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• Key elements of appropriate operation of incinerators include effective waste reduction

and waste segregation, placing incinerators away from populated areas, satisfactory
engineered design, construction following
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• appropriate dimensional plans, proper operation, periodic maintenance, and staff training
and management.

Medium-term

• Further efforts to reduce the number of unnecessary injections to reduce the amount of
hazardous health-care waste that needs to be treated;

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research into the health effect of chronic exposure to low levels of dioxin and furan; and

• risk assessment to compare the health risks associated with: (1) incineration; and (2)
exposure to health-care waste.

Long-term

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• Effective, scaled-up promotion of non-incineration technologies for the final disposal of
health-care waste to prevent the disease burden from: (a) unsafe health-care waste
management; and (b) exposure to dioxins and furans;

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• support to countries in developing a national guidance manual for sound management of
health-care waste;

•
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support to countries in the development and implementation of a national plan, policies
and legislation on health-care waste;

• promotion of the principles of environmentally sound management of health-care waste

as set out in the Basel Convention; and
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• support to allocate human and financial resources to safely manage health-care waste in
countries
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4. Write the principles of hospital hazards management. Explain the various types of
infections.

Some of the principles are,

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1.The Duty to Protect Environment: 1972 Stockholm Conference

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• It is the duty of every person to protect the environment and prevent its pollution.
Domestic laws and international treaties impose this duty on individuals and states.
• The United Nations has convened an International Conference on the Human
Environment at Stockholm in 1972, where a dialogue on protection of environment
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began.
• Later United Nations Environment Programme UNEP was established. The concepts of
sustainable development and Development without destruction evolved.
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• The present generation has an obligation to protect their future generations. A man has no
right to exploit the ecology to the detriment of to be born.
• The International Community recognised this responsibility and drafted several
instruments reminding the mankind to be kind to the natural world.
• After the loss of millions of human beings the UN Charter expressed a deep concern for
the people yet to be born. (Preamble, Charter of the UNO, 1945).

2.Right to healthy world:

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• The Stockholm conference in 1972 explained the imperative goal for mankind as to
defend and improve the human environment for present and future generations.
• Besides war, peace and Development the International Law made a beginning in
regulating the environmental issues. Man has both a right to healthy world around and a
solemn responsibility to protect and improve the environs for the next generation.

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3.The UN and WHO:

• The United Nations General Assembly adopted World Charter for Nature in 1982

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(UNGA Resolution 37/7 GAOR, 37th Session) which explicitly states that the
Governments have a duty to pass on their natural heritage to future generations.
• The WHO regional office for Europe convened a working group of medical
professionals, hospital engineers and administrators, which discussed infectious and
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hazardous waste as a potential risk to public health in 1983.

4.World Commission on Environment and Development & the Earth Summit:

• The World Commission on Environment and Development WCED headed by Giro

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Harlen Bruntland proposed a set of legal principles for sustainable development and
suggested for a global convention for this purpose. (World Commission on Environment
and Development, Our Common Future, 1987) For this purpose and for arresting further
degradation of the environment and to repair damage already done,
•
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The Rio Earth Summit was convened by the UNGA. Maintenance of ecological balance,
prevention and control of environmental pollution, preservation of our natural resources,
disaster mitigation and sustainable development are the basic factors of the "Earth
Charter", which is also called the "Rio Declaration". (Rio Declaration on Environment
and Development, 31 ILM 874, 1992)
• International treaties, Conventions, Conferences and Protocols resulted in regulatory
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legislation to protect the environment in several countries for framing policies to protect
and improve environment, preventing pollution, punishing environmental crimes, and for
compensating the persons affected by breach of protective provisions.
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5.The Liability for Polluting the Nature:

•
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Government of Canada has to agree to pay 350,000 Dollars when US Government raised
a dispute over the issue of Trans-frontier air pollution by sulphur-di-oxide fumes
originated in Canada. The trial before the arbitration went on for thirteen years.
• Even before emergence of environmental laws, polluters were liable under the general
principles of tortious liability like nuisance. Blackstone defined common nuisance as a
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species of the offence against the public order and economic regiment of the State: being
either doing of a thing to the annoyance of the Kings’ subjects, or neglecting to it of a
thing which the common good requires. (Howk, P.C. 167)

6. Environment (Protection) Act

• India, which signed the United Nations Conference on the Human Environment held at
Stockholm in June 1972 recognised the need of a legislation and passed Environment

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(Protection) Act, 1986 for protection and improvement of environment and the
prevention of hazards to human beings, other living creatures, plants and property.
Section 2 (e) defines hazardous substance.
• It "means any substance or preparation which, by reason of its chemical or physico-
chemical properties or handling, is liable to cause harm to human beings, other living
creatures, plants, micro-organism, property or the environment". Section 3 gives a
general power to the Government of India to take any measure in protecting the

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environment, which includes imposing punishment and recovering compensation for the
victims of pollution.

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7. Public Nuisance

• Section 268 of Indian Penal Code, which has provisions relating to offences affecting the
public health, safety, convenience, decency and morals under Chapter XIV, defined
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public nuisance imposed penal liability.
• It says that "a person is guilty of public nuisance who does any act or is guilty of an
illegal omission which causes any common injury, danger or annoyance to the people in
general who dwell or occupy property in the vicinity or must necessarily cause injury,
• obstruction, danger or annoyance to persons who may have occasion to use any public
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right. A common nuisance is not excused on the ground that it causes some convenience
or advantage".
• The High Courts and the Supreme Court of India imposed a duty on individuals and the
state to protect the environment holding that the right to life under Article 21 includes
right to live in an unpolluted environment also. (T. Damoder Rao v. Special Officer,
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Municipal Corporation of Hyderabad, AIR 1987 AP 171, per P. A. Choudary, J)

8. Strict Liability for Hazardous Activity

• Rule in Rylands v. Fletcher, imposed a strict liability on the persons for the damage
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caused by escape of a thing collected for extra-ordinary usage. However the rule
permitted some defences and exceptions.
• The scope of this rule and right to life was further extended by the Supreme Court in
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Shriram Gas Leak case (M.C. Mehta v. Union of India, AIR 1987 SC 965) and Bhopal
Gas tragedy hearings (Union Carbide v. Union of India, AIR 1992 SC 248) by creating a
new principle of "Absolute Liability".
• According to this principle, the industry would be absolutely liable for the loss caused by
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the hazardous and inherently dangerous activity.

• A law, which is not in consonance with the fast-developed technological hazards, cannot
deal with dangerous consequences of accidents with abnormal and extraordinary
prepositions.
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• The law needs to undergo a process of reform and rethinking to race with fast changing
technological applications in multinational industrial activities. The judges rightly
imposed an absolute and non-delegable duty to ensure that no harm results to any one, on
an enterprise engaged in Hazardous or Inherently Dangerous Activity (HOIDA) posing a
potential threat to the health and safety of the persons working in the factory and residing
in the surrounding areas.

9. Absolute Liability: Principle of "Polluter Pays"

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• The Supreme Court rightly used the opportunity to create landmark judgment imposing
absolute liability for a noble cause of protecting humanity and environment. The
principle in Mehta case was reiterated in simple terms in Indian Council for Enviro-Legal
Action v.
• Union of India, AIR 1996 SC 1466. The apex court called it a rule of "Polluter pays",
which gained global appreciation and acceptance. ‘Generator is responsible’ is the

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universal principle holding the health care establishments legally accountable for damage
caused by waste management processes.
• It should be no answer to the enterprise to say that it had taken all reasonable care and

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that the harm occurred without any negligence on its part. Because it is not possible to
isolate the process of operation from the hazardous preparation of substance or any other
related element that caused the harm, it is reasonable and justified to impose strict
liability to pay the social cost of the tragedy.
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10. Duty of the State

• However, it is also the duty of the state to provide for effective remedies against the
environmental hazards. The Public Liabilities Insurance Act, 1991 is a step towards
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fulfilling such an obligation to some extent.
• This law enables the District Collector to determine immediate relief up to a maximum of
Rs 37,500. For larger compensation, the affected person has to seek remedies under other
laws or common law developed by the courts. There is another piece of legislation with
ambitious plans. The National Environmental Tribunal Act, 1995 creates tribunals to
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enforce the absolute liability principle.

11.The Direction of Supreme Court

• The Supreme Court directed all hospitals with 50 beds and above to install incinerators or
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any other effective alternate methods under their administrative control, in 1994 in a
public interest writ petition filed Dr. B. L. Wadhera against dumping of Hospital waste
from Safdarjang Hospital in the Capital city.
•
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The Apex Court also imposed a dead line i.e., 30th November 1996 for incorporating
scientific methods of disposing hazardous medical waste. It also directed that a prior
approval from Central Pollution Control Board should be obtained after conforming to
the settled standards and also that the CPCB should regularly inspect different hospitals
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and monitor the garbage disposal processes.

12. Biomedical Waste (Management and Handling) Rules, 1998

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• Surprisingly the Government took a long time to act on the directions of the Supreme
Court in formulating the guidelines for enforcing the standards in hospital waste disposals
and the Biomedical Waste (Management and Handling) Rules under sections 6, 8 and 25
of the Environment (Protection) Act, 1986 was passed in 1998.

• Establish the context and identify the hazard: These are the first steps. You have learned
that a hazard is something that is harmful to our health. A description of the categories of
hazards is given in Section 2.2 above. You should identify the type of the hazard in as

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much detail as you can. You should also describe the exposure conditions and try to
answer the following questions: What is the source of the hazard? Who is exposed? What
are the pathways or activities that expose a person? What part of the environment is
involved in the transfer of the hazard to humans?
• Hazard/risk analysis and evaluation: Here you would analyse the risk and evaluate the
potential of the hazard to cause damage to health. This step needs a deeper appraisal in
collaboration with the woreda environmental health worker. The evaluation may require

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appropriate design, sampling and laboratory investigation.

Hospital Hazard Management

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Various types of infections :

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• Bloodborne Pathogens. Contact with blood, whether through needlesticks or other

accidental exposure, can put you at risk for HIV and other infectious diseases. ...
• Hazardous Chemicals. ...
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• Stress. ...
• Slips and Falls. ...
• Latex Allergies.
• Infection is the effect of a foreign organism in the body.
• Types of infection include bacterial, fungal, viral, protozoan, parasitic, and prion disease.
• They are classified by the type of organism causing the infection.

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• Infections can range from mild inflammation in one person to an epidemic.
• bacterial meningitis.
• otitis media.
• pneumonia.

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• tuberculosis.
• upper respiratory tract infection.
• gastritis.

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• food poisoning.
• eye infections. pa
5. How does the color coding helps in medical waste management. Explain with examples.
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Color coding helps waste disposal companies distinguish different types of wastes, and easily
sorts them into different categories. Because proper waste removal is so important, it’s necessary
to understand what each of these colors mean.

Colour Coding:
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You may be wondering why waste needs to be color coded in the first place. Well, contrary to
popular belief, it doesn’t all go to the same place. Certain waste can only be disposed of via a
certain process.
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For instance, harmful chemical byproducts must be incinerated, which means they must be
separated from other waste that is simply going to a landfill. Facilities that create biomedical
waste must clearly label and color code waste bins, to ensure staff is properly disposing of
biomedical waste.
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Different Colors Means :

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There are several different colors that indicate different types of biomedical waste. These colors
also define the level of caution that needs to be taken when handling such materials.

1. Yellow: A yellow colored waste bin indicates several different types of wastes. In yellow bins,
there could be human waste, tissues, organs, or bodily fluids. They could also contain chemicals,
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soiled bed sheets, animal carcasses, or laboratory waste. Yellow bins are going to be used for
most general medical practitioners.

2. Red: In red containers, there should be contaminated waste material that has been in contact
with hazardous substances. For instance, IV tubes, catheters, tubing, or syringes (without the
needle) can all be collected in red bins. Most of these materials can be recyclable, because they
are plastic.

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3. White: These containers are used for sharps, and must be lined with puncture-proof bags.
Sharps can include used needles, scalpels, or blades. It must be sent to a sanitary landfill.

4. Blue: Blue cardboard boxes can be used to discard various glass materials. Beakers, medicine

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vials, and other broken glass equipment can be placed in these receptacles.

To ensure collection is conducted properly, all of these containers should be clearly labeled and
placed in the same area. This way, no waste will be left behind, and the entire premises can be

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safe from biomedical hazards.

For the best biomedical waste removal in Maryland, look no further than BWS. We have decades
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of experience, a flock of happy customers, and an experienced staff, willing to help you safely
remove all biomedical hazards.

If you have any further questions about color coding your biomedical waste, don’t hesitate to call
BWS. We can help you on your way to becoming a sanitized, safer, cleaner facility that will
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continue to help others for years to come.

5.Purple:For cytotoxic or cytostatic medicine waste or any items contaminated with these, it
must be sent for incineration at an authorised facility. This type of waste includes containers with
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residues of cytotoxic or cytostatic medicines and sharps from treatment using cytotoxic or
cytostatic medicines.

6.Yellow & Black:Also referred to as Tiger, this colour coding symbolises non-infectious,
offensive/hygiene waste which may be recycled, incinerated or deep landfilled. This type of
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waste can include items contaminated with bodily fluids, such as incontinence pads, catheter
bags or maternity waste.
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7.Black:This should be used for domestic or municipal waste and should not contain any
hazardous material, sharps or medicinal products. Items you would typically find in this type of
waste are food and tissues, for instance.
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Examples of Color Representation

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6. How disinfection is carried out in hospitals to safeguard from medical wastes?

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Bio-medical waste means “any solid and/or liquid waste including its container and any
intermediate product, which is generated during the diagnosis, treatment or immunization of
human beings or animals or research activities pertaining thereto or in the production or testing
of biological or in health camps.

Biomedical waste poses hazard due to two principal reasons – the first is infectivity and other
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toxicity.

6.1 Some of the disinfection is carried out in hospitals

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• Human anatomical waste like tissues, organs and body parts

• Animal wastes generated during research from veterinary hospitals
• Microbiology and biotechnology wastes
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• Waste sharps like hypodermic needles, syringes, scalpels and broken glass
• Discarded medicines and cytotoxic drugs
• Soiled waste such as dressing, bandages, plaster casts, material contaminated with blood,
tubes and catheters
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• Liquid waste from any of the infected areas
• Incineration ash and other chemical wastes

6.2 Bio-medical waste and its segregation

1. How does segregation help?

2. Collection
3. Storage

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4. Transportation
5. Personnel safety devices
6. Cleaning devices
7. Storage devices
8. Handling devices

All human activities produce waste. We all know that such waste may be dangerous and needs

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safe disposal. Industrial waste, sewage and agricultural waste pollute water, soil and air. It can
also be dangerous to human beings and environment. Similarly, hospitals and other health care
facilities generate lots of waste which can transmit infections, particularly HIV, Hepatitis B & C

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and Tetanus, to the people who handle it or come in contact with it.

India generates around three million tonnes of medical wastes every year and the amount is

6.3 Safeguard from medical wastes

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The biomedical waste (BMW) management requires its categorisation as a first step. The
BMW Rules classify the BMW into following categories.
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TYPE OF
BAG OR
TREATMENT AND
CATEGORY TYPE OF WASTE CONTAINER
DISPOSAL OPTION
TO BE USED
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Human tissues, organs, body parts

and fetus below the viability period
(as per the Medical Termination of Yellow
Pregnancy Act 1971, amended from coloured
time to time).
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Animal Anatomical Waste : non- Incineration or Plasma

Yellow Experimental animal carcasses, chlorinated Pyrolysis or deep burial *
body parts, organs, tissues, including
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the waste generated from animals plastic bags

used in experiments or testing in
veterinary hospitals or colleges or
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animal houses.
Soiled Waste: Items contaminated Incineration or Plasma Pyrolysis
with blood, body fluids like or deep burial *
dressings, plaster casts, cotton swabs In
and bags containing residual or absence of above facilities,
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discarded blood and blood autoclaving or micro-waving/
components. hydroclaving followed by
shredding or mutilation or
combination of sterilization and
shredding. Treated waste to be
sent for energy recovery.

Expired cytotoxic drugs and

Expired or Discarded Medicines:
Pharmaceutical waste like antibiotics,
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items contaminated with
cytotoxic drugs to be returned
back to the manufacturer or
supplier for incineration at
Yellow
temperature >1200 0 C or to
coloured
common bio - medical waste

cytotoxic drugs including all items
contaminated with cytotoxic drugs
along with glass or plastic ampoules,
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non- treatment facility or hazardous
chlorinated waste treatment, storage and
disposal facility for incineration
plastic bags or at >1200 0 C Or Encapsulation

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vials etc.
or Plasma Pyrolysis at >1200 0
containers
C
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shall be either sent back to
manufacturer or disposed by
incineration.

Yellow
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coloured
Disposed of by incineration or
Chemical Waste: Chemicals used in containers or Plasma Pyrolysis or
production of biological and used or Encapsulation in hazardous
discarded disinfectants. non- waste treatment, storage and
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chlorinated disposal facility .

plastic bags

Chemical Liquid Waste : Liquid waste Separate

generated due to use of chemicals in After resource recovery, the
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production of biological and used or collection chemical liquid waste shall be

discarded disinfectants, Silver X - ray pre - treated before mixing with
system leading
film developing liquid, discarded other wastewater. The combined
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Formalin, infected secretions, aspirated to effluent discharge shall conform to the

body fluids , liquid from laboratories an discharge norms given in
d floor washings, cleaning, house - treatment Schedule - III.
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keeping and disinfecting activities etc. system

Discarded linen, mattresses, beddings Non- Non - chlorinated chemical

contaminated with blood or body fluid. chlorinated disinfection followed by
incineration or Plazma Pyrolysis
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yellow plastic or for energy recovery. In
absence of above facilities,
bags or shredding or mutilation or
suitable combination of sterilization and
packing shredding. Treated waste to be
material sent for energy recovery or
incineration or Plazma Pyrolysis
.

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Microbiology, Biotechnology and
other clinical laboratory waste: Blood
Pre - treat to sterilize with non -
bags, Laboratory cultures, stocks or Autoclave safe chlorinated chemicals on - site
specimens of micro - organisms, live or
as per National AIDS Control
attenuated vaccines, human and animal plastic bags or
Organisation or World Health

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cell cultures used in research, industrial
Organisation guidelines
laboratories, production of biological, containers
thereafter for Incineration.
residual toxins, dishes and devices used
for cultures.

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Autoclaving or micro -
pa waving/ hydroclaving
Contaminated Waste Red coloured followed by shredding or
mutilation or combination of
(Recyclable) Wastes
non- sterilization and shredding.
generated from disposable items
Treated waste to be sent to
such as tubing, bottles, intravenous chlorinated
Red registered or authorized
tubes and sets, catheters, urine bags,
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plastic bags or recyclers or for energy
syringes (without needles and fixed
recovery or plastics to diesel
needle syringes ) and vaccutainers containers
or fuel oil or for road making,
with their needles cut) and gloves.
whichever is possible. Plastic
waste should not be sent to
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landfill sites.
Autoclaving or Dry Heat
Sterilization followed by
shredding or mutilation or
Puncture encapsulation in metal
Waste sharps including Metals:
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proof,
container or cement concrete;
Needles, syringes with fixed
combination of shredding
needles, needles from needle tip
White cum autoclaving; and sent for
cutter or burner, scalpels, blades, or Leak proof,
(Translucent) final disposal to iron
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any other contaminated sharp object

tamper proof foundries (having consent to
that may cause puncture and cuts.
operate from the State
This includes both used, discarded containers
Pollution Control Board s or
and contaminated metal sharps
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Pollution Control Committee

s) or sanitary landfill or
designated concrete waste
sharp pit.
Blue Glassware: Broken or discarded and Cardboard Disinfection (by soaking the
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contaminated glass including medicine boxes washed glass waste after
vials and ampoules except those cleaning with detergent and
contaminated with cytotoxic wastes with blue Sodium Hypochlorite treatment)
colored or through autoclaving or
marking microwaving or hydroclaving
Metallic Body Implants
and then sent for recycling.

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* Disposal by deep burial is permitted only in rural or remote areas where there is no access to
common bio - medical waste treatment facility. This will be carried out with prior approval from
the prescribed authority and as per the Standards specified in Schedule - III. The deep burial
facility shall be located as per the provisions and guidelines issued by Central Pollution Control
Board from time to time.

6.4 Segregation

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Segregation refers to the basic separation of different categories of waste generated at source and
thereby reducing the risks as well as cost of handling and disposal. Segregation is the most

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crucial step in bio-medical waste management. Effective segregation alone can ensure effective
bio-medical waste management.

• Segregation reduces the amount of waste needs special handling and treatment
•
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Effective segregation process prevents the mixture of medical waste like sharps with the general

Displaying Biohazards
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• Prevents illegally reuse of certain components of medical waste like used syringes, needles and
other plastics.
• Provides an opportunity for recycling certain components of medical waste like plastics after
proper and thorough disinfection.
• Recycled plastic material can be used for non-food grade applications.
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• Of the general waste, the biodegradable waste can be composted within the hospital premises and
can be used for gardening purposes.
• Recycling is a good environmental practice, which can also double as a revenue generating
activity.
• Reduces the cost of treatment and disposal (80 per cent of a hospital’s waste is general waste,
which does not require special treatment, provided it is not contaminated with other infectious
waste)

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6.5 Examples of Bio waste diaplay

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Proper labelling of bins
The bins and bags should carry the biohazard symbol indicating the nature of waste to the
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patients and public.

7. Explain in detail about the disposal of biomedical waste and discuss its merits and
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demerits.

7.1 Disposal of biomedical waste is done in two steps:

1. Pretreatment – The infected waste that cannot be incinerated (e.g. plastic and rubber items,
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sharps, etc.) has to be disinfected first, before it is sent for the final disposal.

2. Final disposal – This involves incineration or secured land filling and deep burial (restricted).

1. Pretreatment:
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Disinfection of non-incinerable items can be done in many ways as described below:

i. Chemical Disinfection:
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Plastic, rubber and metallic items (like IV sets, blood bags, gloves, catheters, syringes and
needles) must be chemically disinfected before they are sent for final disposal (landfill).
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Chemical disinfection can be done in following steps:

a. Mutilate the syringes and needles with a needle destroyer. Cut all other plastic/rubber item
with the help of scissors (so that they cannot be reused.
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b. Make 1% hypochlorite solution (fresh everyday) by dissolving 10 g of this powder (approx. 2
spoonful) in 1 L of water in a plastic bucket.

c. Keep another, smaller bucket with perforations inside the main bucket (having the solution).
Put all the items that are to be disinfected inside the perforated bucket and ensure that they are
kept well-dipped in the solution for 30-60 minutes.

d. After 30-60 minutes, pull out the perforated bucket (while solution remains back in the main

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bucket), take out the disinfected items and put them in a proper waste bag. Sharps should be first
kept in a tough cardboard box and then only put in the plastic bag so as to avoid damage to the
bags.

e. Change the solution every 12 hours.

ii. Autoclave:

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This is an effective technique for sterilization of microbiology, biotechnology waste and also for
the infected disposable plastic and rubber waste (e.g. gloves, blood bags, IV sets, syringes, etc.).

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This technique works on the basis of heat and pressure applied for a period of time.

Certain rules should be followed while using autoclave:

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a. There should be a separate autoclave for the sterilization of biomedical waste.

b. While an autoclave works, the indicator must show appropriate temperature, time and
pressure. If not, the whole procedure should be repeated.
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c. Medical waste shall be subjected to:

Operating a Gravity Flow Autoclave:

I. A temperature of not less than 121°C and pressure of 15 pounds per square inch (psi) for an
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autoclave residence time of not less than 60 minutes, or

II. A temperature of not less than 149°C and a pressure of 52 psi for an autoclave residence time
of less than 30 minutes.
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Operating a Vacuum Autoclave:

I. A temperature of not less than 121°C and pressure of 15 psi for an autoclave residence time of
not less than 45 minutes; or
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II. A temperature of not less than 135°C and a pressure of 131 psi for an autoclave residence
time of not less than 30 minutes.
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d. Each autoclave shall have graphic of computer regarding device throughout the autoclave
cycle for proper record and efficiency.

e. Validation test, spore tests.

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f. Routine test strip/temperature strips should be recorded.

g. After autoclave, plastic items can be shredded but rest of the items should be sent for final
disposal in the landfill.

iii. Hydroclave:

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In this method, shredded infectious waste is exposed to high temperature, high-pressure steam
like an autoclave. This also inactivates most of the microorganisms if temperature and contact
time are sufficient.

This method has a relatively low investment and operating cost and its environmental impact is
also less.

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Certain rules to be followed are:

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a. All waste must be shredded before subjecting to this method. Sharps must be milled or
crushed.

b. Effectiveness should be routinely checked.

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c. The equipment should be operated and maintained by adequately trained technicians.

iv. Plasma Pyrolysis:

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Alternate to incinerator, plasma pyrolysis treatment technology can be installed for disposal of
biomedical waste categories 1, 2, 5 and 6 wherein destruction of biomedical waste similar to
incineration can be achieved. In this technique, waste is treated at high temperature under
controlled conditions to form gases like methane, hydrogen and carbon monoxide which are
subjected to combustion (oxidation) in secondary chamber.
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In the plasma pyrolysis process, waste is converted into small clinker which can be disposed in
the secured landfill.

V. Microwave Irradiation:
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This technique is also effectively (like autoclave/hydroclave) in sterilizing the infected,

disposable waste. Most microorganisms are destroyed by the action of microwaves. The water
contained within the waste is rapidly heated and the infectious components are destroyed by the
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heat conduction. The waste is first shredded (in the unit itself) and then humidified and
irradiated. Lastly, the waste is compacted inside a container and can go to the municipal waste
system. This is an expensive system and it also requires a good operational and maintenance
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control. These disadvantages may make it unsuitable for use in a developing country.
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Vi Shredder for Plastic Material:

Shredder for plastic material (plastic bottles, IV sets, syringes, etc.) cuts the plastic waste into
small pieces of 1 cm size chips. It ensures that syringes and other plastic material are rendered
non-recyclable.

2. Final Disposal:

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The following techniques can dispose of the biomedical waste on a final basis:

I. Incineration:

It is a high temperature, dry oxidation process that reduces organic and combustible waste to
inorganic, incombustible mater. It also reduces the waste volume and weight. It is usually
selected for the waste that cannot be reused, recycled or disposed of in a landfill site.

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Incineration requires no pretreatment provided certain waste types are not included.

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Following waste types may be easily submitted for incineration:

i. Human waste (tissues, body parts, blood and body fluids)

ii. Animal waste

iii. Dressing material.

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Following waste should not be incinerated:
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a. Pressurized gas containers

b. Large amount of reactive chemical waste

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c. Photographic/radiographic waste

d. Halogenated plastic such as polyvinyl chloride (PVC)

e. Waste with high mercury or cadmium content (such as thermometers, used batteries)
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f. Sealed ampoules or ampoules containing heavy metals.

Incinerators are of three types:

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i. Single Chamber Furnaces:

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These may be the cheapest units.

ii. Double Chamber Pyrolytic Incinerators:

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These are most reliable and are commonly used for disposal of biomedical waste. They are also
referred to as double-chamber incinerators. In the first (pyrolytic) chamber, waste is destroyed
through an oxygen deficient, medium temperature combustion process (800°C). This produces
solid ashes and gases. In the second (post-combustion) chamber, gases are burnt at a high
temperature (900° to 1200°C) using an excess of air to minimize smoke and odor. This
equipment may be somewhat expensive and requires trained personnel to handle it. Regular
maintenance and operational care are also needed.

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iii. Rotary Kilns:

It comprises of a rotating oven and a post-combustion chamber. It may be specifically used to

burn chemical waste (chemicals, pharmaceuticals including cytotoxic drugs).

A number of recommendations are to be made while using incineration as a final disposal

facility for the biomedical waste:

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a. An incinerator should be situated at a safe distance from the residential areas.

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b. Incinerator plant should have a strong fencing and unauthorized entry (including that of rag-
pickers) should be prohibited.

c. The plant area should have proper electricity and water facility.
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d. Waste should be loaded directly to the furnace preferably using an automatic loading device.

e. Biomedical waste should not be stored for more than 24 hours at the incineration plant.
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f. Efficiency of the plant should be regularly checked.

g. Biomedical waste should be introduced into the furnace only when the normal conditions of
combustion have been established (never during start-up or shut down of the process).
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h. Suitable techniques must be adopted to keep the air pollution to the minimum.

i. Residual ashes should be sent to the landfill.

j. Facilities should be available at the incineration site for the cleaning and disinfection of
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transportation equipment including vehicles.

ii. Safe Pit for Sharps:

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Besides other methods of disposal for sharp, burial in safe pit is an effective and economical
method. Sharps (needles and blades) are being used in day-to-day practice in all healthcare units.
Needle prick may be responsible for tetanus, HBV and HIV/AIDS diseases. To avoid recycling
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of needles and sharps, these should be buried in safe pits.

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Design and Construction:

It can be constructed by 5 feet deep circular concrete ring of 3′ diameter or by using bricks (4′ x
3′ x 5′ deep) which can be made circular or rectangular. A slab is used on top in which GIC pipe
with 5″ or 6″ diameter is used which is fitted with lock and key arrangements. Size will vary as
per requirement, i.e. is quantum of sharp waste.

The pit is plastered inside at bottom and around. The size and shape of pit varies as per space

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available and requirement. When it is filled up, cement slurry can be used to close it and second
pit is constructed.

Advantages:

i. Eco-friendly

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ii. Cost-effective

iii. Easy to construct within 48 hours

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iv. Most suitable for rural health center and hospitals when space is available.

iii.Landfill: pa
Local bodies such as Gram Panchayats, Municipalities or corporations will provide or allocate
suitable land for secured landfill/common biomedical waste treatment and disposal facility for
safe treatment and disposal of biomedical waste in their respective jurisdictions.
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It is another choice for final disposal of biomedical waste and it can be quite effective if
practised appropriately. While open dumping of biomedical waste cannot be recommended for
the reasons of acute pollution problems, fire, higher risk of disease transmission and open access
to scavengers and animals, a sanitary landfill observing certain rules can be an acceptable choice
particularly in developing countries.
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Some essential elements for design and operation of a sanitary landfill are given below:

a. A specifically designated place should only be used for the landfill. Proper permission to use
the place for the said purpose must be obtained from the relevant authority.
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b. The site should preferably be away from the residential areas.

c. Location should be such that vehicles carrying waste can easily approach it in all weathers.
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d. The area should be under constant supervision and security control. Unauthorized entry must
be strictly prohibited.
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e. It should not be in the vicinity of a drinking water source as pollution may result.

f. The site should be divided into various manageable phases and all of them should be
adequately prepared before the actual landfill starts.
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g. The site should be so organized that the waste can be spread, compacted and covered daily.

h. A final cover should be constructed to prevent the rain water infiltration when each phase of
landfill is completed.

i. Waste should be buried as rapidly as possible so as to minimize the exposure to humans or

animals.

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Common biomedical waste treatment facility as an option has been legally introduced in India. It
is set-up where biomedical waste generated from small and big healthcare units is collected,
treated and disposed off at a comparatively less cost. It also reduces the monitoring pressure on
regulatory agencies.

In order to set-up a Common Biomedical Waste Treatment Facility (CBWTF) to its maximum
perfection, care shall be taken to in choosing the right technology, development of CBWTF area,

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proper designing of transportation system to achieve optimum results. On these key features,
CBWTF’s guidelines for the establishment have been prepared to be followed throughout the
country.

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7.2 The guidelines have the following features:

i. Location pa
ii. Land requirement

iii. Coverage area of CBWTF

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iv. Treatment equipment

v. Infrastructure setup

vi. Regular record keeping, regular for waste movements, log book for the equipment site
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records

vii. Collection and transportation of biomedical waste

viii. Disposal of treated biomedical waste

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ix. Cost to be charged by CBWTF from healthcare units

x. Setting up and operation of CBWTF

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xi. Checklist for development of common biomedical waste treatment facility.

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7.3 Techniques for Management of Biomedical Waste:

Several other techniques have been developed for management of biomedical waste.
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1. Plasma Arc Technology:

Using a plasma converter, the system forces gas through an electrical field to ionize the gas into
plasma state that conducts electricity and achieves high temperatures. The converter is fired by
electricity and uses a plasma torch to produce an intense field of radiant energy reaching very
high temperature that causes waste material to break up into its elemental atomic components
thereby completely destroying the waste. Useful recyclable such as elemental metals, silicates
and pure hydrogen gas can also be produced. The plasma converter is very well-insulated and

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completely computer controlled.

The advantages are:

i. Can process any and all waste material.

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ii. Recycles waste into valuable commodities.

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iii. Provides safe and irreversible destruction of the most hazardous waste.

iv. Converts toxic substances into harmless material and does not require the waste to be sorted.
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v. As there is almost no residue, it eliminates the need for landfills and can be used in the
countries which lack landfill space.

2. Electro Thermal Deactivation (ETD) Technology:

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It uses radioactive frequency (RF) waves from treatment of regulated waste. This is an
alternative technology to incineration and similar to microwave.

The advantages over microwave is that RF waves have a longer wave length (9-12 feet) having
deep penetration.
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Compared to incineration, this technology has no toxic air or water emissions. The waste is
reduced by 80% volume and rendered unrecognizable.

Accessory Processes:
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Before treatment with RF, waste is shredded, usually under continuous negative pressure using
filters to present aerosol contamination of the environment. After treatment with RF, a roll off
compactor is applied to reduce the volume of the waste.
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The validation of the process is done by Bacillus subtilis spores count with at least 1 x 104 spores
per milliliters.
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3. Detoxification Technology:

Under detoxification technology, waste is simultaneously shredded and heated to 480-700°C.

Gases evolved raise temperature to 1540°C, by which the organic compound is destroyed.
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4. Other Emergency Technologies:

Other emergency technologies include electrochemical oxidation, molten metal technology,

solvated electron process and superficial water oxidation.

7.4 Merits :

This practice is highly lucrative:

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The Journal of Waste management says that the revenues generated by the waste management
would top by $60 million by 2018. But, there are only a few people who sincerely consider this
as an industry into various facets of waste management like recycling and reusing, and reap the
benefits. Now many companies are looking forward to associate themselves with this industry
and are ready for a long term investment.

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2. Keeps the environment clean and fresh:

Perhaps, the greatest advantage of waste management is keeping the environment fresh and neat.

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These waste disposal units also make the people go disease free as all the resultant wastes are
properly disposed and taken care of.

More number of waste disposal units can be placed in all the tier-1 and tier-2 cities so that the
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waste disposal process can be prepped up. Also a point worthy of our consideration here is that
this advantage can be taken into account only if extensive and proper safety measures are
implemented along with proper waste disposal techniques. There is no use in simply
implementing a half-baked technique which, if no use to both the people and the environment.
This is the best effects of proper waste disposal.
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3. Saves the Earth and conserves energy:

This characteristic of waste management includes specifically the recycling aspect. As recycling
of waste helps in reducing the cutting down of trees. This cutting of trees is mainly done for the
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production of paper.

By using this method, we can use the recycled waste to make quality papers rather than relying
on trees. Also, recycling needs only a minimal amount of energy for utilization and complete
processing. The resultant product we obtain is a renewable source of energy and is eco-friendly.
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4. Reduces environmental pollution:

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As explained above, waste management if done in a proper manner not only eliminates the
surrounding waste but also will reduce the intensity of the greenhouse gases like methane,
carbon monoxide which is emitted from the wastes accumulated.
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The depth of the existing landfills and incineration will be curbed, thereby cutting down the
harmful factors that affect the environment. Also, the amount of fossil fuels will get reduced in
this manner, leading to a cleaner and a greener environment.
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5. Waste management will help you earn money:

Can you believe if I say that what I have said above is absolutely true? Yes, waste management
earns you a few extra bucks every month. Actually, there are many companies which will pay
you for your waste.

Right from old and used bottles to tin cans and e-wastes, all kinds of wastes are collected and
paid. These wastes are then segregated according to the extent of pollution they cause to the

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environment and these wastes are recycled accordingly for various purposes.

There are also crash courses available which will aid you to reuse your trash. Above all, by
following this method you can create an awareness to your fellow people by earning money,
which is a win-win concept.

6. Creates employment:

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Again, this aspect too is unbelievable for you… right? You may even ask how come this is
possible? But in all the facets of waste management, a huge amount of labour is needed. Right

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from the collection to the final step of segregation, every phase needs manpower and ultimately a
large number of employment opportunities get opened up. This claim is evident from the labour
statistics provided by the US government, according to which around 3.1 million new jobs are
produced due to the waste management factor.
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7.5 Demerits of Waste Management:

We have now seen the merits of waste management in detail. Let us now have a look at the
disadvantages also.
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1. The process is not always cost-effective:

Yes, though it may pay cash to the contributors, the truth is this process needs a lot of money,
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time and land to set up a plant and run. As the amount of waste that is being contributed to the
waste product unit increases, so are the number of plants that process these resources.

Setting up a huge factory obviously needs a lot of money, and this management will start
fetching yields only in the long run. Hence, this is not seen as a short-term lucrative investment.
While dumping more and more garbages in the landfills cause only $50 per ton, recycling them
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in the proper manner will cause $150 per ton, which is exactly triple the cost and thus many of
the companies tend to switch over to the landfill method itself.
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2. The resultant product has a short life:

This is also true since the resulting recycled product cannot be expected to have a durable
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quality. As the product itself has its origin from the remains of the other trashed waste products
and heaps of partially used ones. The recycled product, though, is eco-friendly is expected to
have a shorter life span than the intended original one.
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3. The sites are often dangerous:

As the waste management sites include the landfills to recycling units under its aegis, these sites
are highly susceptible to fungal and bacterial growth thereby leading to various diseases.

Even the debris formation will be accelerated by such bacterial growth, which makes it totally
unsafe for the workers who work there. It also causes widespread pollution and releases harmful
chemicals. These chemicals, when mixed with drinking water or any other consumable item pose

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a high amount of danger to human health.

4. The practices are not done uniformly:

Still, a large scale of these waste management practices are done only as a small scale process
and is mostly confined to residential homes, schools and colleges and is not practised in a
uniform manner in large industries and conglomerates. It is not even practised globally, as the

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global level consists of curbing oil spills, ocean disposals and decreasing the tree felling.

5. Waste management can cause more problems:

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Though waste management creates employment, it only has the ability to produce low quality
jobs. These jobs include right from sorting the garbage collected to the intensive and laborious
jobs that are needed in the factories and outlets.
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Daily basis collection of garbages will make the streets look unpleasant and unhygienic leaving
excess debris on the streets to rot up. Even after the successful completion of the final stage,
many chemical stews will be left behind which needs to be properly and completely disposed,
otherwise, they will also pose a threat to the environment which makes the ultimate purpose of
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waste management go redundant.

Also, in the areas where these management units are present, it is noticed that the groundwater
gets affected. So, it too causes a considerable extent of water pollution and land pollution.
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VIVEKANANDHA
COLLEGE OF TCHNOLOGY FOR WOMEN
ELAYAMPALAYAM, TIRUCHENGODE – 637 205, NAMAKKAL Dt., TAMIL NADU, INDIA
Phone : 04288-234064, Fax : 04288-234134, Website :www.vctw.ac.in,E-mail:principal@vctw.ac.in
VIVEKANANDHA

DEPARTMENT OF COMPUTER SCIENCE AND ENGINEERING

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FIFTH SEMESTER
OMD552 - HOSPITAL WASTE MANAGEMENT
UNIT III
2 MARK AND 13 MARK PART - A & B QUESTION BANK
HAZARDOUS MATERIALS

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Hazardous Materials : Hazardous Substance Safety, OSHA Hazard Communication Standard,
DOT Hazardous Material Regulations, Healthcare Hazardous Materials, Medical Gas Systems,
Respiratory Protection.

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PART - A
1.Define hazardous materials. pa
A hazardous material is any item or agent (biological, chemical, radiological, and/or
physical), which has the potential to cause harm to humans, animals, or the environment, either
by itself or through interaction with other factors.
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2.What are the hazardous materials in the hospital ?

The most common hazardous materials in healthcare facilities include mercury,

pharmaceuticals, radiological, sterilants and disinfectants, cleaning chemicals, laboratory
chemicals and pesticides.
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3.How do you treat hazard materials ?

Hazardous waste can be treated by chemical, thermal, biological, and physical methods.
Chemical methods include ion exchange, precipitation, oxidation and reduction, and
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neutralization.

4.How do you handle hazard materials ?

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• Carefully read the ingredient list of any product or chemical you use
• Purchase the proper personal protective equipment like gloves or goggles
• Be aware of the hazardous materials you come in contact with. Learn about the specific
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characteristics and dangers.

• Follow safe procedures when you handle hazardous material. Don't take shortcuts.
• Always carry chemicals in approved containers.
• Always wash your hands after using any unsafe material.
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5.What are the types of chemicals ?

• Acid-Base Reactions. Many chemistry sets come with acids and bases that react strongly
when mixed together
• Acids. In simple terms, acids are chemical compounds charged with highly reactive
hydrogen ions
• Bases
• Metallic Chemicals

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• Heat Reaction Chemicals
• Polymers.

6.Give some examples of hazard materials.

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• Antifreeze
• Batteries
• Brake fluid

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• Chemical strippers
• Chlorine bleach
• Contact cement pa
• Drain cleaners
• Fire extinguishers.

7.What is meant by Hazardous substances ?

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Hazardous substances may be things you see every day such as paint, glue, cleaning
liquid and powders. Dangerous goods are classified on the basis of immediate physical or
chemical effects, such as fire, explosion, corrosion and poisoning.
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8. List the Possible side effects of exposure to hazardous substances.

• Poisoning
• Nausea and vomiting
• Headache
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• Skin rashes, such as dermatitis

• Chemical burns
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• Birth defects
• Disorders of the lung, kidney or liver
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• Nervous system disorders.

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9.Mention the Labels Safety Data Sheets for hazardous substances.

• Warning labels on hazardous substances

• Hazard pictograms
• Signal words (such as danger and warning)
• Hazard statements (such as fatal if swallowed)
• Precautionary statements (such as wear protective gloves).

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10.Define the Safety Data Sheets for hazardous substances.

The Safety Data Sheet lists important information on handling the product safely, including:

• Potential health effects

• Precautions for use

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• Safe storage suggestions
• Emergency first aid instructions
•

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Contact numbers for further information.

11. What are the Reducing exposure to hazardous substances ?

•
•
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Where possible, perform the task without using hazardous substances
Where possible, substitute hazardous substances with less hazardous alternatives
(for example, use a detergent in place of a chlorinated solvent for cleaning)
• Isolate hazardous substances in separate storage areas
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• Purge or ventilate storage areas separately from the rest of the workplace
• Thoroughly train employees in handling and safety procedures
• Provide personal protection equipment such as respirators, gloves and goggles.
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12. Mention the written records for hazardous substances.

• Details of risk assessments

• Results of air and environment tests, if required
•
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Details of health monitoring of employees, if required

• Records of each employee who works with a scheduled carcinogenic substance at the
workplace.
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13. What are the Medical help for exposure to hazardous substances ?

• In an emergency dial triple zero (000) for an ambulance.

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• Otherwise, see your doctor immediately for treatment, information and referral.
• Notify your employer.
• Try not to handle the hazardous substance again.
14. List the Dangerous substances. www.rejinpaul.com
• Allergies
• Skin diseases
• Cancers
• Reproductive problems and birth defects
• Respiratory diseases
• Poisoning

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15. What are the purpose of OSHA Hazard Communication Standard ?

It is “to ensure that the hazards of all chemicals produced or imported are evaluated and
details regarding their hazards are transmitted to employers and employees."

16.Define Hazard communication standard.

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The Hazard Communication Standard requires employers in the United States to disclose
toxic and hazardous substances in workplaces. This is related to the Worker Protection Standard.

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Specifically, this requires unrestricted employee access to the Material Safety Data Sheet or
equivalent, and appropriate training needed to understand health and safety risks.

•
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17.Give the four main requirements of the hazard communication standard.

Ensuring the proper chemical labeling

• Providing safety data sheets
• Training employees
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• Creating a written hazard communication program.

18.Define SDS.
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A Safety Data Sheet (formerly called Material Safety Data Sheet) is a detailed
informational document prepared by the manufacturer or importer of a hazardous chemical. It
describes the physical and chemical properties of the product.

19.What do you know about hazard communication standard label requirements ?

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OSHA has updated the requirements for labeling of hazardous chemicals under its
Hazard Communication Standard (HCS). All labels are required to have pictograms, a signal
word, hazard and precautionary statements, the product identifier, and supplier identification.
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20.Who has hazard communication duties ?

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Hazard Communication is meant to be a program that is regularly and consistently used,

as it provides several layers of safety for your workers. HazCom compliance is the responsibility
of everyone who has known (or potential) exposure to chemical hazards.
21.What are the OSHA Hazard Communication Standard ? www.rejinpaul.com
• Ensuring the proper chemical labeling
• Providing safety data sheets
• Training employees
• Creating a written hazard communication program.

22.Why is safety data sheet important ?

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It is an essential starting point for the development of a complete health and safety
program. It also contains information on the use, storage, handling and emergency procedures all
related to the hazards of the material. The MSDS contains much more information about the
material than the label.

23.What is a safety data sheet used for ?

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Safety Data Sheets are an essential component of the GHS and are intended to provide
comprehensive information about a substance or mixture for use in workplace chemical

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management. In the GHS, they serve the same function that the Material Safety Data Sheet or
MSDS does in OSHA's HazCom Standard.
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24. What are the purpose of OSHA Hazard Communication Standard ?

According to OSHA, the purpose of the Hazard Communication Standard (HCS) is “to
ensure that the hazards of all chemicals produced or imported are evaluated and details regarding
their hazards are transmitted to employers and employees."
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25. What is DOT Hazardous Material Regulations ?

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Department of Transportation (DOT) defines a hazardous material as any item or

chemical which, when being transported or moved in commerce, is a risk to public safety or the
environment, and is regulated as such under its Pipeline and Hazardous Materials Safety
Administration regulations(49 CFR 100-199), which includes the Hazardous Materials .
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26.What are hazardous materials regulations ?

The Hazardous Materials Regulations (HMR) are in the volume containing Parts 100-185
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and govern the transportation of hazardous materials in all modes of transportation – air,
highway, rail and water. The regulations are issued by Federal agencies to carry out the
responsibilities imposed on those agencies by Congress.
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27.What is DOT placard ? www.rejinpaul.com
The Department of Transportation (DOT) mandates that Hazmat Placards be used when
transporting hazardous materials and dangerous goods in the United States. ... Clearly marking
trucks as carrying hazardous materials with hazmat placards ensures the proper and safe
transportation of such cargo.

28.Define DOT shipping.

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Shipping hazardous materials within DOT guidelines. The U. S. Department of
Transportation (DOT) has specific rules for shipping hazardous materials. Freight quote can help
you determine the DOT hazard class for your shipment and find contract freight carriers that
meet DOT safety and transportation requirements.

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29.What is DOT training ?

DOT Hazmat Ground Shipper Training. The US DOT Pipeline and Hazardous Materials
Safety Administration (PHMSA) requires training for all employees who prepare or offer hazmat

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for transportation. Initial hazmat employee training must occur within 90 days of hire.

30.List the nine DOT hazard classes.

 Class 1: Explosives.
 Class 2: Gases.
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 Class 3: Flammable and Combustible Liquids.
 Class 4: Flammable Solids.
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 Class 5: Oxidizing Substances, Organic Peroxides.
 Class 6: Toxic Substances and
 Class 7:Infectious Substances.
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 Class 8: Radioactive Materials.

 Class 9: Corrosives.

31.What is DOT regulated ?

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The United States Department of Transportation (DOT), and in the particular the Federal
Motor Carrier Safety Administration (FMCSA), requires that regulated employers conduct
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certain background checks on drivers who operate certain vehicles on national roadways.

32.How long is DOT hazmat training good for ?

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For the in-depth security training required, a hazmat employee must be trained at least
once every three years or, if the security plan for which training is required is revised during the
three-year recurrent training cycle, within 90 days of implementation of the revised plan.
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33.How to get hazmat certificate ?

Step 1: Obtain a Valid Commercial Driver's License. There are a few stringent requirements to
become certified to transport large quantities of hazardous materials.
Step 2: Obtain the HAZMAT Endorsement.

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Step 3: Obtain Tanker Endorsement.

34.Who is subject to DOT regulation ?

Generally, DOT regulations cover safety-sensitive transportation employers and

employees. Each DOT agency (e.g. FRA, FMCSA, FTA, FAA, and PHMSA) and the USCG
have specific drug and alcohol testing regulations that outline who is subject to their

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testing regulations.

35.What are DOT regulations ?

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Required DOT Rules and Regulations. The DOT rules and regulations are meant to be
followed by all truckers and other drivers on US roads. Each state has its own variation of
these regulations, but some of the rules are enforced on a federal level.
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36.What are the health care waste ?

• Hospitals and other health facilities

• Laboratories and research centres
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• Mortuary and autopsy centres
• Animal research and testing laboratories
• Blood banks and collection services
• Nursing homes for the elderly
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37.Mention the four types of hazardous waste.

• Ignitability, or something flammable

• Corrosivity, or something that can rust or decompose
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• Reactivity, or something explosive

• Toxicity, or something poisonous.
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38.How we can reduce hazardous waste ?

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• Avoid the Use of Commercial Household Cleaners

• Use Natural Compost as Fertilizer
• Avoid the Use of Pesticides
• Use Water Based Paints
 • Avoid Using Toxic Drain Cleaners www.rejinpaul.com
• Use Natural Alternatives for Floor and Metal Polish
• Dispose of any Hazardous Waste Safely

39.What is medical gas system ?

Types of Gas Used in Medical Gas Systems in Hospitals. Medical gas systems in
hospitals are, in a word, lifesaving. These assemblies supply piped oxygen, nitrous oxide,
nitrogen, carbon dioxide, and medical air to hospital areas such as patient rooms, recovery areas,

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operating rooms, and more.

40.Give examples of medical gases.

Air, helium, nitrogen, freon, carbon dioxide, water vapor, hydrogen, natural gas, propane,
oxygen, ozone, and hydrogen sulfide are some examples of gases. Oxygen and nitrous oxide are

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examples of oxidizers.

41.What gases are used in hospital ?

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• Medical Air. Medical Air refers to a clean supply of compressed air used in hospitals and
healthcare facilities to distribute medical gas
• Oxygen pa
• Carbon Dioxide
• Nitrogen (Medical Liquid Nitrogen)
• Nitrous Oxide.
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42.What are the type of oxygen gases ?

• Compressed oxygen cylinders, or "green tanks"

• Oxygen concentrators.
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• Liquid oxygen systems.

43.List the properties of common medical gases.

• Chemical symbol
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• Molecular weight
• Color, odor, taste
• Physical state
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• Critical temperature, boiling point

• Combustion characteristics
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44.Mention the types and colors of cylinder.

Air - Yellow
Oxygen - Green – Int’l (White)
Helium - Brown
 CO 2 - Grey www.rejinpaul.com
Nitrogen - Black
Nitrous Oxide - Blue

45.What is Respiratory Protection ?

A respirator is a device designed to protect the wearer from inhaling hazardous

atmospheres, including particulate matter such as dusts and airborne microorganisms, as well as
hazardous fumes, vapours and gases.

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46. What is the use of Respiratory Protection ?

The primary objective of the respiratory protection program is to prevent exposure to air
contaminated with harmful dusts, fogs, fumes, mists, gases, smokes, vapors, or sprays, and thus
to prevent occupational illness.

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47. What are the two main types of respiratory protection?

 Air Purifying Respirators. These types of respirators include: - Air Purifying

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Disposable Particulate Masks- Air Purifying Half Mask Respirators
 Supplied Air Respirators. These types of respirators include: - Airline Respirators-
Emergency Escape Breathing Apparatus
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48. What is the purpose of a respiratory protection program?

The primary objective of the respiratory protection program is to prevent exposure to air
contaminated with harmful dusts, fogs, fumes, mists, gases, smokes, vapors, or sprays, and thus
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to prevent occupational illness. A program administrator must be responsible for the program.

49.What is respiratory protection standards ?

The final standard replaces the respiratory protection standards adopted by OSHA in
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1971. Establishments whose respiratory protection programs for tuberculosis formerly covered
under 29 CFR 1910.139 were required to adapt their programs to comply with
the requirements of 29 CFR 1910.134 effective July 2, 2004.

50. What Is the Difference Between a Ventilator and a Respirator?

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According to the American Thoracic Society, mechanical ventilators are devices that
deliver air into the lungs through a tube placed within the windpipe. A respirator, on the other
hand, refers to a mask that filters harmful substances from the air.
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PART – B

1.Explain in detail about Hazardous Materials and Substances. (13 Mark)

A hazardous material is any item or agent (biological, chemical, radiological,

and/or physical), which has the potential to cause harm to humans, animals, or the
environment, either by itself or through interaction with other factors.

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1.1 Common hazardous substances in the workplace include:

 Acids
 Caustic substances
 Disinfectants

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 Glues
 Heavy metals, including mercury, lead, cadmium and aluminium
 Paint

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 Pesticides
 Petroleum products
 Solvents pa
1.2 Possible side effects of exposure to hazardous substances

Health effects depend on the type of hazardous substance and the level of exposure
(concentration and duration). A hazardous substance can be inhaled, splashed onto the skin or
eyes, or swallowed. Some of the possible health effects can include:
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 Poisoning
 Nausea and vomiting
 Headache
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 Skin rashes, such as dermatitis

 Chemical burns
 Birth defects
 Disorders of the lung, kidney or liver
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 Nervous system disorders.

1.3 Labels and Safety Data Sheets for hazardous substances

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Manufacturers and importers of hazardous substances in Victoria are required by law to

provide warning labels and Safety Data Sheets with their products.
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Employers must ensure that the Safety Data Sheets for each hazardous substance used in
the workplace is available to employees, and that a central register of hazardous substances is
established.
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Types of Labelling Display

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In accordance with the Globally Harmonised System of Classification and Labelling of
Chemicals (GHS) or other methods set out in the Occupational Health and Safety Regulations,
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warning labels on hazardous substances should feature:

 Hazard pictograms
 Signal words (such as danger and warning)
 Hazard statements (such as fatal if swallowed)
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 Precautionary statements (such as wear protective gloves).

The GHS classifies and communicates chemical hazards using internationally consistent
hazard pictograms, terms and information displayed on chemical labels and Safety Data Sheets.
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The Safety Data Sheet lists important information on handling the product safely,
including:

 Potential health effects

 Precautions for use
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 Safe storage suggestions

 Emergency first aid instructions
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 Contact numbers for further information.

1.4 Reducing exposure to hazardous substances

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Suggestions on reducing exposure to hazardous substances in the workplace include:

 Where possible, perform the task without using hazardous substances

 Where possible, substitute hazardous substances with less hazardous alternatives
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(for example, use a detergent in place of a chlorinated solvent for cleaning)
 Isolate hazardous substances in separate storage areas

 Purge or ventilate storage areas separately from the rest of the workplace
 Thoroughly train employees in handling and safety procedures
 Provide personal protection equipment such as respirators, gloves and goggles
 Regularly monitor the workplace with appropriate equipment to track the degree of
hazardous substance in the air or environment
 Regularly consult with employees to maintain and improve existing safety and

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handling
practices.

1.5 Hazardous substances – written records

Under the Occupational Health and Safety Regulations, certain records have to be

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maintained if hazardous substances are used in the workplace, including:

 Details of risk assessments

 Results of air and environment tests, if required

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 Details of health monitoring of employees, if required
 Records of each employee who works with a scheduled carcinogenic substance at the
workplace. pa
1.6 Professional advice about hazardous substances

Organisations such as Work Safe Victoria can offer valuable information on how to
reduce the risks of working with hazardous substances. Publications include:
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 Compliance code: hazardous substances
 Information about safety data sheets
 Information about compliance codes and codes of practice
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 hazardous substances: safety basics.

1.7 Medical help for exposure to hazardous substances

If you suspect you have been exposed to hazardous substances:

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 In an emergency dial triple zero (000) for an ambulance.

 Otherwise, see your doctor immediately for treatment, information and referral.
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 Notify your employer.

 Try not to handle the hazardous substance again.
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1.8 Nine hazardous materials classifications

 Class 1: Explosives.
 Class 2: Gases.
 Class 3: Flammable and Combustible Liquids.
  Class 4: Flammable Solids. www.rejinpaul.com
 Class 5: Oxidizing Substances, Organic Peroxides.
 Class 6: Toxic Substances and
 Class 7:Infectious Substances.
 Class 8: Radioactive Materials.
 Class 9: Corrosives.

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2.Explain in detail about Hazardous Substance Safety. (13 Mark)

A hazardous substance can be any substance, whether solid, liquid or gas, that may cause
harm to your health. Hazardous substances are classified on the basis of their potential health

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effects, whether acute (immediate) or chronic (long-term)

2.1 Hazardous substance safety precautions

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Once you have identified any risk of exposure to your workers, you then need to consider
how to protect them.
You should consider control measures, in the following order. These are known as a hierarchy of
controls.
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1. Eliminate the use of a substance.
2. Use a safer form of the substance, for example a readymade paste rather than a
powder.
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3. Change the process to emit less of the substance, including waste streams.
4. Enclose the process so that the substance does not escape.
5. Extract emissions from the substance near the source through exhaust ventilation.
6. Minimize the number of workers who could be exposed to the hazard even with
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controls in place.
7. Provide personal protective equipment (PPE), for example gloves, coveralls
and respirator (these must fit the wearer and provide the correct protection for the task,
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the substance and the work environment).

You should also ensure that
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• you provide appropriate protective equipment free of charge

• workers are properly trained to use control measures correctly
• workers understand the process and the hazards associated with it
• you keep records of issue, and checks and maintenance in logbooks
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you follow the recommended schedules for checking, maintenance and testing of your
systems.

2.2 Accidental exposure

Even the best controls can fail at some point. It is important to plan and practice how to
deal with accidents such as spills, and emergencies such as
• Splashes on skin or eyes
• A leak from a gas or fume

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• A worker losing consciousness.

2.3 Monitoring exposure

You need to ensure that the control measures you put in place remain effective. This may
mean that you need to carry out exposure monitoring involving taking air or biological samples.

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If a risk of exposure remains you may need to carry out health checks. These could include skin
checks for dermatitis or health surveillance on exposed workers.

2.4 Local Exhaust Ventilation (LEV)

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LEV is an engineering control system for reducing exposure to
• Fibres
•

•
Mists
Gases
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• Airborne dusts
• Solvent vapours
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• Metal and rubber fumes.
Most systems will have the following.
• Hood, which captures contaminants in the air.
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• Ducting, which transports the air and the contaminants mixed in it towards the air
cleaner/arrester or to the discharge point.
• Air cleaner or arrester, which filters particles or microorganisms through a filter bank
to clean the air. Not all systems have air cleaners or an arresters.
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• Air mover, which transports the air and contaminants through the system.
• Discharge point, where contaminated or cleaned air is discharged safely.
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If LEV is required, you should

• Look at the relevant trade good practice guides for the processes where LEV is needed
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• Identify what the LEV needs to do, for example extract vapours, mists, fumes or dust
particles
• Seek advice from a reputable supplier or specialist to ensure the right design is
constructed and installed
• Regularly maintain and check that the equipment is doing its job correctly
 • Keep records of maintenance and inspection. www.rejinpaul.com
Make sure that the introduction of LEV does not create other safety or health risks such as
loud noise or reduced access.
2.5 Safety Data Sheet
A Material Safety Data Sheet (MSDS) is a document that contains information on the
potential hazards (health, fire, reactivity and environmental) and how to work safely with
the chemical product.

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A material safety data sheet is a technical document which provides detailed and
comprehensive information on a controlled product related to:
• Health effects of exposure to the product
• Hazard evaluation related to the product’s handling, storage or use
• Measure to protect workers at risk of exposure

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• Emergency procedures.
2.6 The Purpose of the Data Sheet

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The data sheet is the second element of the WHMIS information delivery system and
is intended to supplement the alert information provided on labels. The third element of the
system is the education of employees in hazard information on controlled products, including
instruction in the content and significance of information on the MSDS.
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2.7 11 Rules for safe handling of hazard materials

Rule #1. Follow all established procedures and perform job duties as you’ve been trained.
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Rule #2. Be cautious and plan ahead. Think about what could go wrong and pay close attention
to what you’re doing while you work.

Rule #3. Always use required PPE—and inspect it carefully before each use to make sure it’s
safe to use. Replace worn out or damage PPE; it won’t provide adequate protection.
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Rule #4. Make sure all containers are properly labeled and that the material is contained in an
appropriate container. Don’t use any material not contained or labeled properly. Report any
damaged containers or illegible labels to your supervisor right away.
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Rule #5. Read labels and the material safety data sheet (MSDS) before using any material to
make sure you understand hazards and precautions.
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Rule #6. Use all materials solely for their intended purpose. Don’t, for example, use solvents to
clean your hands, or gasoline to wipe down equipment.
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Rule #7. Never eat or drink while handling any materials, and if your hands are contaminated,
don’t use cosmetics or handle contact lenses.

Rule #8. Read the labels and refer to MSDSs to identify properties and hazards of chemical
products and materials.
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Rule #9. Store all materials properly, separate incompatibles, and store in ventilated, dry, cool
areas.

Rule #10. Keep you and your work area clean. After handling any material, wash thoroughly
with soap and water. Clean work surfaces at least once a shift so that contamination risks are
minimized.

Rule #11. Learn about emergency procedures and equipment. Understanding emergency
procedures means knowing evacuation procedures, emergency reporting procedures, and

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procedures for dealing with fires and spills. It also means knowing what to do in a medical
emergency if a co-worker is injured or overcome by chemicals.

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3.Discuss in detail about OSHA Hazard Communication Standard. (13 Mark)

The Hazard Communication Standard (HCS) (29 CFR 1910.1200(g)), revised in 2012,
requires that the chemical manufacturer, distributor, or importer provide Safety Data Sheets

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(SDSs) (formerly MSDSs or Material Safety Data Sheets) for each hazardous chemical to
downstream users to communicate information on these hazards.
The information contained in the SDS is largely the same as the MSDS, except now the
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SDSs are required to be presented in a consistent user-friendly, 16-section format. This brief
provides guidance to help workers who handle hazardous chemicals to become familiar with the
format and understand the contents of the SDSs.
The SDS includes information such as the properties of each chemical; the physical,
health, and environmental health hazards; protective measures; and safety precautions for
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handling, storing, and transporting the chemical.
The information contained in the SDS must be in English (although it may be in other
languages as well). In addition, OSHA requires that SDS preparers provide specific minimum
information as detailed in Appendix D of 29 CFR 1910.1200. The SDS preparers may also
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include additional information in various section(s).

3.1Identification
This section identifies the chemical on the SDS as well as the recommended uses. It also
provides the essential contact information of the supplier. The required information consists of:
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 Product identifier used on the label and any other common names or synonyms by which
the substance is known.
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 Name, address, phone number of the manufacturer, importer, or other responsible party,
and emergency phone number.
 Recommended use of the chemical (e.g., a brief description of what it actually does, such
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as flame retardant) and any restrictions on use (including recommendations given by the
supplier).
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3.2 Hazards Identification

This section identifies the hazards of the chemical presented on the SDS and the
appropriate warning information associated with those hazards. The required information
consists of:

 The hazard classification of the chemical (e.g., flammable liquid, category1).

 Signal word.

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 Hazard statement(s).
 Pictograms (the pictograms or hazard symbols may be presented as graphical
reproductions of the symbols in black and white or be a description of the name of the
symbol (e.g., skull and crossbones, flame).
 Precautionary statement(s).


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Description of any hazards not otherwise classified.
 For a mixture that contains an ingredient(s) with unknown toxicity, a statement
describing how much (percentage) of the mixture consists of ingredient(s) with unknown
acute toxicity. Please note that this is a total percentage of the mixture and not tied to the

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individual ingredient(s).

3.3 Composition/Information Ingredients

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This section identifies the ingredient(s) contained in the product indicated on the SDS,
including impurities and stabilizing additives. This section includes information on substances,
mixtures, and all chemicals where a trade secret is claimed.
The required information consists of : Substances
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 Chemical name.
 Common name and synonyms.
 Chemical Abstracts Service (CAS) number and other unique identifiers.

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Impurities and stabilizing additives, which are themselves classified and which contribute
to the classification of the chemical.
 Mixtures
 Same information required for substances.
 The chemical name and concentration (i.e., exact percentage) of all ingredients which are
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classified as health hazards and are:

o Present above their cut-off/concentration limits or
o Present a health risk below the cut-off/concentration limits.
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 The concentration (exact percentages) of each ingredient must be specified except

concentration ranges may be used in the following situations:
o A trade secret claim is made,
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o There is batch-to-batch variation, or

o The SDS is used for a group of substantially similar mixtures.
 Chemicals where a trade secret is claimed
 A statement that the specific chemical identity and/or exact percentage (concentration) of
composition has been withheld as a trade secret is required.
3.4 First aid Measures www.rejinpaul.com
This section describes the initial care that should be given by untrained responders to an
individual who has been exposed to the chemical. The required information consists of:

 Necessary first-aid instructions by relevant routes of exposure (inhalation, skin and eye
contact, and ingestion).
 Description of the most important symptoms or effects, and any symptoms that are acute
or delayed.

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 Recommendations for immediate medical care and special treatment needed, when
necessary.

3.5 Fire –Fighting Measures

This section provides recommendations for fighting a fire caused by the chemical. The
required information consists of:

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 Recommendations of suitable extinguishing equipment, and information about
extinguishing equipment that is not appropriate for a particular situation.

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 Advice on specific hazards that develop from the chemical during the fire, such as any
hazardous combustion products created when the chemical burns.
 Recommendations on special protective equipment or precautions for firefighters.
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3.6 Accidental Release Measures

This section provides recommendations on the appropriate response to spills, leaks, or

releases, including containment and cleanup practices to prevent or minimize exposure to people,
properties, or the environment. It may also include recommendations distinguishing between
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responses for large and small spills where the spill volume has a significant impact on the
hazard. The required information may consist of recommendations for:

 Use of personal precautions (such as removal of ignition sources or providing sufficient

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ventilation) and protective equipment to prevent the contamination of skin, eyes, and
clothing.
 Emergency procedures, including instructions for evacuations, consulting experts when
needed, and appropriate protective clothing.
 Methods and materials used for containment (e.g., covering the drains and capping
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procedures).
 Cleanup procedures (e.g., appropriate techniques for neutralization, decontamination,
cleaning or vacuuming; adsorbent materials; and/or equipment required for
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containment/clean up)

3.7 Handling and Storage

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This section provides guidance on the safe handling practices and conditions for safe
storage of chemicals. The required information consists of:

 Precautions for safe handling, including recommendations for handling incompatible

chemicals, minimizing the release of the chemical into the environment, and providing
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advice on general hygiene practices (e.g., eating, drinking, and smoking in work areas is
prohibited).
 Recommendations on the conditions for safe storage, including any incompatibilities.
Provide advice on specific storage requirements (e.g., ventilation requirements)

3.8 Exposure controls/Personal Protections

This section indicates the exposure limits, engineering controls, and personal protective
measures that can be used to minimize worker exposure. The required information consists of:

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 OSHA Permissible Exposure Limits (PELs), American Conference of Governmental
Industrial Hygienists (ACGIH) Threshold Limit Values (TLVs), and any other exposure
limit used or recommended by the chemical manufacturer, importer, or employer
preparing the safety data sheet, where available.
 Appropriate engineering controls (e.g., use local exhaust ventilation, or use only in an

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enclosed system).
 Recommendations for personal protective measures to prevent illness or injury from
exposure to chemicals, such as personal protective equipment (PPE) (e.g., appropriate
types of eye, face, skin or respiratory protection needed based on hazards and potential

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exposure).
 Any special requirements for PPE, protective clothing or respirators (e.g., type of glove
material, such as PVC or nitrile rubber gloves; and breakthrough time of the glove
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material).

3.9 Physical and Chemical Properties

This section identifies physical and chemical properties associated with the substance or
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mixture. The minimum required information consists of:

 Appearance (physical state, color, etc.)

 Upper/lower flammability or explosive limits
 Odor
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 Vapor pressure
 Odor threshold
 Vapor density
 pH
 Relative density
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 Melting point/freezing point

 Solubility
 Initial boiling point and boiling range
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 Flash point
 Evaporation rate
 Flammability (solid, gas)
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 Partition coefficient: n-octanol/water

 Auto-ignition temperature
 Decomposition temperature and
 Viscosity.
3.10 Stability and Reactivity www.rejinpaul.com
This section describes the reactivity hazards of the chemical and the chemical stability
information. This section is broken into three parts: reactivity, chemical stability, and other. The
required information consists of:
Reactivity

 Description of the specific test data for the chemical(s). This data can be for a class or
family of the chemical if such data adequately represent the anticipated hazard of the

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chemical(s), where available.

Chemical stability

 Indication of whether the chemical is stable or unstable under normal ambient

temperature and conditions while in storage and being handled.

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 Description of any stabilizers that may be needed to maintain chemical stability.
 Indication of any safety issues that may arise should the product change in physical
appearance.

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3.11 Toxicological Information

This section identifies toxicological and health effects information or indicates that such
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data are not available. The required information consists of:

 Information on the likely routes of exposure (inhalation, ingestion, skin and eye contact).
The SDS should indicate if the information is unknown.
 Description of the delayed, immediate, or chronic effects from short- and long-term
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exposure.
 The numerical measures of toxicity (e.g., acute toxicity estimates such as the LD50
(median lethal dose)) - the estimated amount [of a substance] expected to kill 50% of test
animals in a single dose.

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Description of the symptoms. This description includes the symptoms associated with
exposure to the chemical including symptoms from the lowest to the most severe
exposure.
 Indication of whether the chemical is listed in the National Toxicology Program (NTP)
Report on Carcinogens (latest edition) or has been found to be a potential carcinogen in
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the International Agency for Research on Cancer (IARC) Monographs (latest editions) or
found to be a potential carcinogen by OSHA

3.12 Ecological Information

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This section provides information to evaluate the environmental impact of the

chemical(s) if it were released to the environment. The information may include:
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 Data from toxicity tests performed on aquatic and/or terrestrial organisms, where
available (e.g., acute or chronic aquatic toxicity data for fish, algae, crustaceans, and
other plants; toxicity data on birds, bees, plants).
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Whether there is a potential for the chemical to persist and degrade in the environment
either through biodegradation or other processes, such as oxidation or hydrolysis.
 Results of tests of bioaccumulation potential, making reference to the octanol-water
partition coefficient (Kow) and the bioconcentration factor (BCF), where available.
 The potential for a substance to move from the soil to the groundwater (indicate results
from adsorption studies or leaching studies).
 Other adverse effects (e.g., environmental fate, ozone layer depletion potential,
photochemical ozone creation potential, endocrine disrupting potential, and/or global
warming potential).

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3.13 Disposal Consideration

This section provides guidance on proper disposal practices, recycling or reclamation of

the chemical(s) or its container, and safe handling practices. To minimize exposure, this section
should also refer the reader to Section 8 (Exposure Controls/Personal Protection) of the SDS.

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The information may include:

 Description of appropriate disposal containers to use.

 Recommendations of appropriate disposal methods to employ.

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 Description of the physical and chemical properties that may affect disposal activities.
 Language discouraging sewage disposal.
 Any special precautions for landfills or incineration activities
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3.14 Transportation Information

This section provides guidance on classification information for shipping and

transporting of hazardous chemical(s) by road, air, rail, or sea. The information may include:
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 UN number (i.e., four-figure identification number of the substance)1.
 UN proper shipping name1.
 Transport hazard class(es)1.
 Packing group number, if applicable, based on the degree of hazard2.
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 Environmental hazards (e.g., identify if it is a marine pollutant according to the

International Maritime Dangerous Goods Code (IMDG Code)).
 Guidance on transport in bulk (according to Annex II of MARPOL 73/783 and the
International Code for the Construction and Equipment of Ships Carrying Dangerous
Chemicals in Bulk (International Bulk Chemical Code (IBC Code)).
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 Any special precautions which an employee should be aware of or needs to comply with,
in connection with transport or conveyance either within or outside their premises
(indicate when information is not available).
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3.15 Other Information

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This section indicates when the SDS was prepared or when the last known revision was
made. The SDS may also state where the changes have been made to the previous version. You
may wish to contact the supplier for an explanation of the changes. Other useful information also
may be included here.
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4.Analyze the DOT Hazardous Material Regulations. (13 Mark)

DOT defines a hazardous material as any item or chemical which, when being
transported or moved in commerce, is a risk to public safety or the environment, and is regulated
as such under its Pipeline and Hazardous Materials Safety Administration regulations (49 CFR
100-199), which includes the Hazardous Materials.

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The hazardous materials regulations are applicable to the transportation of hazardous
materials in commerce and their offering to the representation that a hazardous material is
present in a package, container, rail car, aircraft, motor vehicle or vessel.

The U.S. Department of Transportation Pipeline and Hazardous Materials Safety

Administration regulates the transport ofhazardous materials through Title 49 of the Code of

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FederalRegulations (49 CFR), Subchapter C, "Hazardous Materials Regulations."

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4.1 Pipeline and Hazardous Materials Safety Administration

The Pipeline and Hazardous Materials Safety Administration (PHMSA) has numerous
responsibilities that include:

 Hazardous materials transportation

 Pipeline safety

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 Transportation emergency preparedness
 Safety training responsibilities are subdivided among its offices.

The office in charge of developing and issuing amendments to the Hazardous Materials
Regulations is the Office of Hazardous Materials Safety

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4.2 International regulations

Although DOT’s Hazardous Materials Regulations are paramount throughout all the

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jurisdictional territory of the United States, a shipment of hazardous materials in international
commerce may also be subject to the regulations of other countries or international-based
regulatory bodies. This may be true whether the shipment:
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 Originates in the U.S. and is destined for a point outside the U.S.
 Originates outside the U.S. and is destined for a point within the U.S.
 Travels through the U.S. between origin and destination points, both outside the U.S.
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This section is designed to familiarize you with the overall recommendations and
regulatory implications of the United Nations (UN), International Maritime Organization (IMO),
International Civil Aviation Organization (ICAO), International Air Transport Association
(IATA), Transport Canada, and the Mexican Department of Communications and
Transportation.
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4.3 Hazardous Materials Security

Shippers and carriers are required to develop and implement a security plan addressing
risks related to the transportation of hazardous materials. FedEx Ground has a Security Plan in
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place and is in full compliance with this regulation, along with the security-training requirements
specified in 49 CFR 172.704.
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4.4 Packaging

All hazardous materials must be packaged in United Nations Performance Oriented

Packaging (UN POP) except when non-specification packaging is authorized by the 49 CFR. All
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packaging must meet the requirements set out in 49 CFR 173.24 and 173.24a. Packaging that is
not in new or “like new” condition will not be accepted. In addition, the following requirements
apply:
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FedEx Ground requires Fiberboard “Non-Specification Packaging” or “Strong
Outer Packaging” to meet the following requirements:
 For packages weighing up to 20 lbs. the outer package minimum requirements
will be a 200 lb. Bursting test or 32 Edge Crush test package.
 For packages weighing 21-50 lbs. a 250 lb. Bursting test or 44 Edge Crush test
will be required. o For packages weighing 51-70 lbs. the outer container must be
275 lb. Bursting test or 55 Edge Crush test.
 Hazardous materials cannot be shipped in any FedEx packaging.

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 Class 2 cylinders must be placed inside an overpack (outer package) marked
“OVERPACK.”
 Example 9.4 methods to follow when Shipping the Hazardous Material.

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5.Write briefly about Healthcare Hazardous Materials. (13 Mark)

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Hazardous materials are substances that could harm human health or the
environment. Hazardous means dangerous, so these materials must be handled the right
way. Hazard communication, or HAZCOM is teaching people how to work with hazardous
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materials and waste.

There are two categories of hazardous materials such as,

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• "Hazardous materials" generally applies to certain raw materials or products, purchased

from outside suppliers, that are stored and used at your facility.
• "Hazardous wastes" is a term with a specific legal meaning that applies to certain
materials that have been generated as wastes from processes carried out at your facility.
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In general terms, materials are designated as "hazardous materials" when they pose a
significant risk to people or property. The specific definitions depend on the agencies
that write the rules.
• Hazardous materials are of particular concern for:

5.1 Worker Health and Safety

The federal Occupational Safety and Health Agency (OSHA), and its counterpart
agencies at the state level, are responsible for developing and enforcing the rules for hazardous

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materials that relate to worker health and safety issues.

The rules cover two main topics:

• Determining whether a particular material poses a risk to workers

• Informing workers when they need to take appropriate precautions

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A material's manufacturer (or the importer, if it is manufactured in another country) is
responsible for determining whether or not a material is hazardous from a worker safety

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standpoint.

If a material is determined to be hazardous, the manufacturer or importer must provide a

Material Safety Data Sheet (MSDS) to its customers. Any company that uses these chemicals in
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the workplace must communicate information on the hazards and provide appropriate training to
any worker who might be affected by the material.

5.2 Transportation
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The federal Department of Transportation and its state counterparts write the rules for
determining whether or not a material is hazardous from a transportation safety standpoint. The
determination generally involves a somewhat different set of criteria from worker health and
safety concerns.
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The Federal Motor Carrier Safety Administration's page on complying with Federal
Hazardous Materials Regulations contains descriptions of what types of materials are considered
hazardous under federal transportation regulations, and summarizes the responsibilities of
transporters that carry those materials.
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5.3 Hazardous waste

The term "hazardous waste" is reserved for materials that meet very specific criteria
spelled out in the federal Resource Conservation and Recovery Act (RCRA) and the regulations
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associated with it.

Hazardous waste regulations are developed and enforced by the Environmental

Protection Agency (EPA), and by state and local environmental agencies.
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Any facility that generates hazardous wastes is subject to detailed rules concerning topics
such as,
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• How the wastes must be stored on site
• How long they may be stored
• Who is allowed to transport and receive them
• What kinds of records have to be maintained.

The basic regulatory approach taken by RCRA is to separate the responsibilities of those
who generate hazardous waste from those who treat and dispose of it. It is easy to qualify as a

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generator of hazardous waste, and much harder to qualify as a "treatment, storage, and disposal",
or "TSD" site.

• Examples of Hazardous waste,

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pa
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There are two primary ways that a waste material can become classified as a hazardous
waste, subject to the RCRA requirements:
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1. Listed wastes: Wastes from certain industrial processes are automatically classified as
hazardous. Each waste of this type is given a code number. The full list of hazardous
waste codes appears in the Code of Federal Regulations, 40 CFR 261.
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2. Characteristic wastes: Wastes that do not appear on the CFR lists may nevertheless be
classified as hazardous if they have one of four properties:
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 Ignitability
 Corrosivity
 Reactivity
 Toxicity

In addition, materials can acquire hazardous waste status if they are mixed with, or
contaminated with, or are derived from, other wastes that are themselves hazardous.

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The generator of the waste is responsible for determining if the waste is hazardous. The
rules can get complicated.

In addition to determining whether a waste is hazardous, you will need to know how each
particular waste is classified. The rules that apply to your facility will depend on how much

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waste, and what type of waste, you generate. Misclassifications can (and do) lead to citations
and penalties.

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6.Write shorts of the following

i.Medical Gas Systems

pa (8 Mark)

Medical gas supply systems in hospitals and other healthcare facilities are utilized to
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supply specialized gases and gas mixtures to various parts of the facility. Products handled by
such systems typically include:

 Oxygen

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Medical air
 Nitrous oxide
 Nitrogen
 Carbon dioxide
 Medical vacuum
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 Waste anaesthetic gas disposal (US) or anaesthetic gas scavenging system (ISO)

6.1 Oxygen
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Oxygen may be used for patients requiring supplemental oxygen via mask.
Usually accomplished by a large storage system of liquid oxygen at the hospital which is
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evaporated into a concentrated oxygen supply, pressures are usually around 345–380 kPa
(50.0–55.1 psi), or in the UK and Europe, 4–5 bar (400–500 kPa; 58–73 psi). This
arrangement is described as a vacuum insulated evaporator or bulk tank.
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In small medical centers with a low patient capacity, oxygen is usually supplied
by a manifold of multiple high-pressure cylinders. In areas where a bulk system or high-
pressure cylinder manifold is not suitable, oxygen may be supplied by an oxygen
concentrator. However, on site production of oxygen is still a relatively new technology.

6.2 Medical air

Medical air is compressed air supplied by a special air compressor, through a

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dryer (in order to maintain correct dew point levels), and distributed to patient care areas
by half hard BS:EN 13348 copper pipe and also use isolation ball valve for operating the
services of compressed air 4 bar. It is also called medical air 4 bar. In smaller facilities,
medical air may also be supplied via high-pressure cylinders. Pressures are maintained
around 345–380 kPa (50.0–55.1 psi).

6.3 Nitrous Oxide

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It is supplied to various surgical suites for its anaesthetic functions during
preoperative procedures. It is delivered to the hospital in high-pressure cylinders and

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supplied through the Medical Gas system. Some bulk systems exist, but are no longer
installed due to environmental concerns and overall reduced consumption of nitrous
oxide. System pressures are around 345 kPa (50.0 psi), 4 bar (400 kPa; 58 psi) UK.

6.4 Nitrogen
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It is typically used to power pneumatic surgical equipment during various
procedures, and is supplied by high-pressure cylinders. Pressures range around 1.2 MPa
(170 psi) to various locations.
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6.5 Instrument air/Surgical air

Like nitrogen, instrument air is used to power surgical equipment. However, it is

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generated on site by an air compressor (similar to a medical air compressor) rather than
high-pressure cylinders. Early air compressors could not offer the purity required to drive
surgical equipment. However, this has changed and instrument air is becoming a popular
alternative to nitrogen. As with nitrogen, pressures range around 1.2 MPa (170 psi). UK
systems are supplied at 11 bar (1.1 MPa; 160 psi) to the local area and regulated down to
7–8 bar (700–800 kPa; 100–120 psi) at point of use.
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6.6 Carbon dioxide

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Typically used for insufflation during surgery, and also used in laser surgeries.
System pressures are maintained at about 345 kPa (50.0 psi), UK 4 bar (400 kPa; 58 psi).
It is also used for certain respiratory disorders. It contains 5 percent
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6.7 Medical Vacuum

Medical vacuum in a hospital supports suction equipment and evacuation

proceures, supplied by vacuum pump systems exhausting to the atmosphere. Vacuum
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will fluctuate across the pipeline, but is generally maintained around −75 kPa
(−560 mmHg; −22 inHg), −450 mmHg (−60 kPa; −18 inHg) UK.

6.8 Waste anaesthetic gas disposal/ anaesthetic gas scavenging system

Waste anaesthetic gas disposal, or anaesthetic gas scavenging system, is used in

hospital anaesthesia evacuation procedures. Although it is similar to a medical vacuum system,
some building codes require anaesthetic gases to be scavenged separately. Scavenging systems

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do not need to be as powerful as medical vacuum systems, and can be maintained around −50 to
−65 kPa (−380 to −490 mmHg; −15 to −19 inHg).

6.9 Medical Gas Mixtures

There are many gas mixtures used for clinical and medical applications. They are often
used for patient diagnostics such as lung function testing or blood gas analysis. Test gases are

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also used to calibrate and maintain medical devices used for the delivery of anaesthetic gases. In
laboratories, culture growth applications include controlled aerobic or anaerobic incubator
atmospheres for biological cell culture or tissue growth. Controlled aerobic conditions are
created using mixtures rich in oxygen and anaerobic conditions are created using mixtures rich in

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hydrogen or carbon dioxide. Supply pressure is 4 bar (400 kPa; 58 psi).
Ex : There are two common medical gas mixtures are entonox and heliox.

ii. Respiratory Protection.

pa (8 Mark)

A respirator is a protective device that covers the nose and mouth or the entire face or
head to guard the wearer against hazardous atmospheres.
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6.2.1 Respirators may be,

 Tight-fitting - that is, half masks, which cover the mouth and nose and full face pieces
that cover the face from the hairline to below the chin; or
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 Loose-fitting, such as hoods or helmets that cover the head completely.

 In addition, there are two major classes of respirators:
 Air-purifying, which remove contaminants from the air; and
 Atmosphere-supplying, which provide clean, breathable air from an uncontaminated
source. As a general rule, atmosphere-supplying respirators are used for more hazardous
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exposures.

6.2.2 There are two major categories of respirators:

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 Air Purifying Respirators - These types of respirators include - Air Purifying Disposable
Particulate Masks - Air Purifying Half Mask Respirators.
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 Supplied Air Respirators - These types of respirators include: - Airline Respirators -

Emergency Escape Breathing Apparatus.
6.2.3 Respiratory Protective Equipment (RPE) www.rejinpaul.com
Respiratory Protective Equipment (RPE) is a particular type of Personal Protective
Equipment(PPE), used to protect the individual wearer against the inhalation of hazardous
substances in the workplace air.

In the control of substances hazardous to health (COSHH) hierarchy of controls, use of

RPE should not be the first or only precaution taken to protect your workforce. It is however a
very good temporary precaution while you make arrangements for proper protection.

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The equipment must,
• Fit the wearer
• Be the right type for the task, the substance and the work environment.
Long term use of RPE must only be considered when exposure cannot be adequately

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reduced by other means.
It is important that you chose the right RPE for the job, it must reduce exposure as low as
reasonably practicable (below any applicable workplace exposure limits or other control limits).

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RPE must fit the face of the wearer properly to be effective. Face-fit testing must be
carried out to ensure the chosen face piece adequately fits and protects the wearer. This includes
testing of full-face masks, half-face masks and disposable masks.
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6.2.4 Elements of a Respiratory Protection Program

• Written operating procedures

• Proper selection
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• Training and fitting
• Cleaning and disinfecting
• Storage
• Inspection and maintenance
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• Work area surveillance

Respiratory Protection Equipments

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6.2.5 Effective Use of Respirators

• During installation of engineering controls

• During maintenance operations
• During process turnarounds
• For non routine tasks
• For emergency response

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• At hazardous waste site operations
• When other controls are inadequate
• When other controls are not feasible.

6.2.7 Respiratory Program

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• Inspection and evaluation to determine effectiveness
• Medical examinations
• Approved respirators.

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 UNIT IV www.rejinpaul.com
2 MARK AND 13 MARK PART - A & B QUESTION BANK
FACILITY SAFETY

Introduction, Facility Guidelines: Institute, Administrative Area Safety, Slip, Trip, and Fall
Prevention, Safety Signs, Colors, and Marking Requirements, Tool Safety, Electrical Safety,
Control of Hazardous Energy, Landscape and Ground Maintenance, Fleet and Vehicle Safety.

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PART – A

1.What is Facility Guidelines Institute ?

The Facility Guidelines Institute (FGI) is a nonprofit organization that works to

develop guidelines for designing and building hospitals and other health care facilities.

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2.What are the steps of facility planning in healthcare ?

The steps of facility planning are used to conduct a study, develop a budget, organize a

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planning committee, set realistic goals, study the financial marketplace, and get the right people
for the project. These steps include understanding, analyzing, planning, and acting.

3.Define healthcare facilities.

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Health facilities are places that provide health care. They include hospitals, clinics,
outpatient care centers, and specialized care centers, such as birthing centers and psychiatric care
centers.
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4.What are the types of healthcare facilities ?

 Ambulatory surgical centres

 Birth centres
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 Blood banks
 Clinics and medical offices
 Diabetes education centres
 Dialysis Centres
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 Hospice homes
 Hospitals.
 Imaging and radiology centers
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 Mental health and addiction treatment centers

 Nursing homes
 Orthopedic and other rehabilitation centers
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 Urgent care
 Telehealth

5.What is public healthcare facility ?

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Medical nursing homes, including residential treatment centers and geriatric care
facilities, are health care institutions which have accommodation facilities and which engage in
providing short-term or long-term medical treatment of a general or specialized nature not
performed by hospitals to inpatients.

6. Define Administrative Area Safety.

Administrative controls are training, procedure, policy, or shift designs that lessen the
threat of a hazard to an individual. Administrative controls typically change the behavior of

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people (e.g., factory workers) rather than removing the actual hazard or providing personal
protective equipment (PPE).

7.Give some examples of Administrative Area Safety.

Some common examples of administrative controls include work practice controls such

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as prohibiting mouth pipetting and recapping of needles, as well as rotating worker shifts in coal
mines to prevent hearing loss.

8.What is safety administration ?

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The Role of Safety Administrators. In our view, they are equal partners of a
safety department's team of safety professionals. Administrative Responsibilities. As a Safety
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Administrator, it is typically your responsibility to support the written safety programs,
procedures and requirements of the organization.

9.What are Administrative controls in safety ?

Administrative controls (or work practice controls) are changes in work procedures such
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as written safety policies, rules, supervision, schedules, and training with the goal of reducing the
duration, frequency, and severity of exposure to hazardous chemicals or situations.

10.Define engineering control.

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Engineering controls eliminate or reduce exposure to a chemical or physical hazard

through the use or substitution of engineered machinery or equipment.

11.What is PPE in safety ?

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PPE is equipment that will protect the user against health or safety risks at work. It can
include items such as safety helmets, gloves, eye protection, high-visibility
clothing, safety footwear and safety harnesses. It also includes respiratory protective equipment
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(RPE).

12.How can slip and fall prevented ?

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 Clean up spills immediately

 Keeps walkways and hallways free of debris, clutter and obstacles
 Keep filing cabinets and desk drawers shut when not in use
 Cover cables or cords in walkways
  Replace burnt-out light bulbs promptly. www.rejinpaul.com
13.What is slip trip and fall ?

Slips happen where there is too little friction or traction between the footwear and the
walking surface. Common causes of slips are: wet or oily surfaces. occasional spills. weather
hazards.

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14.What are the types of fall ?

Falls can be categorized into three types: falls on a single level, falls to a lower level, and
swing falls.

15.List the 4 methods of fall protection.

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 Guardrail Systems. Temporary Guardrails. Guardrails for Scaffolds, Aerial Lifts, and
Scissor Lifts.
 Hole Covers. Effective Hole Covers. Plywood Hole Covers.

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 Warning or Marking Systems. Warning Line Systems. Safety Monitoring Systems.
 Fall Restraint Systems and Positioning Devices.

16.What causes tripping and falling ?pa

Diabetes, heart disease, or problems with your thyroid, nerves, feet, or blood vessels can
affect your balance. Some medicines can cause you to feel dizzy or sleepy, making you more
likely to fall. Other causes include safety hazards in the home or community environment. ...
Confusion can sometimes lead to falls.
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17.Define safety signs.

A safety and/or health sign is defined as 'information or instruction about health

and safety at work on a signboard, a colour, an illuminated sign or acoustic signal, a verbal
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communication or hand signal.

18.Mention the types of safety signs.

 Prohibition and fire

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 Mandatory
 Caution
 Safe Condition.
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19.Define safety symbol and What are the safety signs using in industry’s
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Safety symbols, hazard symbols or safety labels are meaningful and recognize
ablegraphical symbols that warn of or identify hazards associated with the location or item.
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Safety Signs in industries,

Danger Signs – Must be red, black, and white.

 Caution Signs – Must have a yellow background color with black lettering for any
elements used against the yellow background.
 Safety Instruction Signs – Must have a white background, and the panel must be green
with white letters.

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20.What are the basic principles of safety signs.

Health and Safety signs' aim is to warn about real or potential dangers or hazards. Safety
signs have different forms of manifestation: color, signboard, acoustic signal, special symbols,
verbal communication, hand signal, illuminated signs. Each detail is very important: color,
shape, the place of installation.

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21.What are the safety colors?

 Red: Fire protection equipment. Danger, high risk of injury or death

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 Orange: Moderate risk of injury. Guarding devices
 Yellow: Caution statements
 Green: Safety equipment or information
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 Blue: No immediate hazard
 Red – combustible materials. Yellow – oxidizers.

22.What are the OSHA safety color ?

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 Red must be used for fire-related hazards, as well as emergency switches, bars, and
buttons on hazardous machines.
 Yellow indicates caution and is used for physical hazards, including striking against,
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stumbling, falling, tripping, and “caught in between.”

23.What are the categories of safety sign ?

Type Shape Colour
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WARNING SIGNS These signs give warning of YELLOW with black

Triangular
potential risks Triangular symbol or text
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MANDATORY SIGNS signs that require actions or BLUE with symbol or

Circular
activities that will contribute towards safety text in white
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24. List the OSHA classifications of signs.

 Danger signs — Indicate immediate danger and that special precautions are necessary.
OSHA specifies that red, black and white colors are to be used for danger signs.
 Caution signs — Warn against potential hazards or caution against unsafe practices.
OSHA specifies that caution signs must have a yellow background and black panel with

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yellow letters. All letters used against the yellow background must be black.
 Safety instruction signs — Must be used where there is a need for general instructions
and suggestions relative to safety measures. OSHA specifies that safety instruction signs
must have a white background, green panel and white letters. Any letters used on the
white background must be black.

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25.What are the sign marking requirements ?

DANGER

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• Indicates a hazardous situation that, if not avoided, will result in serious injury or death.
Its use should be limited to the most extreme situations.
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WARNING

• Indicates a hazardous situation that, if not avoided, could result in serious injury or
death.
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CAUTION

• Indicates a hazardous situation that, if not avoided, could result in minor or moderate
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injury.

• Signal Words for Non-Hazard Alerting Safety Messages

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26.Define safety symbol alert.

• Indicates a potential personal injury hazard exists.

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• It is only used on DANGER, WARNING and CAUTION signs, labels and tags.

27.What is tool safety ?

Ensure that employees are properly trained in the safe use of hand tools. Keep
cutting tools sharp and cover sharp edges with a suitable covering to protect the tool and to

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prevent injuries from unintended contact. Replace cracked, splintered, or broken handles on files,
hammers, screwdrivers, or sledges.

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28.What are the 3 hazards of electricity ?

• Contact with live parts causing shock and burns

•
•
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Faults which could cause fires
Fire or explosion where electricity could be the source of ignition in a potentially
flammable or explosive atmosphere, e.g. In a spray paint booth.
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29.Lis the electrical safety rule.

• Never put fingers or other objects in an outlet

• Keep metal objects out of toasters
•
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Never use anything with a cord or plug around water

• Never pull a plug out by its cord
• Stay away from substations and power lines
• Don't climb on power poles
• Never fly kites near power lines
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• Stay away from broken or fallen power lines.

30.Define Electrical safety test.
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Electrical safety testing is essential to ensure safe operating standards for any product that
uses electricity. Various governments and agencies have developed stringent requirements
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for electrical products that are sold world-wide

31.How can we reduce electrical hazards at home ?
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 Outdated or Poor Wiring
 Leaving Appliances Plugged-in Near Water Sources
 Wrong Wattage Light Bulbs
 Overloaded Power Strips and Outlets
 Unprotected Electrical Outlets

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 Improper Use of Extension Cords

32.How do you control electrical fire in safety ?

 Stop the fire before it starts

 Turn off power to the electrical system


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Use a Class C-rated extinguisher if you cannot cut the power to the source
 Use a Class A or dry chemical extinguisher if you have cut the power
 Use a fire blanket to smother the fire


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Use water to extinguish the fire
 Call 911.
33.What is Control of Hazardous Energy ?
pa
The OSHA standard for The Control of Hazardous Energy (Lockout/Tagout), Title 29
Code of Federal Regulations (CFR) Part 1910.147, addresses the practices and procedures
necessary to disable machinery or equipment, thereby preventing the release of hazardous
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energy while employees perform servicing and maintenance.

34.What are energy control procedures ?

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Knowing what equipment is, and what sources typically are associated with it, will help
the creation process greatly." Energy control procedures, also known as lockout-tag
out procedures, are procedures that are used to establish a zero-energy state for safe servicing.
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35.What is zero energy state ?

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ZERO ENERGY STATE, before a piece of machinery is left unattended, or is repaired or

maintained, it must be put into a zero energy state (ZES). ZES is a condition in which all sources
of energy have been removed or neutralized.
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36.Define hazardous energy source.
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Hazardous energy is energy sources like electrical, mechanical, hydraulic, pneumatic,
chemical, thermal or other sources found in machines and equipment that can be hazardous to
workers.

37.What is landscape maintenance?

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Landscape maintenance (or grounds keeping) is the art and vocation of keeping a
landscape healthy, clean, safe and attractive, typically in a garden, yard, park, institutional setting
or estate. A garden may also be designed to include exotic animals, such as a koi pond.

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38.Why is landscape maintenance important ?

Ongoing maintenance is important for healthy plants and trees. Unsightly weeds and

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fungi not only look bad, they steal soil nutrients, water, and sunlight that your landscape plants
need to grow properly. Maintaining your lawn and landscape is essential to the health and growth
of your landscape investment.

39.What does ground maintenance do ?

pa
A grounds maintenance worker is someone who provides a pleasant outdoor environment
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by ensuring that the grounds of houses, businesses, and parks are attractive, orderly, and healthy.
Many grounds maintenance jobs are seasonal, available mainly in the spring, summer, and fall.
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40.What is fleet safety program ?

A fleet safety program establishes the policies and procedures that are needed to help
ensure a safe work environment for employees. It can also help protect against liability from
vehicle accidents.
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41.What is vehicle policy ?

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The safety of University students, faculty, staff, and the public is a central concern of this
University. This policy, which governs the use of motor vehicles used on official University of
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Nebraska business by students, faculty and staff, is designed to support safe, prudent use
of vehicles. Authorized Drivers.
42.How can fleet safety be improved ?
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 Improve Vehicles Maintenance Process. A safe fleet doesn't just mean that you have safe
drivers – you must also ensure that your vehicles are safe
 Defensive Driving Courses for Employees
 Monitor Driver Behaviour
 Create Safety Incentive Programs
 Start & Continue the Safety Conversation.

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43.How can drivers improve safety ?

Always drive the speed limit; driving faster than everyone around you can increase your
chance of an accident exponentially. Maintain your vehicle: Having a well-maintained vehicle

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can keep you safe. Make sure your tires are properly inflated and have adequate tread depth.

44.What is safety checklist ?

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A checklist is a list of items you need to verify, check or inspect. Checklists are used in
every imaginable field from building inspections to complex medical surgeries. Using
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a checklist allows you to ensure you don't forget any important steps. Here is
a safety audit checklist and a Crane Operation Checklist.

45.What is consider a fleet vehicle ?

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Fleet vehicles are groups of motor vehicles owned or leased by a business, government
agency or other organization rather than by an individual or family. Typical examples
are vehicles operated by car rental companies, taxicab companies, public utilities, public bus
companies, and police departments.
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46.What is the inspection checklist ?

An inspection checklist, when used properly, is an assurance that a particular piece of

equipment has been inspected. As each item on the checklist is ticked off, the person doing
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the inspection is verifying that each component of the equipment is in correct working order.

47.What is vehicle maintenance program ?

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Preventive maintenance (PM) is the key to any successful maintenance program for
commercial motor vehicles. A preventive maintenance program, on the other hand,
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brings vehicles in for inspection and maintenance on a schedule, and repairs any items that are at,
or even approaching, an established cut-off point.
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48.What is fleet policy ?

Fleet Insurance is designed for businesses with multiple vehicles, to have them all on
one policy.You can also choose to have a policy covering Any Driver to drive any vehicle, or
fixed to Named Drivers for specific vehicles.

49.List the elements of fleet safety program.

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• Identifying all of your drivers
• Management commitment
• Screening and selecting drivers carefully
• Training drivers

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• Managing drivers on an ongoing basis
• Managing accidents, when they occur
• Establishing written policies and procedures

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• Formalizing a plan for vehicle inspection.

50. Draw the fleet safety performance diagram.

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PART – B

1.Explain in detail about Facility Guidelines Institute.

The Facility Guidelines Institute (FGI) is a nonprofit organization that works to

develop guidelines for designing and building hospitals and other health care facilities.

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1.1 FGI Goals And Documents

o The FGI Guidelines is a minimum standard, consensus document that aids in the
construction and design of health care facilities.

o Use of research, science, and expert opinion to set criteria for health care and

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residential care facility design.

o Provides a series of baseline requirements vetted through an open consensus process,

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enforceable by adopting federal and state agencies.

o The Guidelines is a research-based document with various versions used in more

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than 35 states.

FGI references example

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1.2 FGI Process Overview

 Collective multidisciplinary experience

 Professional stakeholder consensus, including many AHJs (no manufacturers vote on
proposals)
 Public proposal and review process
 Clinical and evidence-based research


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Continual improvement process.

1.3 FGI Minimum Standard

Minimum standard: The Guidelines is considered to be minimum consensus requirements

for the design and construction of new and renovated health care facilities.

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Minimum is difficult to define :

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 Risk of being too minimal
 Risk/benefit for new minimum
 The minimum benchmark changes over time.
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1.4 FGI two new chapters:

 Long-term substance abuse treatment facilities

 Settings for individuals with Intellectual and/or developmental disabilities.
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1.5 FGI Procedures
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An understanding of the following is required to inform the planning of diagnostic,

surgical, and interventional spaces.

 Level of invasiveness, likelihood of infection

 Number of staff expected in the room during procedure
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 Equipment needed to support procedure

 Type of sedation used to conduct procedure
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Invasive Procedure

A procedure that is performed in an aseptic surgical field and penetrates the protective
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surfaces of a patient’s body (e.g., subcutaneous tissue, mucous membranes, cornea).

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Percutaneous Procedure

A procedure during which the skin is penetrated by a needle puncture or an incision that
goes no deeper than the skin or subcutaneous space and may involve introduction of wires and
catheters and/or insertion of an indwelling foreign body (temporary or permanent).

1.6 Types of Health Facilities :

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Hospital

A hospital is an institution for healthcare typically providing specialized treatment

for inpatient (or overnight) stays. Some hospitals primarily admit patients suffering from a
specific disease or affliction, or are reserved for the diagnosis and treatment of conditions

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affecting a specific age group. Others have a mandate that expands beyond offering dominantly
curative and rehabilitative care services to include promotional, preventive and educational roles
as part of a primary healthcare approach

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Healthcare center
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Healthcare centers, including clinics, doctor's offices, urgent care centers and ambulatory
surgery centers, serve as first point of contact with a health professional and provide outpatient
medical, nursing, dental, and other types of care services.
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Medical Nursing Homes

Medical nursing homes, including residential treatment centers and geriatric care
facilities, are health care institutions which have accommodation facilities and which engage in
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providing short-term or long-term medical treatment of a general or specialized nature not

performed by hospitals to inpatients with any of a wide variety of medical conditions.

Pharmacies and drug stores

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Pharmacies and drug stores comprise establishments engaged in retailing prescription or

nonprescription drugs and medicines, and other types of medical and orthopaedic goods.
Regulated pharmacies may be based in a hospital or clinic or they may be privately operated, and
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are usually staffed by pharmacists, pharmacy technicians, and pharmacy aides.

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Medical laboratory and research

A medical laboratory or clinical laboratory is a laboratory where tests are done on

biological specimens in order to get information about the health of a patient. Such laboratories
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may be divided into categorical departments such as microbiology, hematology, clinical
biochemistry, immunology, serology, histology, cytology, cytogenetics, or virology.

1.7 Facility Management

Facility management (or facilities management or FM) is a professional management

discipline focused upon the efficient and effective delivery of support services for the
organizations that it serves. The International Organization for Standardization(ISO) defines
facility Management as the "organizational function which integrates people, place and process

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within the built environment with the purpose of improving the quality of life of people and the
productivity of the core business."

Facility Management Includes,

 Communication


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Emergency preparedness and business continuity
 environmental stewardship and sustainability
 Finance and business


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Hospitality management
 human factors
 Leadership and strategy pa
 Operations and maintenance
 project management
 Quality
 real estate and property management
 Technology.
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2. Discuss briefly about Safety Color Coding Labels. (13 Mark)

The Occupational Safety and Health Administration (OSHA) requires that workplace
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hazards be marked to alert employees to dangers that exist at a facility or worksite. Depending
on the specific situation, different regulations could apply.
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 OSHA requirements are often non-prescriptive in regards to size, color and wording
of markings. To help provide uniformity among organizations and industry, the
American National Standards Institute (ANSI) and the National Electrical
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Manufacturers Association (NEMA) have developed and published the ANSI/NEMA

Z535 series of standards for safety signs and colors (see Quick Tips #201: Safety Sign
and Marking Requirements).
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 The last major changes to the Z535 standards were published in 2011 and the
standards were reaffirmed in 2017 with only minor changes to the technical
specifications for colors.

 The color(s) of the labels and tape identify the type of hazard, which helps the
employee identify the level of severity. The intent is to reduce the possibility of
accidents and injuries.

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2.1 The ANSI/NEMA Z535 series is composed of six documents and a color chart :

 ANSI/NEMA Z535 Color Chart

 ANSI/NEMA Z535.1 Safety Colors
 ANSI/NEMA Z535.2 Environmental Facility and Safety Signs

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 ANSI/NEMA Z535.3 Criteria for Safety Symbols
 ANSI/NEMA Z535.4 Product Safety Signs and Labels

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 ANSI/NEMA Z535.5 Safety Tags and Barricade Tapes (for Temporary Hazards)
 ANSI/NEMA Z535.6 Product Safety Information in Product Manuals, Instructions and
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Other Collateral Materials

2.2 The following chart represents the color codes of both ANSI/NEMA Z535.1-2017 and OSHA :
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COLOR MEANING APPLICATION

Danger Safety cans and signs.

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Red
Emergency stop bar or button on machinery.
Stop
Identification of fire equipment.
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Labels and containers for blood and infectious

Fluorescent
waste. (Warning labels must be fluorescent
Orange, Orange- Biosafety
orange or orange-red with the biosafety
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Red
symbol in a contrasting color.)
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Tripping, falling and striking hazards.

“Flammable, Keep Fire Away” labels on
Yellow Caution
cabinets. Safety cans and containers for
explosives, corrosives or unstable materials.
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Parts of machinery or energized equipment
Orange Warning that may cut, crush or otherwise injure. Inside
of transmission guards for pulleys, gears, etc.

Location of first aid equipment. Location of

Green Safety safety equipment, respirators, safety showers,
etc.

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Signs and bulletin boards. Specific railroad
Blue Information warnings against starting, using or moving
equipment being repaired.

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Black, White,
Yellow or
Traffic or housekeeping markings. Stairways,
Combination of Boundaries

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directions and borders.
Black with White
or Yellow

Magenta or Purple
on Yellow
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Radiation Caution
X-ray, alpha, beta, gamma, neutron and
proton radiation.
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2.3 Identification of Piping Systems (ANSI A13.1)
 Safety red indicates fire protection.
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 Safety yellow indicates danger.

 Safety green indicates safety.
 Safety blue indicates protective materials.
There are Four Types Of Safety Signs
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 Prohibition and fire.

 Mandatory.
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 Caution.
 Safe Condition.
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Ansi Safety Color: Red

Red is universally recognized for identifying the most serious hazards, as well as fire
hazards and fire equipment. Safety signs that comply with the ANSI Z535 standard use red for
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“Danger” signs and labels that warn when death or serious injury is almost certain to occur if the
hazard is not avoided.
In addition to “Danger” signs, here are other scenarios where red should be used:
• Fire safety items, including fire extinguishers and fire alarms
• Emergency stop switches, buttons, and bars on machinery
• Containers carrying flammable liquid
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Confined space hazards
• Construction hazards and PPE requirements
Ansi Safety Color: Orange
Orange identifies dangerous machines or equipment that may crush, cut, shock, or injure
workers in other ways. Orange is used on “Warning” signs and labels when a hazard may result

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in death or serious injury, but when the overall risk isn’t severe enough for a “Danger” sign.
The following scenarios may call for orange signs and labels:

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• Exposed and moving machine parts
• Low clearance levels
• Electrical hazards (such as high voltage or potential static)
•
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Most work zone markings (including safety cones and barrels)
• Road construction signs
Ansi Safety Color: Yellow
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Much like the OSHA standard for safety colors, ANSI recognizes yellow as a color for
communicating hazards that may lead to worker injuries if not avoided. Most commonly, these
signs warn against unsafe practices.
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Here are a few situations where yellow signs and labels should be used:
• Instruct workers to wear PPE while working on certain machines or when in a specific
area
• Point out common hazards, such as wet floors
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• Inform employees when entering a construction area, or where only authorized

employees are allowed
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• Alert employees to exposed edges of loading docks, platforms, and curbs

• Warn workers of moving equipment, overhead hazards, and other physical hazards
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Ansi Safety Color: Green

Green is reserved for general safety signs, which offer safety-related messages that don’t
touch on specific workplace hazards.
Green signs should:
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Point out first aid kits, emergency eye wash fountains, and other medical equipment
• Offer general sanitation guidelines and reminders
• Encourage employees to report accidents, unsafe conditions, and other incidents
• Motivate employees to be mindful of general hazards
• Suggest best practices and other safety measures
Ansi Safety Color: Blue

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Blue communicates information unrelated to personal injuries and other hazards (most
commonly on “Notice” signs). It is most commonly associated with maintenance work and other
safety precautions.
Blue signs may:
• Alert employees to designated smoking and non-smoking areas

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• Remind employees of best work practices
• Communicate procedures, information, instructions, and rules for maintenance

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Share the overhead clearance in a given area

2.4 Following is the classification of materials and designated colors:

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 Fire quenching substances: White on red background
 Toxic and corrosive fluids: Black lettering on orange background
 Flammable and oxidizing fluids: Black on yellow background
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 Combustible fluids: White on brown background
 Other water: White on green background
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 Compressed air: White on blue background

Safety Sign and Marking Tool

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The purpose of having safety signage in the workplace is to identify and warn workers
who may be exposed to hazards in the workplace. Safety signs can assist in
the communication of important instructions, reinforce safety messages and provide instruction
for emergency situations.

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3.Write briefly about control of hazardous energy ? (13 Mark)

The OSHA standard for The Control of Hazardous Energy (Lockout/Tagout), Title 29
Code of Federal Regulations (CFR) Part 1910.147, addresses the practices and procedures
necessary to disable machinery or equipment, thereby preventing the release of hazardous

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energy while employees perform servicing and maintenance

 The purpose of any lockout procedure is to render inoperative electrical systems,

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pumps,pipelines, valves, and any other systems that could be energized while employees are
working.
 The OSHA standard in 29 CFR 1910.147 places four basic requirements on employers whose
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workers are engaged in service and/or maintenance functions:
• Written procedures for lockout/tagout
• Training of employees
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• Accountability of engaged employees
• Administrative controls

3.1 Basic Lockout Steps

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Before beginning service or maintenance, the following steps must be accomplished in

sequence and according to the specific provisions of the employer’s energy-control procedure:
 Prepare for shutdown.
 Shut down the machine.
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 Disconnect or isolate the machine from the energy sources.

 Apply the lockout or tagout devices to the energy-isolating devices.
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 Release, restrain, or otherwise render safe all potential hazardous stored or residual energy.
 If a possibility exists for re-accumulation of hazardous energy, regularly verify during the
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service and maintenance that such energy has not re-accumulated to hazardous levels.
 Verify the isolation and degeneration of the machine.
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3.2 Lockout Employees
 Those who work on de-energized machinery may be seriously injured or killed if someone
removes lockout/tagout devices and re-energizes machinery without their knowledge; thus,
it is extremely important for all employees to respect lockout and tagout devices, and only
personnel who applied these devices should remove them.
 Training must ensure that employees understand the purpose, function, and restrictions of

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the energy-control program.
 Employers must provide training specific to the needs of authorized, affected, and other
employees. Authorized employees are those responsible for implementing the energy-
control procedures or performing the service or maintenance activities.

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 They need the knowledge and skills necessary for the safe application, use, and removal of
energy-isolating devices. They also need training in the following:

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• Hazardous energy source recognition
• Types and magnitude of hazardous energy sources in the workplace
• Energy-control procedures, including the methods and means to isolate and control those
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energy sources
3.3 Affected Employees
 Affected employees are usually machine operators or users who operate the relevant
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machinery or whose jobs require them to be in the area where service or maintenance is
performed.
 These employees do not service or maintain machinery or perform lockout/tagout activities.
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 Affected employees must receive training in the purpose and use of energy-control
procedures. They also need to be able to do the following:
• Recognize when the energy-control procedure is being used.
• Understand the purpose of the procedure.
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• Understand the importance of not tampering with lockout or tagout devices and not starting
or using equipment that has been locked out or tagged out.
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3.4 All Other Employees

 Employees whose work operations are or may be in an area where energy-control procedures
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are used must receive instruction regarding the energy control procedure and the prohibition
against removing a lockout or tagout device and attempting to restart, re-energize, or operate
the machinery.
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 In addition, if tagout devices are used, all employees must receive training regarding the
limitations of tags. The employer must provide initial training before starting service and
maintenance activities and must provide training as necessary.
 In addition, the employer must certify that the training has been given to all employees
covered by the standard.
 The certification must contain each employee’s name and dates of training. Employers must

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provide retraining for all authorized and affected employees whenever a change in the
following occurs:
• Job assignments
• Introduction of machinery or processes that present a new hazard
• Energy-control procedures

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3.5 Periodic Inspection
 This inspection ensures that employees are familiar with their responsibilities under the

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procedure and continue to implement energy-control procedures properly.
 The inspector, who must be an authorized person not involved in using the particular control
procedure being inspected, must be able to determine the following:
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• Employees are following steps in the energy-control procedure.
• Employees involved know their responsibilities under the procedure.
• The procedure is adequate to provide the necessary protection, and what changes, if any, are
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needed.
3.6 Periodic Reviews
 For a lockout procedure, the periodic inspection must include a review of each authorized
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employee’s responsibilities under the energy-control procedure being inspected.

 Where tagout is used, the inspector’s review also extends to affected employees because of
the increased importance of their role in avoiding accidental or inadvertent activation of the
machinery.
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 Also, the employer must certify that the designated inspectors perform periodic inspections.
The certification must specify the following:
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• Machine or equipment on which the energy-control procedure was used

• Date of the inspection
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• Names of employees included in the inspection

• Name of the person who performed the inspection
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3.7 Maintenance
 The issues of servicing and maintenance require further clarification with regard to the
unexpected release of hazardous energy inadvertent activation of the machinery.
 Also, the employer must certify that the designated inspectors perform periodic inspections.
The certification must specify the following:

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• Machine or equipment on which the energy-control procedure was used
• Date of the inspection
• Names of employees included in the inspection
• Name of the person who performed the inspection
3.8 Lockout and Tagout Definitions

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• “Maintenance” is the act of maintaining or the state of being maintained.
• “To maintain” means keeping in an existing state or preserving from failure.

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• “To service” is to repair or provide maintenance.
• “To refurbish” means to brighten up, freshen up, or renovate.
•
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“To renovate” is to restore to a former better state.
• “To modify” is to make a fundamental change or to give a new orientation.
3.9 General Lockout Guidelines
 If energy-isolating devices cannot be locked out, they must be modified so that they are
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capable of being locked out whenever major replacement, repair, renovation, or modification
of the machine or equipment takes place.
 Whenever new machines or equipment are installed, energy-isolating devices for such
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machines or equipment must be designed to accept a lockout device.

•Open the main switch, which is usually a side arm switch located on the main electrical
panel, and pull down.
•Insert the lock into the slotted hole, which should prevent the side arm switch from moving
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upward to close the main switch.

•Insert a DANGER tag through the slotted hole next to the lock.
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•Never trade assigned lock, tags, or duplicate keys with other employees.
•Be sure the tagout devices include information such as the following: DO NOT START, DO
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NOT OPEN, DO NOT CLOSE, DO NOT OPERATE, or DO NOT ENERGIZE.

•Check areas around the equipment when maintenance is complete and normal operation is
ready to begin.
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•Remove all lockout or tagout devices when all tools have been removed from the
equipment, guards have been reinstalled, and employees are in the clear.
•Operate the energy-isolating devices to restore energy to the machine or equipment.
3.10 Tagout Devices
 Tags affixed to energy-isolating devices do not provide the physical restraint on those
devices that a lock would provide.
 No tag attached to an energy-isolating device should be removed without authorization of

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the person who attached it, and it must never be bypassed, ignored, or otherwise defeated.
 Tags must be legible and understandable in order to be effective. Tags must be made of
materials that will withstand environmental conditions encountered in the workplace.
 When utilized, tags must be securely attached to energy-isolating devices so they cannot be

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inadvertently or accidentally detached during use.
 Tagout devices must be substantial enough to prevent inadvertent or accidental removal.

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 Tagout devices must warn against hazardous conditions if the machine or equipment is
energized and must include appropriate warnings such as:
• DO NOT START. pa
• DO NOT ENERGIZE.
• DO NOT OPEN.
• DO NOT OPERATE.
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•DO NOT CLOSE.
3.11 Lockout Devices
 Lockout devices and practices vary by nature and function.
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 The use of key-operated padlocks that have been assigned individually is recommended.
 Multiple lock adapters will allow more than one worker to place their own padlocks on the
isolating device to guarantee that the machine or equipment will remain deactivated until all
employees have completed their tasks; only then will the last padlock be removed.
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3.12 Plug–Cord and Hose-Connected Equipment

 When servicing or installing plug–cord or hose-connected electrical, pneumatic, or
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hydraulically powered equipment, the cord or hose should be disconnected from the
equipment to be worked on prior to beginning the work.
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 A tag warning against reconnecting the plug or hose should be affixed to the plug or hose
end. Any stored energy should be safely released prior to the start of maintenance or
installation work.
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3.13 Electrically Powered Equipment
 Electrically powered equipment should be de-energized and the source of electricity
manually disconnected from them prior to removal of protective covers or initiation of other
maintenance or installation work.
 It is important to recognize that locking and tagging on/off switches is often not sufficient to

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prevent accidental start up or prevent voltage from being present in the equipment.
3.14 Chemical or Pressurized Lines
 The line to be serviced must have two block valves upstream of the work area or device to
be serviced or installed, placed in the closed position and tagged.
 The bleed valve (between the two block valves) should be opened and tagged so that leakage

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of the valve upstream is readily obvious.
 The line should be depressurized or drained in a safe manner. Lines should be broken in

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such a manner as to release pressure away from the employee. All solids or liquids drained
should be safely collected.
3.15 Stored Mechanical Energy
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 In situations where equipment to be worked on has stored mechanical energy, such as in a
flywheel, the stored energy must be released or blocked in a safe manner before beginning
maintenance or installation work.
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 Effective blocking practices include the installation of safety blocks or adequate supports.
Under no circumstances will bumper jacks or scissor jacks be considered to be adequate
blocks.
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3.16 Training
 The purpose in providing training to employees is to ensure that they understand the purpose
and function of the lockout/tagout program and procedures and that they possess the
knowledge and skills required for the safe application, usage, and removal of energy controls.
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 Personnel who work around electrical equipment but who do not perform a primary duty of
electrical system installation or maintenance should be briefed by their supervisor on the
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hazards of electricity and proper precautions to observe.

3.17 Retraining
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 Retraining is necessary whenever a periodic inspection reveals, or an employer has reason to

believe, that shortcomings exist in an employee’s knowledge or use of the energy-control
procedure.
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 Employers are required to review their procedures at least once a year to ensure that they
provide adequate worker protection.
 As part of the review, employers must correct any deviations and inadequacies identified in
the energy-control procedure or its application.
 Employees must be retrained whenever a change in their job assignment occurs; a change in
machines, equipment, or processes presents a new hazard.

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Retraining should also be provided when a change in the lockout/tagout procedures is
implemented.Hazardous energy is defined: "any electrical, mechanical, hydraulic, pneumatic,
chemical, nuclear, thermal, gravitational, or other energy that can harm personnel" (CSA Z460-
13 "Control of Hazardous Energy - Lockout and Other Methods").

3.18 The purpose of Lockout/Tagout and LOTO Safety,

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• LOTO stands for lockout/tagout. When done properly before equipment service or
maintenance, lockout/tagout procedures control hazardous energy and protect
workers from harm.

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• When machines or equipment are being prepared for service or maintenance, they often
contain some form of “hazardous energy” that can cause harm to people in the area.
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• When we talk about hazardous energy, we mean any type of energy that can be released
and might harm a person. This could include energy of the following types:

 Chemical
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 Electrical
 Hydraulic
 Mechanical
 Pneumatic
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 Thermal

• Other sources of energy

Without the use of proper LOTO safety procedures, the serviced equipment can unexpectedly
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start up or otherwise release these forms of energy. This can lead to injuries and even death to
the people working on the machine and even to others working in the area or living in the
community.
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3.19 Lockout/Tagout Standards

 OSHA regulates lockout/tagout through the “Control of Hazardous Energy” standard, 29

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CFR 1910.147.

 MSHA regulates lockout/tagout through 30 CRF 56.12016, .12017.

3.20 Employer responsibilities under the “Control of Hazardous Energy” standard

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 Establish an energy control program
 Establish energy control procedures for machines and equipment
 Provide employee training
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 Conduct periodic inspections or audits of the energy control program

 An employee is required to remove or bypass a guard or other safety device.
 An employee is required to place any part of their body in contact with the point of
operation of an operational machine or piece of equipment.
 An employee is required to place any part of their body into a “Danger Zone” associated
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with a machine operating cycle.

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4. Explain fleet and vehicle safety. (13 Mark)
4.1Vehicle safety
• Permit only those employees who are specifically authorized and possess a valid license or
permit according to regulations to operate vehicles on organizational business; drivers
should know and obey all federal, state, and local motor vehicle laws applicable to the
operation of their vehicle and should drive at safe speeds no greater than those allowed by

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law.
• Advise drivers to give consideration to traffic, road, and weather conditions when deciding
the safe speed within the legal limit at which a vehicle should be operated.
• Require drivers to complete a defensive driving course and attend annual refresher training.

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• Obtain permission from all drivers to check their driving records with the state Department
of Motor Vehicles as often as necessary.
4.2 Driver Safety

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• Drivers should determine that the brakes are in proper working condition before operating
any equipment. If they are not working properly, they must be repaired before the vehicle is
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used, and drivers must report any defects.
• The use of seat belts must be mandatory. Seat belts protect the driver and passengers by
absorbing the forces of a crash and help the driver stay in control of the vehicle.
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• Those operating a motor vehicle should clearly signal their intentions when turning,
passing, or stopping. Drivers should be courteous toward other operators and pedestrians.
• Drivers should yield the right of way in all instances necessary to avoid an accident and
should stay a safe distance behind when following another vehicle so they can safely stop
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the vehicle.
• Drivers should exercise added caution when driving through residential and school zones.
4.3 Powered Industrial Trucks (Forklifts)
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• Some healthcare facilities use powered industrial trucks (forklifts) in their receiving and
materials management departments.
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• OSHA regulates forklifts under 29 CFR 1910.178 (Powered Industrial Trucks), and
organizations regulated by OSHA must comply with this standard, which incorporates by
reference a number of other OSHA standards as well as industry standards describing truck
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design, approval, and labeling.

• Preventing forklift incidents requires comprehensive worker training, systematic traffic
management, a safe work environment, a safe forklift, and safe work practices.
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• NIOSH investigations of forklift-related deaths indicate that many workers and employers
may not be aware of the risks of operating or working near forklifts.
4.4 OSHA Training Requirements
• The training requirement found in 29 CFR 1910.178 specifies that employers must develop
a complete training program.
• OSHA requires that operators of powered industrial trucks be trained in the operation of

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such vehicles before they are allowed to operate them independently.
• The training must consist of classroom-type and practical training in proper vehicle
operation, the hazards of operating the vehicle in the workplace, and requirements of the
OSHA standard for powered industrial trucks.
• Operators who have completed training must then be evaluated while they operate vehicles

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in the workplace.
• Operators must be periodically evaluated (at least once every 3 years) to ensure that their

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skills remain at a high level, and they must receive refresher training whenever a need is
demonstrated.
• To maximize the effectiveness of the training, OSHA does not require training that
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duplicates training previously received by operators, but such operators must be evaluated
and found competent to operate trucks safely.
• Finally, the training provisions require that the employer certify that the training and
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evaluations have been conducted.
4.5 Recommended Training Policy
• Operators must receive training from a certified instructor.
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• All operational training should be conducted under close supervision.

• All training and evaluation must be completed before an operator is permitted to use a
powered industrial truck.
• Training consists of a combination of formal instruction, practical training exercises, and
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evaluation of the operator’s performance in the workplace.

• Refresher training should be provided to the operator when observation reveals operation of
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the truck in an unsafe manner, and retraining is required when an operator is involved in an
incident or near-miss event.
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• Training should be provided on new types of trucks or when conditions change in the work
place. Refresher training is necessary every 3 years.
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4.6 Basic Safety Rules
• Only authorized and trained personnel should operate such trucks.
• All forklifts should be equipped with an overhead carriage, fire extinguisher, rotating
beacon, face plate, horn, and back-up alarm.
• The operator should perform daily pre inspections before use and report any safety defects

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such as hydraulic fluid leaks, defective brakes, defective steering, missing face plate, horn
that does not work, or missing fire extinguisher.
• Trucks with such defects should be taken out of service. Operators should follow proper
recharging or refueling safety procedures.
• Loads should be tilted back and carried no more than 6 inches from the ground. Loads that

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restrict operator vision must be transported backwards.
• Operators should sound the horn and use extreme caution when encountering pedestrians,

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making turns, or cornering. Passengers may not ride at any time.
• Trucks used as a man lift must have an appropriate platform or cage with standard rails and
toe boards. Material storage area aisles must be kept free of obstructions and properly
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marked.
• Aisle(walkway) width should be a minimum of 6 feet.
• The lift capacity should be marked on all trucks, and operators should be sure a load does
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not exceed the rated limits.
• Operators should turn trucks off when not attended, lower the fork to the ground, apply the
brake, and remove the key.
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• Operators must report all incidents regardless of cause or seriousness to the safety
department.
4.7 Changing, Charging, and Storing Batteries
• Battery charging installations should be located in well-ventilated areas designated for that
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purpose. Facilities should be provided for flushing and neutralizing spilled electrolyte, for
fire protection, for protecting charging apparatus from damage by trucks, and for adequate
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ventilation for dispersal of fumes from gassing batteries.

• When batteries are being charged, the acid should be poured into the water; water should
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not be poured into the acid.

• The truck should be properly positioned and brake applied before batteries are changed or
charged. Care should be taken to ensure that vent caps are functioning.
• The battery (or compartment) cover should be open to dissipate heat.
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• Smoking is prohibited in the charging area, and precautions should be taken to prevent
open flames, sparks, or electric arcs in such areas.
• Storage of combustibles is also prohibited in charging locations. Tools and other metallic
objects should be kept away from the top of uncovered batteries.
4.8 Operational Safety
• Tag and remove from service any forklift in need of repair or with defects.

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• Never drive forklifts up to anyone standing in front of a bench or other fixed object.
• Do not allow anyone to stand or pass under the elevated portion of any truck, whether
loaded or empty.
• Do not place arms or legs between the uprights of the mast or outside the running lines of
the truck.

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• Block wheels when parking on an incline.
• Maintain a safe distance from the edge of ramps or platforms while on any elevated dock or

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platform or freight car.
• Never use trucks for opening or closing freight doors.
• Maintain sufficient headroom under overhead installations, lights, pipes, and sprinkler
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systems.
• Use an overhead guard as protection against falling objects.
• Use a load backrest extension whenever necessary to minimize the possibility of the load or
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part of it falling rearward.
• Never allow parked trucks to block fire aisles or access to stairways or fire equipment.
• Obey all traffic regulations and speed limits.
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• When ascending or descending grades in excess of 10%, drive loaded trucks with the load
upgrade.
• Refrain from stunt driving and horseplay.
4.9 Fueling Safety
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• Fueling operations should be located in well-ventilated areas designated for that purpose.
• Fuel tanks should not be filled while the engine is running, and spillage should be avoided.
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• Spilled oil or fuel should be carefully washed away or completely evaporated in a well-
ventilated area.
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• The fuel tank cap should be replaced before restarting the engine.
• No trucks should be operated with a leak in the fuel system until the leak has been
corrected.
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• Open flames should not be used for checking the electrolyte level in storage batteries or
gasoline level in fuel tanks.

Fleet Safety Performance Diagram

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4.10 8 Essential Elements of a Fleet Safety Program
An effective fleet safety program must be comprehensive, up-to-date and instituted as a part
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of your company’s safety culture. It should be thorough, reaching each employee who gets
behind the wheel. And the commitment has to start at the top.
1. Identifying all of your drivers. Businesses may not be aware of the full extent of
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their non-owned vehicle exposure. You should identify everyone who drives on
behalf of the business, even those employees that use personal and/or rented vehicles.
2. Management commitment. Leadership support of the program can help assure that
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the program is used.

3. Screening and selecting drivers carefully. This can help create a reliable, safe team.
Without safe drivers, no organization is likely to have a good long-term safety record.
Establish clear hiring standards and a thorough screening process for anyone who
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drives on company business.

4. Training drivers. This can help to ensure that all drivers understand vehicle safety
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policies and procedures. All drivers should have access to information on safe driving
strategies and techniques, including instruction in defensive driving.
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5. Managing drivers on an ongoing basis. This is essential in helping to ensure

that drivers are following fleet safety rules and driving safely.
6. Managing accidents, when they occur. This can help mitigate accident costs. It also
helps you to understand your exposures and can reduce the potential for future losses.
 7. Establishing written policies and www.rejinpaul.com
procedures. This
sets clear consistent
expectations.
8. Formalizing a plan for vehicle inspection, repair and maintenance. This can help
reduce costly, unexpected breakdowns, and can assist in avoiding accidents due to
faulty equipment

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5. Elucidate tool safety with suitable examples. (13 Mark)
5.1 Tool Safety

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Employees must be trained in the proper use of all tools, recognizing hazards associated
with different types of tools, and the safety precautions necessary to prevent accidents. Basic
tools safety rules include the following:

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• Keep all tools in good condition with regular maintenance.
• Use the appropriate tool for the job.
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• Examine each tool for defects before use.
• Operate according to the manufacturer’s instructions.
• Use any necessary protective equipment.
5.2 Hand Tools
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Preventing accidents involving hand tools on the job site is a matter of good instruction,
adequate training, and proper use. Hand tool safety requires that the tools be of good quality and
adequate for the job. All tools should be kept in good repair, maintained by qualified personnel,
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and stored in racks, shelves, or tool boxes when not in use. Workers should wear tool belts when
working on ladders, scaffolds, or platforms. Supervisors should periodically inspect all hand
tools used in any operations under their supervision. They should immediately remove defective
tools from service. Workers should wear the appropriate personal protective equipment for the
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hand tools being used (e.g.,safety glasses or goggles for most tasks). Workers should protect
their hands from cuts, abrasions, and repeated impact and should wear the proper shoes for the
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task and work site.

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5.3 Wrenches
Wrenches come in an endless variety of styles such as socket, open-end, combination,

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adjustable, and torque, just to name a few. Following are some tips for using them safely:
• Choose a wrench that properly fits the fastener to be turned.
• Use the proper wrench for the type of bolt being turned (metric or American) to help prevent
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slippage.
• Never use an extension to improve the leverage of a wrench.
• Never use open-end or adjustable wrenches for final tightening or to loosen frozen fasteners.
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• Always try to pull on a wrench (instead of pushing), in case the fastener loosens suddenly.
• Turn power off and use electrically insulated wrenches when working on or around electrical
components.
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5.4 Pliers
Pliers come in all shapes and sizes, such as lineman, diagonal cutting, needle nose, slip
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joint, and locking tongue and groove. Following are some safety tips for their use:
• Use them as intended.
• Do not substitute pliers for a wrench when turning nuts and bolts.
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• Never attempt to increase the handle length of pliers to gain more leverage.
• Cut hardened wire only with pliers designed for that purpose.
• Be sure the pliers being used can properly grasp the wire when bending rigid wire.
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• Cut wire at right angles without bending wire back and forth against the cutting edge of a
pliers.
• Never use pliers as a hammer.
• Always use non sparking pliers when in the presence of flammable vapors or dusts.

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5.5 Hammers
Hammers are the most abused of all hand tools. They come in many types for specific

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tasks or industries. The head of a hammer is tailored to work best for particular applications.
Manufacturers now design hammers to be stronger and ergonomically shaped and to transmit
less shock to the user. The following tips are important for safe hammer use:

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• Match the hammer to the task; always use a hammer of the proper weight and size.
• Never strike the surface at an angle.
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• Never use a hammer with a damaged or loose handle.
• Select a hammer face that is 3/8 inch larger in diameter than the object to be struck.
• Never weld, heat, or regrind a hammer head.
• Remove from service any hammer exhibiting signs of excessive wear, cracks, or mushrooming.
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5.6 Screwdrivers
The many types of screwdrivers include the common flat and cross-point varieties.
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Following are some safety tips for their use:

• Match the screwdriver to the type of job.
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• Always use a screwdriver tip that properly fits the slot of the screw.
• Never use a screwdriver as a pry bar, chisel, punch, stirrer, or scraper.
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• Throw away screwdrivers with broken or worn handles.

• Turn power off and use electrically insulated screwdrivers when working on or around
electrical components.
• Straighten tips or redress rounded edges with a file.
• Never use pliers on a screwdriver for extra leverage. www.rejinpaul.com
• Use magnetic or screw-holding screwdrivers to start fasteners in tight areas.
• Use both hands when using a screwdriver — one to guide the tip and the other to turn the
handle.
• Use both hands on the screwdriver handle for final tightening.

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5.7 Portable Power Tools

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Workers must follow these safety rules when using power tools:
5.7.1 Power Tool Safety Tips
•
•
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Never carry a tool by the cord or hose.
Never pull the cord or hose when disconnecting the plug from the receptacle.
• Keep cords and hoses away from heat, oil, and sharp edges.
• Disconnect tools when not in use and when changing blades, bits, or cutters.
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• Secure bulky work with a clamp or vise.
• Never keep fingers over the switch button when carrying a plugged-in tool.
• Avoid wearing loose clothing, ties, and jewelry that can become caught in moving parts.
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• Remove all damaged electric tools from use immediately and tag them until repaired.
• Use tools with a three-wire cord with ground or powered by a low-voltage transformer.
• Use double-insulated cords for additional safety.
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• Operate tools within the design limitations.

• Wear gloves and safety footwear when using electric tools.
• Store tools in a dry place and never use tools in a wet or damp location.
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• Keep work areas well lighted.

• Be sure power cords do not create tripping hazards.
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 Understand that each tool presents unique hazards.

 Read the tool manual to understand applications, limitations, operation, and hazards.
 Never use electric power tools in the proximity of flammable vapors, dusts, or construction
materials.
 Avoid using electric power tools in wet environments. www.rejinpaul.com
 Be sure tools are properly grounded and use a ground fault circuit interrupter for corded
tools.
 Check for hidden wires that may contact bladed tools.
 Select a tool based on the task being accomplished.
 Inspect tool cords before use.
 Check for damage, presence of guards, correct alignment, binding of components, or any

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condition that would affect the operation of the tool.
 Keep control by maintaining a tight grip on the tool.
 Maintain your balance and never over reach.
 Secure the work in a vise or clamp for increased stability.

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 Verify that all tools are unplugged or that the power source is removed when changing blades
or performing maintenance or when tools are not in use.

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 Be sure adjustment knobs are tightened, and remove any adjustment keys before use.
 Keep tools in a secure location when not in use.
 Avoid unintentional tool start-up by keeping your finger off of the power switch.
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6. Point out Electrical safety in workplace. (13Mark)

 Electrical equipment can cause shock, electrocution, and catastrophic property damage
due to its potential for causing fire or explosion.
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 Electrical fires in healthcare facilities many times result from short circuits, overheated
equipment, and failure of current safety devices.
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 Explosions may occur when flammable liquids, gases, and dusts are exposed to ignition
sources generated by electrical equipment.
 Electrical installations and utilization equipment must follow the requirements of the
NFPA/ANSI 70 (National Electrical Code).
 This code applies to every replacement, installation, or utilization of electrical equipment.
 Supervisors must inspect work areas for possible electrical hazards and provide adequate

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space around electric equipment to permit safe operation and maintenance of such
equipment.
6.1 About Electricity
 Electrical safely requires some knowledge about how electricity works and the hazards it
presents. Electrical current travels through electrical conductors.

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 Its pressure is measured in volts.
 Resistance to the flow of electricity is measured in ohms and can vary widely.

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 Resistance is determined by the nature of the substance itself, the length and area of the
substance, and the temperature of the substance.
 Some materials, such as metal, offer very little resistance and become conductors very
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easily. Other substances, such as porcelain and dry wood, offer high resistance.
 Materials that prevent the flow of electricity are referred to as insulators. Water that
contains impurities such as salts and acids makes a ready conductor.
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 Electricity travels in closed circuits and its normal route is through a conductor. Electrical
shock occurs when the body becomes part of the circuit.
 Shock normally occurs when a person:
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• Contacts both wires of an electrical circuit

• Contacts one wire of an energized circuit and the ground
• Contacts a “hot” metallic part that has become energized and the ground
6.2 Shock Severity
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The severity of shock is affected by several factors, including:

• Amount of current (amperes) flowing through the body
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• Path of the current through the body

• Length of time the person is in the circuit
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• Phase of the heart cycle when the shock occurs

• General health of the person involved
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6.3 Electrical Burns and Other Injuries
Severe shock can cause falls, cuts, burns, and broken bones. Three types of burns can result from
shocks:
• Electrical burns result from current flowing through tissue or bone, which are damaged
by the intense heat.

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• Thermal burns occur when the skin comes into contact with the hot surfaces of
overheated conductors or other energized parts.
• Arc burns are caused by high temperatures near the body and are produced by an
electrical arc or explosion.
6.4 Protecting Workers

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 Proper insulation protects workers from electrically energized wires and parts. Insulation
should always be checked before working with electrical equipment.

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 Insulation requirements are regulated by 29 CFR 1910, Subpart S, which requires
insulation to be suitable for the voltage and existing conditions.
 Conductors and cable are marked by the manufacturer to show maximum voltage,
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American Wire Gage size, type of insulation, and manufacturer’s name or trademark.
 Insulation is often color coded. Grounding conductors are green or green with yellow
stripes.
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 Grounded conductors that complete a circuit are usually white or natural gray.
 Hot wires are colors other than these, often black or red. Live parts of electrical
equipment operating at 50 volts or higher must be guarded against accidental contact.
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Electrical safety in workplace

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6.5 Guarding
Guarding can be accomplished by:
• Locating the equipment in a room, vault, or enclosure that has limited access
• Use of permanent partitions or screens

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• Locating the equipment on a suitable balcony or elevated platform to limit access
• Elevating the equipment 8 feet or higher above the floor
• Using warning signs to mark entrances to locations with exposed live parts
• Containing indoor electric installations over 600 volts in metal enclosures or in vaults or
areas controlled by locks

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• Marking high-voltage equipment with caution signs.

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6.6 Grounding
 “Grounding” refers to creating a conductive connection.
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 This low-resistance path prevents a buildup of voltage that results in shock.
 The frames of all electrical equipment should be grounded regardless of voltage.
 Exposed non-current-carrying metal parts of electrical equipment that may be come
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energized under abnormal conditions must also be grounded in accordance with the National
Electrical Code.
 For grounding requirements in patient areas, refer to NFPA 99. 29 CFR 1910, Subpart S,
which covers two types of grounds:
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• Neutral conductor — The neutral conductor (normally a white or gray wire) is grounded at the
generator or transformer and again at the service entrance to a building. This ground protects
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machines, tools, and insulation against damage.

• Equipment ground — This additional ground offers enhanced protection for the worker by
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providing another path from the machine or tool through which the current flows into the ground.
This protects the worker should the metal frame of the tool become accidentally energized. The
resulting heavy surge of current will activate the circuit protection devices and open the circuit.
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6.7 Circuit Protection Devices

 Circuit protection devices are designed to limit or shut off the flow of electricity in the

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event of a ground-fault overload or short circuit in the wiring system.
 Fuses and circuit breakers are over-current devices that automatically open or break when
the amount of current becomes excessive.
 Fuses and circuit breakers primarily protect equipment and conductors.

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 Ground-fault circuit interrupters are designed to shut off electrical power immediately by
comparing the amount of current going to the equipment and the amount returning along

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the circuit conductors.
 They should be used in wet locations and construction areas.
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6.8 Safe Work Practices
Electrical safety-related work practice requirements are contained in 29 CFR 1910.331–335 and
NFPA 70E:
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• Employers must ensure that workers are trained in safety-related work practices.
• Maintenance employees should be qualified electricians who also have been instructed in
lockout/tagout procedures.
• Workers whose jobs require them to work constantly and directly with electricity must
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use the required personal protective equipment.

• Equipment may consist of rubber insulating gloves, hood, sleeves, line hose, and
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protective helmet. Workers should always use tools that are designed to withstand
voltage and stresses of electricity.
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6.9 Electrical Equipment Safety

 Electrical malfunction is the second leading cause (after matches and smoking) of fires in
hospitals.
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 Violations of standards governing the use of electrical equipment are the most frequently
cited causes of fires.
 Hospital personnel use a wide variety of electrical equipment in all areas, including general
patient care, intensive care units, emergency rooms, maintenance, housekeeping service,
food preparation, and research.
 Thorough electrical maintenance records should be kept, and considerable effort should be

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devoted to electrical safety, particularly in areas where patient care is involved.
 Personal electrical appliances, such as radios, coffeepots, fans, power tools, and electric
heaters, that are not grounded, have frayed cords or poor insulation, or are otherwise in poor
repair should not be used. Equipment and appliances that are frequently ungrounded or
incorrectly grounded include:

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• Three-wire plugs attached to two-wire cords
• Grounding prongs that are bent or cut off

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• Ungrounded appliances resting on metal surfaces
• Extension cords
• Cords molded into plugs that are not properly wired
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• Ungrounded multiple-plug strips often found in office areas and nurse stations
6.10 National Electrical Code
Other requirements include the following:
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• Outlets, switches, junction boxes, etc. should be covered.
• Flexible cords should not be used as a substitute for fixed wiring.
• Flexible cords should be connected without any tension on joints or terminal screws.
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• Frayed cords or cords with deteriorated insulation should be replaced.

• Splices in flexible cords should be brazed, welded, soldered, or joined with suitable
splicing devices; splices, joints, or free ends of conductors must be properly insulated.
6.11 Healthcare Electrical Safety Requirements
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 Healthcare facilities contain many damp or wet areas, thus electrical safety requirements,
such as the following, are especially important:
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 A switch or circuit breaker in a wet area or outside a building should be protected by a

weatherproof enclosure.
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• Cabinets and surface-type cutout boxes in damp or wet areas should be weatherproofed
and located in such a way as to prevent moisture from entering and accumulating in the
cabinet or box.
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• The boxes should be mounted with at least 0.25 inch of air space between the enclosure and
the wall or supporting surface.
• Non-metallic-sheathed cable and boxes made of nonconductive material are recommended.
6.12 Healthcare Electrical Standards
• NFPA 37 (Standard for Installation and Use of Stationary Combustion Engines and Gas
Turbines).

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• NFPA 70 (National Electric Code) — Addresses many of the electrical requirements for
healthcare facilities including installation requirements, incoming power lines, voltage,
noise, and frequency; transformers, distribution lines, conduit, wiring systems, junction
boxes, and panel boards; generator requirements, battery systems, and emergency
systems. Article 517 provides healthcare-specific requirements.

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• NFPA 70B (Recommended Practice for Electrical Equipment Maintenance).
• NFPA 70E (Standard on Electrical Safety Requirements for Workplaces) — Provides

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safety guidance for those working with electrical systems within the facility; OSHA
recently announced that the agency plans to adopt the standard in the 29 CFR 1910.
• NFPA 72 (Fire Alarm Code) — This standard provides power supply requirements for
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fire alarm systems.
6.13 Preventing Shock
The following work practices can help prevent shocks to hospital workers:
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• Under no circumstance should an electrically operated apparatus be located inside of any
canopy when oxygen is flowing.
• Portable electric heaters or heating pads should not be used unless approved in advance.
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• Unapproved appliances should be removed immediately and placed with security until
further notice.
• Adapters that convert three prongs to two prongs have no place in the healthcare
environment.
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• Broken or cracked receptacles should be reported immediately and not used until
repaired.
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 Develop a policy for using extension cords.

 Use a sign-out system to list the number and location of all extension cords currently in
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use.
 Do not work near electrical equipment or outlets when hands, counters, floors, or pieces
of equipment are wet.
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 Consider any device to be defective that blows a fuse or trips a circuit breaker, and
prohibit its use until it has been inspected.
 Do not use any electrical equipment, appliance, or receptacle that appears to be damaged
or in poor repair.
Report all shocks immediately; even small tingles may indicate trouble and precede
major shocks. Do not use the equipment again until it has been inspected and repaired if

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necessary.

Common Safety Rules in working place

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VIVEKANANDHA
COLLEGE OF TCHNOLOGY FOR WOMEN
ELAYAMPALAYAM, TIRUCHENGODE – 637 205, NAMAKKAL Dt., TAMIL NADU,
INDIA
Phone : 04288-234064, Fax : 04288-234134, Website :www.vctw.ac.in,E-
mail:principal@vctw.ac.in
VIVEKANANDHA

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OMD552 - HOSPITAL WASTE MANAGEMENT
Common to CSE and IT Department
UNIT V
INFECTION CONTROL, PREVENTION AND PATIENT SAFETY

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Healthcare Immunizations, Centers for Disease Control and Prevention, Disinfectants,
Sterilants, and Antiseptics, OSHA Bloodborne Pathogens Standard, Tuberculosis,

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Healthcare Opportunistic Infections, Healthcare-Associated Infections, Medication Safety.

PART-A
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1. List out basic categories of vaccines to healthcare workers.
Administration of vaccines to healthcare workers falls into three basic categories:
• Strongly recommended — Diseases posing special risks to healthcare workers include
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hepatitis B, influenza, measles, mumps, rubella, and varicella.
• Recommended in some situations — Active and/or passive immunization of healthcare
workers as indicated by certain circumstances such as occurrences of tuberculosis, hepatitis A,
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meningitis, and typhoid fever.

• Recommended for all adults — Immunization of all adults for tetanus, diphtheria, and
pneumonia disease.
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2. What are contraindications for immunizations?

The oral poliovirus vaccine is contraindicated. When indicated, measles-mumps-rubella
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(MMR), influenza, and varicella vaccines should be administered to patients who have
immunocompromised household contacts.
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3. What are the contraindications to live virus vaccine immunizations?

Permanent contraindications to vaccination:

• Severe allergic reaction to a vaccine component or following a prior dose.

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• Encephalopathy not due to another identifiable cause occurring within 7 days of
pertussis vaccination.
• Severe combined immunodeficiency (rotavirus vaccine)
• History of intussusception (rotavirus vaccine)

4. What are the vaccination guidelines that Advisory Committee for Immunization Practices

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(ACIP) will give?

• Mumps
• rubella
• diphtheria
• measles

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• Hepatitis B
• Influenza

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5. State out the Other Vaccination Program.
Healthcare employees working abroad should consider vaccinations for diseases such
as hepatitis A, poliomyelitis, encephalitis, meningitis, plague, rabies, typhoid, and yellow
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fever.

6. What causes pertussis?

Causes. Pertussis, a respiratory illness commonly known as whooping cough, is a very
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contagious disease caused by a type of bacteria called Bordetella pertussis.
These bacteria attach to the cilia (tiny, hair-like extensions) that line part of the upper
respiratory system
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7. What are the first signs of whooping cough?

Early symptoms can last for 1 to 2 weeks and usually include:

• Runny nose.
• Low-grade fever (generally minimal throughout the course of the disease)
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• Mild, occasional cough.

• Apnea – a pause in breathing (in babies)
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8. Why was routine smallpox immunization with vaccinia virus discontinued?

• Because of vaccination programs and quarantine regulations, the risk of importation

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of smallpox into the United States was reduced by the 1960s.

• As a result, routine vaccinia vaccination was discontinued in 1971.
• However, only selected groups of military personnel are currently vaccinated
against smallpox
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9. What causes pneumonia?
Pneumonia is a lung disease characterized by inflammation of the airspaces in the
lungs, most commonly due to an infection. Pneumonia may be caused by viral infections,
bacterial infections, or fungi; less frequently by other causes. The most common bacterial
type that causes pneumonia is Streptococcus pneumonia

10. What type of disease that experts can recommended vaccines related with
Pneumonia?

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Chronic cardiovascular disease, chronic pulmonary disease, emphysema, diabetes,
alcoholism, chronic liver disease, cerebrospinal fluid leaks, or sickle cell disease.

11. Who is all need Influenza vaccine recommended by ACIP?

The ACIP recommends vaccination for those working in hospitals, nursing homes,

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walk-in clinics, physicians’ offices, public health clinics, employee health clinics, dialysis
centers, outpatient rehabilitation programs, and mobile clinics. Inpatients and outpatients at
high risk for complications from influenza should receive the vaccine beginning in September

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and throughout the influenza season.

12. What is the Centers for Disease Control and Prevention?

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The Centers for Disease Control and Prevention (CDC) is a federal agency that
conducts and supports health promotion, prevention and preparedness activities in the United
States, with the goal of improving overall public health.
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13. What is Disease Control and Prevention?

The Centers for Disease Control and Prevention (CDC) is the leading national public
health institute of the United States. Its main goal is to protect public health and safety through
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the control and prevention of disease, injury, and disability in the US and internationally.

14. What are the CDC guidelines?

The Prevention Guidelines Database is a comprehensive compendium of all of the

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official guidelines and recommendations published by the US Centers for Disease Control and
Prevention (CDC) for the prevention of diseases, injuries, and disabilities.
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15. List out FDA Antiseptic Product Categories.

• Patient preoperative skin preparation

• Antiseptic handwash or HCW handwash
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• Surgical hand scrub

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16. Classify the three general categories of chemical germicides.

• Disinfectants
• Sterilants
• Antiseptics
17. How Germicidal Effectiveness depends?

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Their effectiveness depends on:
• Shape and texture of the surface
• Amount of contamination on the surface
• Resistance of contaminants to the germicide
• Amount of soil buildup, including blood, mucous, or tissue

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• Chemical composition of the germicide
• Time of exposure to the germicide
• Temperature of the germicide

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18.Define Disinfection.

Disinfect is to cleanse so as to destroy or prevent the growth of disease carrying

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microorganisms. Therefore a disinfectant is an agent, such as heat, irradiation or chemical that
disinfects by destroying, neutralizing or inhibiting the growth of disease-carrying
microorganisms.

19.List the types of disinfects.

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• Air disinfectants

• Alcohols

• Aldehydes
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• Oxidizing agents

• Peroxy and peroxo acids

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• Phenolics

20.Define sterilants.
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An agent used to destroy microorganisms; a disinfectant, a chemical agent used to

destroy pests and diseases in the soil, especially fungi and nematodes.
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21. What are chemical sterilants?

"Sterilization," as defined in FDA's Liquid Chemical Sterilants/High Level

Disinfectants guidance document, is a validated process used to render a product free of all
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forms of viable microorganisms. In many cases, thermal methods, such as steam, are used to
achieve sterilization.

22.Define Antiseptics

Antiseptics are antimicrobial substances that are applied to living tissue/skin to reduce
the possibility of infection, sepsis, or putrefaction. Antiseptics are generally distinguished
from antibiotics by the latter's ability to safely destroy bacteria within the body, and

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from disinfectants, which destroy microorganisms found on non-living objects

23.Mention some of the antiseptics.

• Alcohols

• phenols

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• iodine

• chlorine.

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24. What is a good antiseptic?
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Conventional wisdom suggests using disinfectants and antiseptics like hydrogen
peroxide, rubbing alcohol, or iodine to clean open wounds. Most of these substances are better
suited for disinfecting household surfaces and are far too harsh for use on human tissue. They
are more likely to damage tissue than help it heal.
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25. What are the 6 types of wounds?

• Abrasion
• Laceration
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• Puncture
• Avulsion
26. What is considered a bloodborne pathogen?

Blood means human blood, human blood components, and products made from human
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blood. Bloodborne Pathogens means pathogenic microorganisms that are present in human
blood and can cause disease in humans. These pathogensinclude, but are not limited to,
hepatitis B virus (HBV) and human immunodeficiency virus (HIV).
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27. What are standard precautions OSHA?

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OSHA states, "According to the concept of Universal Precautions, all human blood and
certain human body fluids are treated as if known to be infectious for HIV, HBV, and other
bloodborne pathogens." Universal precautions include vigorously washing hands before and
after exposure to blood and other body fluids.
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28. What fluids can contain bloodborne pathogens?

• Semen.
• Vaginal secretions.
• Cerebrospinal fluid.
• Synovial fluid.
• Pleural fluid.
•

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Peritoneal fluid.
• Amniotic fluid.

29. What are the basic rules of standard precautions?

• Hand hygiene

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• Use of personal protective equipment (e.g., gloves, gowns, masks)
• Safe injection practices
• Safe handling of potentially contaminated equipment or surfaces in the patient

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environment
• Respiratory hygiene/cough etiquette.

30. What is Tuberculosis

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Tuberculosis (also known as "TB") is a disease caused by a type of bacteria called
Mycobacteriumtuberculosis. TB mainly infects the lungs, although it can also affect other
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organs. When someone with untreated TB coughs or sneezes, the air is filled with droplets
containing the bacteria.

31. What happens if you have tuberculosis?

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Latent TB Infection and TB Disease. The bacteria that cause TB is spread through the
air from person to person when a person with TB disease coughs, speaks, or sings. People
nearby may breathe in these bacteria and become infected.People with TB disease
usually have symptoms and may spread TB bacteria to others.
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32. What are the stages of tuberculosis?

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TB infection happens in 4 stages: the initial macrophage response, the growthstage, the
immune control stage, and the lung cavitation stage. These four stageshappen over roughly one
month
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33. What is Healthcare Opportunistic Infections ?

Opportunistic infections (OIs) are infections that occur more often or are more severe in
people with weakened immune systems than in people with healthy immune systems. A
weakened immune system makes it harder for the body to fight off HIV-related OIs.

34.List the types of Opportunistic Infections

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• cryptococcal meningitis.
• toxoplasmosis.
• PCP (a type of pneumonia)
• oesophageal candidiasis.
• certain cancers, including Kaposi's sarcoma.

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35. What is an opportunistic infection definition?

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Opportunistic infection: An infection that occurs because of a weakened immune
system. Opportunistic infections are a particular danger for people with AIDS. The HIV virus
itself does not cause death, but the opportunistic infections that occur because of its effect on
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the immune system can.

36. What are healthcare associated infections?

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HAIs are infections that patients get while receiving treatment for medical or surgical
conditions, and many HAIs are preventable. Modern healthcare employs many types of
invasive devices and procedures to treat patients and to help them recover.

37. What are the most common hospital acquired infections?

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Hospital-acquired infections are caused by viral, bacterial, and fungal pathogens;

the most common types are bloodstream infection (BSI), pneumonia (eg, ventilator-associated
pneumonia [VAP]), urinary tract infection (UTI), and surgical siteinfection (SSI).
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38. What are common infections in hospitals?

• Methicillin-resistant Staphylococcus aureus (MRSA)
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• Clostridium difficile (C.Diff)

• Vancomycin-resistant enterococci (VRE)
• Carbapenem-resistant Enterobacteriaceae (CRE) and Carbapenem-resistant Klebsiella
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pneumoniae (CRKP)
• Necrotizing fasciitis, the flesh-eating bacterial disease.
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39. How can hospitals prevent infection?

Wash Your Hands. Hand washing should be the cornerstone of reducing HAIs.
• Create an Infection-Control Policy
• Identify Contagions ASAP.
• Provide Infection Control Education
• Use Gloves

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• Provide Isolation-Appropriate Personal Protective Equipment
• Disinfect and Keep Surfaces Clean
• Prevent Patients From Walking Barefoot.

40. How can opportunistic infections be prevented?

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• Practice safe food preparation
• Take care around animals
• Take care around people

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• Get vaccinated
• Take preventive medicines if needed
• Take antiretroviral medicines for your HIV
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• Keep a health journal and write down any new symptoms.

41. What is medication safety?

Medicines are used to treat diseases, manage conditions, and relieve symptoms.
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Medicines are generally safe when used as prescribed or as directed on the label, but there are
risks in taking any medicine.Learning about medication safety can reduce and even prevent the
risk of harm for you and your loved ones.
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42. Why is medication safety important?

Medication is given to almost every patient in hospital and can be the most
important part of treatment. However, medication is not without risk and
occasionally medications can cause harm. Hospitals and health services aim to prevent harm
by: understanding what contributes to these errors.
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43. what are the 9 medication administration ?

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• Right patient
• Right documentation
• Right drug
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• Right action
• Right route
• Right form
• Right time
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• Right response
• Right dose

44. What does contraindication mean?

A contraindication is a specific situation in which a drug, procedure, or surgery should
not be used because it may be harmful to the person. There are two types of contraindications:
Relative contraindication means that caution should be used when two drugs or procedures are

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used together.

45. What does medication administration mean?

The practice of administering medication involves providing the patient with a
substance prescribed and intended for the diagnosis, treatment, or prevention of a medical
illness or condition.

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PART-B

1. Discuss bout healthcare worker immunizations in detail. (13 Mark)

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1.1 Introduction
• Healthcare organizations should establish a comprehensive written policy regarding
immunizing workers, develop a listing of all required and recommended immunizations, and
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refer workers to the employee health department to receive education and guidance on
appropriate immunizations needed for their positions.
• The employee health department must consider an employee’s medical history and current
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position to determine that worker’s risk for occupational exposure.

• Administration of vaccines to healthcare workers falls into three basic categories:
 Strongly recommended — Diseases posing special risks to healthcare workers
include hepatitis B, influenza, measles, mumps, rubella, and varicella.
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 Recommended in some situations — Active and/or passive immunization of

healthcare workers as indicated by certain circumstances such as occurrences of
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tuberculosis, hepatitis A, meningitis, and typhoid fever.

 Recommended for all adults — Immunization of all adults for tetanus, diphtheria,
and pneumonia disease.
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1.2 Guidelines of the Advisory Committee for Immunization Practices
All healthcare workers should meet the Advisory Committee for Immunization Practices (ACIP)
guidelines for immunization against mumps, rubella, diphtheria, and measles. Vaccinations should
include:
 Rubella — Workers considered to be at risk or who have direct contact with pregnant
patients should be immune to rubella.

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 Hepatitis B — Workers exposed to bloodborne pathogens should be offered the vaccine
within 10 days of their job assignment.
 Measles — For anyone susceptible by history or serology who are considered to be at risk
should be immunized.

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 Influenza — Healthcare personnel should consider receiving flu immunization to help
prevent the spread of influenza from personnel to patients; hospitals should promote such a
program and provide vaccines during the fall of each year.

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1.3 Other Vaccination Program Considerations
 Healthcare organizations must develop comprehensive policies and protocols for
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management and control of outbreaks of vaccine preventable diseases as described in the
ACIP Guidelines.
 Healthcare employees working abroad should consider vaccinations for diseases such as
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hepatitis A, poliomyelitis, encephalitis, meningitis, plague, rabies, typhoid, and yellow fever.
 Healthcare organizations should develop written policies regarding work restrictions or
exclusion from duty for immunization and infection control reasons.
 They should also require workers to report any illnesses, medical conditions, or treatments
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that could make them susceptible to opportunistic infections.

1.4 Pertussis
 The Advisory Committee on Immunization Practices (ACIP) makes no recommendation for
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routinely vaccinating adults, including healthcare workers, for pertussis.

 Longterm-care facilities serving children and acute-care facilities with children staying for
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prolonged periods should follow the recommendations of ACIP for vaccinating children.
 No recommendation can be made for vaccinating adults, including healthcare workers,
during an institutional outbreak of pertussis.
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1.5 Vaccinia Viruses and Smallpox

 The ACIP recommends vaccination for orthopox viruses in laboratory settings for the few
workers directly handling cultures or animals contaminated or infected with vaccinia,
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recombinant vaccinia viruses, or other orthopox viruses that replicate readily in humans such
as monkey pox and cow pox.
 Some physicians and nurses with limited exposure to contaminated materials such as
dressings experience a lower risk but may be considered for vaccination.
 When indicated, vaccinia vaccine should be administered every 10 years. Vaccinia vaccine
should not be administered to immune-suppressed persons, those with a history of eczema, or

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pregnant women.
 Vaccinia vaccine is a highly effective immunizing agent that has brought about the global
eradication of smallpox. In 1976, routine vaccinia vaccination of healthcare workers in the
United States was discontinued.

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 Recently, the federal government instituted a program to vaccinate first responders and
healthcare personnel to protect these groups in a bioterrorism event involving smallpox.
1.6 Pneumonia

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 The ACIP recommends vaccination of all persons 65 years or older.
 Experts now recommend vaccination of those younger than 65 with certain chronic illnesses:
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chronic cardiovascular disease, chronic pulmonary disease, emphysema, diabetes,
alcoholism, chronic liver disease, cerebrospinal fluid leaks, or sickle cell disease.
 It is also recommended for those younger than 65 living in special environments or social
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settings where an increased risk for the disease or its complications exists.
1.7 nfluenza
 The ACIP recommends vaccination for those working in hospitals, nursing homes, walk-in
clinics, physicians’ offices, public health clinics, employee health clinics, dialysis centers,
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outpatient rehabilitation programs, and mobile clinics.

 Inpatients and outpatients at high risk for complications from influenza should receive the
vaccine beginning in September and throughout the influenza season.
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2. Explain the concept of centers for disease control and prevention. (10 Mark)
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The CDC publishes guidelines, advisories, and recommendations that do not carry the
force of law.
2.1 CDC Infection Control Guidelines
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 Environmental Infection Control in Healthcare Facilities (2003)

 Guidelines for Preventing Healthcare Associated Pneumonia (2003)
 Guidelines for Infection Control in Dental Healthcare Settings (2003)
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 Hand Hygiene in Healthcare Settings (2002)
 Intravascular Device-Related Infections (2002)
 Management of Occupational Exposures to Hepatitis B, Hepatitis C, and
 HIV and Recommendations for Post Post-Exposure Prophylaxis (2001)
 Surgical Site Infections (1999)
 Guidelines for Infection Control in Healthcare Personnel (1998)

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 Healthcare Worker Immunizations (1997)
 Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in
Healthcare Facilities (1994)
 Isolation Precautions (1994)

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Biosafety in Microbiological and Biomedical Laboratories (1993)
 The CDC bases their guidance and recommendations on scientific studies; however, some
infection control practices applicable to one setting may not apply in all healthcare

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situations.
 The guidance offered by the CDC gives healthcare infection control personnel the
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information necessary to make informed decisions.
 Healthcare organizations must provide proper education and training on current infection
control practices and keep workers up to date on the latest OSHA requirements and CDC
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developments through periodic in-service sessions.
 The continuous evaluation of care practices under the supervision of the infection control
staff can help ensure continued adherence to correct practices.
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2.2 Non-CDC Guidelines

In 1999, the Association for Professionals in Infection Control and Epidemiology (APIC)
published their State-of-the-Art Report: The Role of Infection Control During Construction in
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Healthcare Facilities.
2.3 Guidelines for Design and Construction of Hospital and Healthcare Facilities
 The American Institute of Architects (AIA) and the Facility Guidelines Institute revised the
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Guidelines for Design and Construction of Hospital and Health Care Facilities in 2001.
 Considered an industry standard by architects, engineers, and healthcare professionals,
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these guidelines set minimum program, space, and equipment needs for clinical and
support areas of hospitals, nursing homes, freestanding psychiatric facilities, outpatient and
rehabilitation facilities, and long-term care facilities.
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 The 2001 edition addresses infection control and the environment of care, including control
provisions designed to protect against waterborne bacteria.
 The guidelines also address infection control risk assessments before and during
construction projects.
 The guidelines are updated every 4 years to keep pace with new concepts and capabilities
in the delivery of health care. More than 40 states and the Joint Commission reference

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these guidelines for licensure or accreditation of healthcare facilities.

3. How do antiseptics disinfectants and sterilization agents differ? Explain.(13 Mark)

Many experts divide chemical germicides into three general categories:

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• Sterilizing agents, which were developed to eliminate all microbial life on objects or surfaces,
including bacterial spores, that can survive other germicides.

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• Disinfectants, which are classified as high, medium, or low, depending on the strength
required, and which can destroy nearly all microbial life on objects or surfaces except for
bacterial spores.
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• Antiseptics, which are used to inactivate or destroy organisms on skin or living tissue.
Product Description

A fast-acting, broad-spectrum, and persistent

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Patient preoperative
antiseptic-containing preparation that
skin preparation substantially reduces the number of
microorganisms on intact skin.
An antiseptic-containing preparation designed
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Antiseptic handwash for frequent use; it reduces the number of

or HCW handwash microorganisms on intact skin to an initial
baseline level after adequate washing, rinsing,
and drying.
An antiseptic-containing preparation that
Surgical hand scrub substantially reduces the number of
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microorganisms on intact skin; it is broad-

spectrum, fastacting, and persistent.
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3.1 Germicidal Effectiveness

 Bacterial spores exhibit the most resistance to germicides followed by mycobacteria, nonlipid
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viruses, fungi, and vegetative bacteria. Lipid viruses exhibit the least resistance.
 Facilities should use FDA- or EPA-approved cleaning agents and should read and follow the
manufacturer’s instructions to ensure proper use. Their effectiveness depends on:
• Shape and texture of the surface
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• Amount of contamination on the surface
• Resistance of contaminants to the germicide
• Amount of soil buildup, including blood, mucous, or tissue
• Chemical composition of the germicide
• Time of exposure to the germicide
• Temperature of the germicide

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3.2 Regulatory Approval of Disinfectants
 The EPA oversees the manufacture, distribution, and use of disinfectants. Manufacturers
must use pre-established test procedures to ensure product stability, determine toxicity to
humans, and assess microbial activity.

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 If the product passes these requirements, the EPA registers the substance for use.
 The EPA regulates disinfectants under the authority of the Federal Insecticide, Fungicide,
and Rodenticide Act (FIFRA).

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3.3 Classifying the Effectiveness of Sterilants and Disinfectants
 The Food and Drug Administration (FDA) regulates liquid chemical sterilants and
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high-level disinfectants such as hydrogen peroxide and peracetic acid under the authority of the
1976 Medical Devices Amendment to the Food, Drug, and Cosmetic Act.
 The FDA regulates the chemical germicides if marketed for use on specific medical
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devices. Regulatory authority requires the manufacturer to provide instructions for the safe and
effective use of substances with that device.
 The FDA uses the same basic terminology and classification scheme as does the CDC,
which categorizes medical devices as critical, semi-critical, and noncritical.
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 The scheme classifies antimicrobial effectiveness or sterilization as high, intermediate,

and low level.
 The EPA registers environmental surface disinfectants based on the manufacturer’s
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microbiological activity claims.

 The EPA does not use the terms “intermediate level” and “low level” when classifying
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disinfectants.
 The CDC designates any EPA-registered hospital disinfectant not claiming a
tuberculocidal claim as a low-level disinfectant; however, an EPA-registered hospital
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disinfectant effective against tuberculosis would be classified as an intermediate level

disinfectant.
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 The EPA also lists disinfectant products according to their labeled use against certain
organisms.
3.4 OSHA Requirements
 The Occupational Safety and Health Administration requires the use of EPA-registered
hospital tuberculocidal disinfectants or EPA-registered hospital disinfectants labeled
effective against human immunodeficiency virus (HIV) and hepatitis B virus (HBV) for

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decontaminating work surfaces.
 Hospital disinfectants with HIV and HBV claims can be used if surfaces are not
contaminated with agents requiring the use of a higher level disinfectant.
 Effectiveness is governed by strict adherence to the label instructions for intended use of

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the product.
3.5 CDC Recommendations
 The CDC does not test, evaluate, or otherwise recommend specific brand-name products

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of chemical germicides.
 The CDC recommends disinfecting environmental surfaces or sterilizing or disinfecting
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medical equipment with products approved by the EPA and FDA.
 When no registered or approved products are available for a specific pathogen or use
situation, the CDC suggests following specific guidance regarding unregistered uses for
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various chemical germicides.
 For example, no antimicrobial products are registered for use specifically against certain
emerging pathogens such as SARS, Norwalk virus, or Creutzfeldt–Jakob disease agents.
 The CDC disinfecting levels are:
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 High-level disinfection, which can be expected to destroy all microorganisms

with the exception of high numbers of bacterial spores
 Intermediate-level disinfection, which inactivates Mycobacterium
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tuberculosis, vegetative bacteria, most viruses, and most fungi but does not
necessarily kill bacterial spores

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Low-level disinfection, which can kill most bacteria, some viruses, and some
fungi but cannot be relied on to kill resistant microorganisms such as tubercle bacilli
or bacterial spores
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3.6 Selecting a Disinfectant

Healthcare facilities use a number of disinfectants, including alcohol, chlorine, chlorine
compounds, hydrogen peroxide, iodophors, phenolics, and quaternary ammonium compounds.
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Disinfectants are not interchangeable. Proper selection and use of disinfectants are key to
effective safety and quality control.
Alcohols
Alcohols demonstrate variable effectiveness against some bacterial and fungal species. They are
good general-use disinfectants that are fast acting, leave no residue, and compatibly combine
with other disinfectants (quaternaries, phenolics, and iodine) to form tinctures.

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Aldehydes
Aldehydes are effective against a wide spectrum of bacteria and viruses. They are also effective
against spores when used properly (10-hour contact period) and demonstrate activity against
other pathogens, including vegetative bacteria and viruses.

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Chlorine Compounds
 Chlorine works very well for cleaning up blood or body-fluid spills. Chlorine compounds
also have a biocidal effect on tuberculosis and vegetative bacteria.

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 They are effective against HIV after 10 to 20 minutes and are also effective at a 1:5 dilution
against bacterial spores and mycobacteria.
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 Diluted chlorine neutralizes rapidly in the presence of organic matter.
 Chlorine compounds are very effective for the decontamination of HBV, HCV, and HIV
and the cleanup of biohazardous spills.
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Iodophor Substances
Iodophor substances show good effective qualities against vegetative bacteria and viruses. They
demonstrate poor activity against bacterial spores but are effective against Gram-negative and
Gram-positive organisms, some viruses, and tubercle bacilli. They are most effective in acid
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solutions but can vaporize at 120 to 125°F. They should never be used in hot water, and their
effectiveness can be reduced by organic matter.
Phenolic Compounds
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 Phenolic compounds work well against vegetative bacteria, fungi, and lipid-containing
viruses.
 They have low solubility in water, remain stable in storage, and demonstrate germicidal
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effectiveness against Gram-negative and Gram-positive organisms.

 They are very effective against tuberculosis but have limited effectiveness against spores.
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 Prolonged contact to phenolic compounds deteriorates rubber and can cause skin and eye
irritations. They should never be used on food-contact surfaces.
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Quaternary Ammonium Compounds
 Quaternary ammonium compounds can control vegetative bacteria and non lipid-containing
viruses.
 They remain stable when stored. The present no odor but can act as deodorizers. They are
not considered a skin irritant but it is best to avoid skin or eye contact.
 They are effective at up to 212°F and work well against Gram-positive organisms.

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 These compounds become bacteriostatic in high dilutions and are ineffective against
tubercle bacilli, spores, and viruses.
 They are more effective in alkaline solutions but can be neutralized by soap or hard water.
Organic compounds also reduce their effectiveness.

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3.7 CDC Guidelines for Hand Hygiene in Healthcare Settings

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The guidelines published in the Morbidity and Mortality Weekly Report (October 25,
2002) provide categories for hand cleansing and disinfecting.
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Hand Hygiene Performance Indicators
• Conduct compliance surveys by unit or department and provide feedback to workers.
• Calculate the volume of alcohol product used per 1000 patient days.
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• Monitor artificial nail wearing compliance during outbreaks.
• Assess hand hygiene compliance during infection outbreaks.
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4. Describe in detail about OSHA Bloodborne Pathogens Standard.(13 Mark)

4.1 Needlestick Safety and Prevention Act of 2000

On November 6, 2000, President Clinton signed the Needlestick Safety and Prevention Act
(Pub. L. 106-430). The Act required OSHA to revise the OSHA Bloodborne Pathogens standard
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within 6 months of enactment of the Act.

Bloodborne Pathogens Standard
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 The Bloodborne Pathogens standard sets forth requirements for employers with workers
exposed to blood or other potentially infectious materials.
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 In order to reduce or eliminate the hazards of occupational exposure, an employer must

implement an exposure control plan for the worksite with details on employee protection
measures.
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 The plan must also describe how an employer will use a combination of engineering and
work practice controls, ensure the use of personal protective clothing and equipment,
and provide training, medical surveillance, hepatitis B vaccinations, and signs and
labels, among other provisions.
 Engineering controls are the primary means of eliminating or minimizing employee
exposure and include the use of safer medical devices, such as needleless devices,

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shielded needle devices, and plastic capillary tubes.
 Many different medical devices have been developed to reduce the risk of needles ticks
and other sharps injuries.
 These devices replace sharps with non-needle devices or incorporate safety features

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designed to reduce injury.
 Despite these advances in technology, needle sticks and other sharps injuries continue to
be of concern due to the high frequency of their occurrence and the severity of the health

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effects.
o The revised exposure control plan requirements make clear that employers must
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implement safer medical devices that are appropriate, commercially available,
and effective and should get input from those responsible for direct patient care.
o The updated standard also requires employers to maintain a log of injuries from
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contaminated sharps.
4.2 Exposure Control Plan
The revision included new requirements regarding the employer’s exposure control plan,
including an annual review and update to reflect changes in technology that eliminate or reduce
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exposures to bloodborne pathogens. The employer must:

• Consider new innovations in medical procedures and technology that reduce the risk of
exposure of workers to needlesticks.
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• Consider and document the use of appropriate, commercially available, and effective
safer needle type.
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• Realize that no single medical device can be appropriate or effective for all
circumstances.
• Identify devices that were candidates for use, the method used to evaluate those devices,
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and justification for the eventual selection.

• Select devices that, based on reasonable judgment, will not jeopardize patient or
employee safety or be medically inadvisable.
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• Select devices that will make an exposure incident involving a contaminated sharp less
likely to occur.
4.3 Employee Input
 Employers must solicit input from non managerial employees responsible for direct
patient care regarding the identification, evaluation, and selection of effective
engineering controls, including safer medical devices.

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 Employees selected should represent the range of exposure situations encountered in
the workplace, such as those in geriatric, pediatric, or nuclear medicine and others
involved in the direct care of patients.
 OSHA will check for compliance with this provision during inspections by questioning

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a representative number of employees to determine if and how their input was
requested.
 Employers are required to document, in the exposure control plan, how they received

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input from employees.
 This obligation can be met by listing the employees involved and describing the process
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by which input was requested.
 Employers can also present other documentation, including references to the minutes of
meetings, copies of documents used to request employee participation, or records of
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responses received from employees.
4.4 Recordkeeping
 Employers who have employees occupationally exposed to blood or other potentially
infectious materials and who are required to maintain a log of occupational injuries and
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illnesses under existing recordkeeping rules must also maintain a sharps injury log.
 This log must be maintained in a manner that protects the privacy of employees. The
sharps injury log may include additional information as long as an employee’s privacy
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is protected.
 The format of the log can be determined by the employer. At a minimum, the log will
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contain the following:

• Type and brand of device involved in the incident
• Location of the incident (e.g., department or work area)
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• Description of the incident

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Modification of Definitions
The revision to the Bloodborne Pathogens standard includes modification of definitions
relating to engineering controls. Two terms have been added to the standard, while the
description of an existing term has been amended.
Engineering Controls
 Engineering controls include all control measures that isolate or remove a hazard from

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the workplace, such as sharps disposal containers and self-sheathing needles.
 The original Bloodborne Pathogens standard was not specific regarding the
applicability of various engineering controls (other than the above examples) in the
healthcare setting.

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 The revision now specifies that safer medical devices, such as sharps with engineered
sharps injury protections and needleless systems, constitute an effective engineering
control.

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4.5 Sharps with Engineered Sharps Injury Protection
“Sharps with engineered sharps injury protection” is a new term that includes non-needle
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sharps or needle devices containing built-in safety features that are used for collecting fluids or
administering medications or other fluids, or other procedures involving the risk of sharps
injury. This description covers a broad array of devices, including:
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• Syringes with a sliding sheath that shields the attached needle after use
• Needles that retract into a syringe after use
• Shielded or retracting catheters
• Intravenous medication (IV) delivery systems that use a catheter port with a needle
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• housed in a protective covering

Needleless Systems
 “Needleless systems” is a new term defined as devices that provide an alternative to
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needles for various procedures to reduce the risk of injury involving contaminated
sharps.
 Examples include intravenous medication systems that administer medication or fluids
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through a catheter port using non-needle connections. Another example would be jet
injection systems, which deliver liquid medication beneath the skin or through a
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muscle.
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4.6 Exposure Determination
Exposure determination involves listing all job classifications in which employees will be
exposed (such as doctors and nurses) or may occasionally be exposed (such as custodians and
laundry workers) to potentially infectious materials on the job. Any specific procedures or
tasks in which exposure occurs must also be listed without regard to the use of personal
protective equipment.

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Control Measures
 Employers should take appropriate preventative measures against occupational
exposure.

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 These include engineering controls and work practice controls. Examples of
engineering controls include biohazard hoods, puncture-resistant sharps containers,
mechanical pipette devices, and other devices that permanently remove the hazard or

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help isolate workers from exposure.
 Personal protective equipment is considered to be appropriate only if it does not permit
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blood or other potentially infectious materials to pass through or reach the employee’s
outer clothing, undergarments, skin, eyes, mouth, or other mucous membranes under
normal conditions of use.
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4.7 Personal Protective Equipment
Personal protective equipment is specialized clothing or equipment used by employees to
protect against direct exposure to blood or other potentially infectious materials:
• Wear gloves whenever hand contact with blood or other potentially infectious materials is
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possible.
• Replace disposable (single-use) gloves, such as examination gloves, as soon as possible when
they have been contaminated or when their ability to function as a barrier is compromised.
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• Do not reuse disposable gloves.

• Decontaminate utility gloves for reuse, but they must be discarded if they become cracked,
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discolored, or punctured or show any signs of deterioration.

• Wear masks, eye protection, face shields, or a combination of these whenever exposure to
splashes, spray, or droplets of infectious materials is possible.
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• Wear gowns, aprons, and other protective clothing to protect against exposure to the body,
head, feet, or clothing.
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5. What is the first sign of tuberculosis?(13 Mark)
The symptoms of TB include a low-grade fever, night sweats, weakness or tiredness, and
weight loss. If TB is in the lungs, the person may also cough, have chest pain, shortness of
breath or might be coughing up blood. Other symptoms depend on the part of the body

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affected by the TB germs.

5.1 Tuberculosis Guidelines

 The CDC describes Mycobacterium tuberculosis as a slow-growing bacteria that affects
the respiratory tract of humans. The bacteria can be carried in airborne particles or

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droplet nuclei.
 Exposure risks occur when generated by infected people through speaking, coughing,

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sneezing, and during medical procedures.
 These micron-sized particles remain airborne via ordinary air ventilation that can
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circulate the particles through a room, building, or vehicle.
 If a susceptible person inhales an airborne particle containing M. tuberculosis, the
bacteria begins to grow in the alveoli (small air sacs) of the lungs and then spreads
throughout the body.
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 The human immune system can usually control the infection within 2 to 10 weeks;
however, in some infected individuals the illness may not develop for years.
 A person exhibiting the symptoms of tuberculosis is known as active and is highly
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infectious to others. The CDC guidelines emphasize the importance of control

measures, including administrative and engineering controls and personal respiratory
protection.
 The CDC defines specific elements that comprise the risk assessment, including review
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of the community tuberculosis profile from public health department data and an
analysis of purified protein derivative skin test results of healthcare workers.
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5.2 OSHA Tuberculosis Exposure Enforcement Guidelines

 These guidelines address patient and worker testing, source control methods,
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decontamination techniques, and prevention of tuberculosis-contaminated air.

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 This enforcement policy uses the 1994 CDC guidelines and the OSHA general-duty
clause. OSHA inspections can be done in response to complaints and during routine
compliance visits in the following workplaces:
• Healthcare settings
• Correctional institutions
• Homeless shelters

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• Long-term-care facilities
• Drug treatment centers
5.3 OSHA Citations
Citations can be issued to employers as a result of exposure or potential exposure to the

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exhaled air of a suspected or confirmed case of tuberculosis. Exposure can occur during high-
hazard procedures performed on individuals with suspected or confirmed tuberculosis.
5.4 OSHA Abatement Methods

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• Early identification of persons with active tuberculosis
• Medical surveillance at no cost to the employee, including preplacement evaluation,
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tuberculosis skin tests, annual evaluations, and twice yearly exams for those who
have been exposed
• Evaluation and management of workers with a positive skin test
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• Utilization of acid-fast bacilli isolation rooms for those with active or suspected
tuberculosis infection, where such rooms are to be maintained under negative
pressure and have outside exhaust or HEPA filtered ventilation
• Employee information and training program
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5.5 OSHA Tuberculosis Respirator Requirements

OSHA now requires healthcare organizations to meet the provisions of 29 CFR 1910.134,
which covers respiratory protection for general industry. OSHA can enforce all provisions,
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including annual fit testing with regard to tuberculosis exposures. If disposable respirators are
used, their reuse is permitted as long as the functional and structural integrity of the respirator
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is maintained.
Fit Testing
 CDC guidelines, NIOSH recommendations, and selection criteria in the OSHA
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standard indicate that most facilities should use half-mask, N95, air purifying, filtering
face piece respirators for TB protection.
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 This type of respirator has a securely fitting face piece. Effective protection requires a
good seal between the face and the face piece to ensure that the worker is protected.

5.6 Fundamentals of Tuberculosis Infection Control

The result of risk assessment should drive the extent of a healthcare facility’s tuberculosis
infection control program. The program should be based on a hierarchy of control measures.

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i. First Level
Administrative procedures are in place to reduce the risk of exposing uninfected individuals to
those with active tuberculosis. These procedures include:
• Developing and implementing written procedures to ensure rapid identification,
isolation, evaluation, and treatment of persons likely to be infected

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• Implementing effective work practices among healthcare workers
• Educating, training, and counseling workers with regard to tuberculosis

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• Screening workers for tuberculosis infection
Second Level
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Engineering controls are used to prevent the spread and reduce the concentration of droplet
nuclei. Controls include:
• Direct source control using local exhaust ventilation
• Controlling the direction of airflow to prevent contamination of adjacent areas
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• Diluting and removing contaminated air through the use of general ventilation
• Air cleaning through the use of filtration devices or ultraviolet germicidal irradiation
Third Level
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The use of personal respiratory protective equipment is required. This control measure is to be
used in rooms with patients with known or suspected (active) tuberculosis and in areas in
which cough-inducing or aerosol-generating procedures are performed on such patients.
5.7 Tuberculosis Exposure Control Program
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 The CDC guidelines include a chart to assist facilities in defining the specific elements
of an infection control program for each risk classification.
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 For the purposes of TB control and prevention, the CDC has retained the following
definition of healthcare workers: all paid and unpaid persons working in healthcare
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facilities, including but not limited to, physicians; nurses; aides; technicians; students;
part-time personnel; temporary staff not employed by the facility; volunteers; and
dietary, housekeeping, maintenance, and clerical staff.
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 Patients or healthcare workers with suspected or confirmed tuberculosis should be
reported immediately to the appropriate public health department so standard
procedures for identification and evaluation can be initiated.
Isolation Room Requirements
 The CDC specifically clarified that nursing homes do not need tuberculosis isolation
rooms if they do not provide care to tuberculosis patients; however, such facilities must

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have a written protocol for referral and periodic (annual) risk assessments as well as a
written infection control plan that is reviewed periodically.
 Except for those acute-care, inpatient facilities that are determined to be at minimal and
very low risk, the CDC recommends that all acute-care facilities have at least one

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tuberculosis isolation room.
Written Protocols
The guidelines clarify that facilities that do not have isolation rooms for tuberculosis and do

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not perform cough-inducing procedures on patients who may have tuberculosis may not need
to have a respiratory protection program for tuberculosis; however, such facilities should have
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written protocols for referral and periodic (annual) risk assessments as well as a written
infection control plan that is periodically reviewed.
Patient Status
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The CDC recommends that patients who are infectious at the time of discharge should only be
discharged to a facility that has isolation capability or to their homes. Facilities accepting and
treating tuberculosis patients should have an engineer on staff or on a consulting basis to
provide guidance in ventilation.
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Performance Criteria
 The performance criteria for respiratory protection were not changed in the new
guidelines. The CDC did remove details on specific respirators such as dust–mist and
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dust–fume–mist.
 The CDC will use the new NIOSH certification process in determining appropriate
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respiratory protection. This will allow healthcare facilities to choose from a broader
range of less-expensive certified masks.
Testing
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 The CDC recommends that all personnel not employed by a facility but working in the
facility should also receive skin testing at appropriate intervals.
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 Healthcare workers with a potential for exposure, including those with a history of
Bacillus Calmette-Guerin (BCG) vaccination, should have baseline testing.
5.8 Worker Training and Education
An effective tuberculosis training program should include the following:
• Basic concepts of transmission, pathogenesis, and diagnosis
• Explanation of the difference between latent and active tuberculosis

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• Signs and symptoms of active tuberculosis
• Increased risk for those infected with HIV
• Potential for occupational exposure
• Information about prevalence of tuberculosis in the community

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• Situations that increase the risk of exposure
• Principles of infection control
• Importance of skin testing and significance of a positive test

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• Principles of preventive therapy for latent tuberculosis
• Drug therapy procedures for active tuberculosis
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• Importance of notifying the facility
• Information about medical evaluation for symptoms of active tuberculosis
Engineering Controls
 Engineering controls are critical in preventing the spread of tuberculosis within a
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facility. The CDC guidelines recommend exhausting air from possibly infected areas to
the outside.
 Healthcare facilities should have isolation rooms with negative pressure. A rate of six
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air changes per hour is recommended, although new construction requires 12 air
changes per hour.
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6. How can opportunistic infections be prevented? Discuss. (13 Mark)

6.1Aspergillus
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 The mold spore produced by Aspergillus can create pathogenic infection opportunities.
Aspergillus exists worldwide and can thrive at elevated temperatures. Ideal growth
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conditions tend to be damp areas with decaying vegetation.

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 Infection with Aspergillus fumigatus is diagnosed in 90% of all infection cases. The
threadlike, flat, white growth soon becomes a powdery blue–green mold spore. Most
infections result from inhaling spores.
 Most people are naturally immune and do not develop any disease, but patients with
other serious ailments tend to be at a greater risk of infection. The severity of
aspergillosis depends on the individual’s immune system.

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Aspergillus Control
 Ventilation plays a key role in maintaining an Aspergillus-free environment in
healthcare settings.
 Facilities should replace ventilation system filters at scheduled intervals and take

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measures during construction activities to reduce the likelihood of introducing
Aspergillus into the facility.
 Aspergillus can enter a healthcare facility on a person’s clothing, so it is important to

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maintain a regular housekeeping schedule that includes vacuuming and surface
cleaning with appropriate disinfectants in high-risk areas.
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 Other measures include the following:
• Give special attention to delivery of construction materials.
• Limit points of entry and exit.
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• Deliver boards, conduits, and fixtures without passing through the facility.
• If possible, assign one elevator for construction use.
• Set up delivery routes that minimize contact with patients, visitors, and staff.
• Use a chute for removing construction debris.
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• Control dust when renovations occur near patient areas.

• Consider risks to other floors during a construction project.
• Develop a plan coordinated with clinical departments, infection control, the
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contractor, and facilities engineering.

• Seal off each room with plastic sheets and create a negative space with fans and
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filters discharging through a window.

6.2 New Construction Aspergillus Control
When constructing new specialized-care units with protective environments for hemopoietic
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stem-cell (HCST) transplant recipients, be sure that patient rooms are equipped to minimize the
accumulation of fungal spores. Among
the required features for such rooms are:
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• HEPA filtration of incoming air
• Directed room airflow
• Positive air pressure with relation to the corridor
• Well-sealed room with 12 or more air changes per hour
6.3 Maintaining Existing Facilities
• Place all at-risk patients in protective environments.

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• Maintain air-handling systems in protective-environment and other high-risk
patientcare areas according to published CDC recommendations.
• Develop a water-damage response plan for immediate execution when water
leaks, spills, and moisture accumulation occur to prevent fungal growth in

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the involved areas.
• Use proper dusting methods for patient-care areas designated for severely
at-risk patients.

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• Wet-dust horizontal surfaces daily using a cloth that has been moistened
with an EPA-registered hospital disinfectant.
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• Avoid dusting methods that disperse dust (such as feather dusting).
ii. Anthrax
 Exposure to the spore-forming bacterium Bacillus anthracis results in black, coal-like
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skin lesions. In the naturally occurring form of anthrax, the disease is passed on by
contact with anthrax-infected or anthrax-contaminated animals and animal products.
 Anthrax is not spread from one person to another person. Humans can host three forms
of anthrax: inhalation, cutaneous, and gastrointestinal. Inhalation anthrax occurs when
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the anthrax spore is inhaled.

 Types of anthrax
• Cutaneous anthrax
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• Gastrointestinal anthrax
 Cutaneous anthrax, the most common naturally occurring form, is contracted by
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handling contaminated hair, wool, hides, flesh, blood, or excreta of infected animals
and from manufactured products such as bone meal. It is introduced through scratches
or abrasions of the skin.
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 Gastrointestinal anthrax occurs as a result of ingesting insufficiently cooked infected

meat or from flies. The spores enter the lungs, migrate to the lymph nodes, change to
the bacterial form, multiply, and produce toxins.
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 Initial signs of nausea, loss of appetite, vomiting, and fever are followed by abdominal
pain, vomiting of blood, and severe diarrhea. Anthrax is diagnosed by isolating the
bacteria from blood, other body fluids, or skin lesions or by measuring specific
antibodies late in the course of the disease.
6.4 Responding to Potential Exposures
Some facilities around the country have received anthrax threat letters. Most were empty

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envelopes, but some have contained powdery substances. As noted, anthrax organisms can
cause infection in the skin, gastrointestinal
system, or lungs.
Handling Suspicious Mail

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• Do not try to open the mail piece.
• Do not shake or empty the contents of any suspicious envelope or package.
• If powder spills out of an envelope, do not try to clean up the powder.

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• Cover the spilled contents immediately with anything available and do not
remove this cover. pa
• Isolate the mail piece.
• Place the envelope or package in a plastic bag or some other type of container to
prevent leakage of contents.
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• Evacuate the immediate area.
• Leave the room and close the door, or section off the area to prevent others from
entering.
• Wash your hands with soap and water to prevent spreading any powder to your
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face.
• Contact your local law enforcement agency.
Exposure Actions
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Remove heavily contaminated clothing as soon as possible and place it in a plastic bag or other
container that can be sealed. This clothing bag should be given to the emergency responders
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for proper handling. Shower with soap and water as soon as possible. Do not use bleach or
other disinfectant on your skin.
Respiratory Protection
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Because anthrax presents as a biological particulate, an air-purifying respirator (APR)

equipped with a mechanical filtering element would be the minimum level of respiratory
protection required.
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According to a study by the Department of Defense, National Institute for Occupational Safety
and Health, and Occupational Safety and Health Administration (Chemical and Biological
Respiratory Protection Workshop Report), “Currently, NIOSH-approved particulate filters (N,
R, and P100 filters) have the capability to filter out biological agents.
Decontamination
To decontaminate materials exposed to anthrax, use a 0.05% hypochlorite solution (1

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tablespoon bleach per gallon of water). Spore destruction requires steam sterilization. Refer to
the OSHA and EPA websites for the latest information about anthrax and decontamination
procedures.
Severe Acute Respiratory Syndrome

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 Severe acute respiratory syndrome (SARS) is an emerging, sometimes fatal,
respiratory illness.
 The CDC has defined a suspected case of SARS as an illness of unknown cause that

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began in February 2003 or later
 and meets the following criteria:
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• Fever of at least 100.5°F
• One or more clinical findings of respiratory illness, such as cough, shortness of
• breath, difficulty breathing, hypoxia, or x-ray evidence of either pneumonia or
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acute
• respiratory distress syndrome
• Onset of symptoms within 10 days of (1) travel to an area with documented or
• suspected community transmission of SARS, or (2) close contact with either a
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person
• with a respiratory illness who traveled to a SARS area or a known suspect
SARS case
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 “Close contact” means having cared for, lived with, or had direct contact with respiratory
secretions and/or body fluids. A list of areas with documented or suspected community.
 The incubation period is typically 2 to 7 days, although some reports suggest an
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incubation period as long as 10 to 12 days. Signs of illness include a decreased white

blood cell count in most patients as well as below-normal blood platelet counts, increased
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liver enzymes, and electrolyte disturbances in a number of patients.

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6.5 Precautions for Healthcare Facilities
• Interim Domestic Guidance for Management of Exposures to Severe Acute
Respiratory Syndrome (SARS) for Healthcare and Other Institutional Settings
• Triage of Patients Who May Have Severe Acute Respiratory Syndrome: Interim
Guidance for Screening in Ambulatory Care Settings
• Updated Interim Domestic Infection Control Guidance in the Healthcare and

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Community Setting for Patients with Suspected SARS
6.7 Standard Precautions and Personal Protective Equipment
Healthcare workers treating patients known to be infected with SARS should take
standard precautions, including good work and hygiene practices and the use of personal

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protective equipment appropriate for bloodborne and airborne exposures. Appropriate PPE
includes protective gowns, gloves, and N95 respirators, in addition to eye protection.
Engineering Controls

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Acute-care facilities already should have appropriate ventilation systems (including
appropriate exhaust and filtration) to eliminate the potential for exposure to airborne infectious
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diseases. If appropriate ventilation systems are in place, any airborne SARS exposures should
also be controlled. Individuals with suspected SARS should be placed in an isolation room
with negative pressure.
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Laboratory Worker Safety
Laboratory personnel in facilities performing diagnostic tests on patients suspected to
be infected with SARS should follow biosafety preventive measures established by the CDC’s
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Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated
with Severe Acute Respiratory Syndrome
Biosafety Precautions
Laboratory workers must wear appropriate personal protective equipment, including
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disposable gloves, gowns, eye protection, and respiratory protection. N95 or N100 air-
purifying respirators or powered air-purifying respirators equipped with HEPA filters are
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recommended. If exposure to blood or other potentially infectious materials is possible,

laboratory workers must use PPE in accordance with OSHA’s Bloodborne Pathogens standard
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(29 CFR 1910.1030).

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Disinfecting
The CDC advises that no disinfectant products are currently registered by the EPA for
newly identified viruses associated with SARS. The CDC recommends the use of EPA-
registered chemical germicides that provide low- or intermediate-level disinfection during
general use against SARS agents because these products are known to inactivate related viruses
with physical and biochemical properties similar to the suspected SARS agents.

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Information for Workers Involved in Air Medical Transport of SARS Patients
The CDC has published interim recommendations to protect employees who may be
required to transport patients with SARS by air (Interim Guidance: Air Medical Transport for
Severe Acute Respiratory Syndrome (SARS) Patients, 2004).

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Personal Protective Equipment
The use of respiratory protection is recommended. OSHA requires that employers
select and use respiratory protection in accordance with 29 CFR 1910.134. In order for

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respirators to be effective in protecting employees, they must be properly fit tested and
employees must be appropriately trained.
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Hygiene Practices
When appropriate, employers must make sure that workers handling the remains of
SARS patients comply with the hygiene provisions of OSHA’s bloodborne pathogen standard
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(29 CFR 1910.1030). In all cases, these workers should use good housekeeping and
handwashing practices.
Employee Training
All employees with potential occupational exposure to SARS, as described in this
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document, should be trained on the hazards associated with that exposure and on the protocols
in place in their facilities to isolate and report cases and to reduce exposures.

iii. Pseudomonas
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 Pseudomonas is a motile, Gram-negative, rod-shaped organism that utilizes glucose

oxidatively. Members of this genus are classified into five groups based on ribosomal
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RNA homology.
 These bacteria are clinically important because they are resistant to most antibiotics and
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are capable of surviving in conditions that few other organisms can tolerate, aided by
their production of a protective slime layer. Pseudomonas is often encountered in
hospital and clinical work because it is a major cause of hospital-acquired infections.
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 The key targets include immune-suppressed individuals, burn victims, and individuals
on respirators or with indwelling catheters. Rarely will Pseudomonas be the cause of
infection in healthy individuals; its noninvasive nature limits its pathogenic capabilities.
 Pseudomonas prefers to inhabit moist environments but it can survive in a medium as
deficient as distilledwater.
iv. Legionella

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 Legionella is a bacteria that causes an estimated 25,000 cases of Legionnaire’s disease
each year in the United States alone.
 A majority of outbreaks are linked to cooling towers and domestic water systems. Other
sources include evaporative condensers, respiratory equipment, showers, faucets,

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whirlpool baths, humidifiers, and decorative fountains.
 Hot-water systems are also a perfect breeding habitat as Legionella grows best in
temperatures ranging from 90 to 120°F. Uncontrollable incidents that can cause

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Legionella problems include surges in water pressure that may disburse dirt into the
water system or dislodge Legionella-laden scale and sediment from the walls of water
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pipes.
 Major excavation work (construction projects) have also been associated with
outbreaks of Legionella. Legionella can enter cooling towers, air intakes, or water
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pipes; it can also be inhaled.

7. What are the solutions to the problem of HCAI? Explain. (6 Marks)

Health care-associated infection (HCAI), also referred to as "nosocomial" or
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"hospital" infection, is an infection occurring in a patient during the process of care in a

hospital or other health care facility which was not present or incubating at the time of
admission.
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Many infection prevention and control measures, including hand hygiene, are
simple, low-cost and effective, however they require staff accountability and behavioural
change.
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The main solutions and perspectives for improvement identified by WHO Clean Care is
Safer Care are:
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• Identifying local determinants of the HCAI burden.

• Improving reporting and surveillance systems at the national level.
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• Ensuring minimum requirements in terms of facilities and dedicated resources available
for HCAI surveillance at the institutional level, including microbiology laboratories'
capacity.
• Ensuring that core components for infection control are in place at the national and
health-care setting levels.
• Implementing standard precautions, particularly best hand hygiene practices at the

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bedside.
• Improving staff education and accountability.
• Conducting research to adapt and validate surveillance protocols based on the reality of
developing countries.

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• Conducting research on the potential involvement of patients and their families in HCAI
reporting and control.

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Prepared by
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1.Mrs. .Sudha Devi AP/IT

2.V.Naveen Kumar AP/CSE

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