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Emergency Department (ED)

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Common safety and health topics:


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Blood, OPIM, Bloodborne Pathogens
Potential Hazard

Emergency Department (ED) workers are at particular risk for exposure to blood, OPIM, and bloodborne pathogens because of the immediate, life-threatening nature of emergency treatment.

Possible Solutions

The Bloodborne Pathogens Standard requires precautions when dealing with blood and other potentially infectious materials. For a complete explanation, see Healthcare Wide Hazards - Bloodborne Pathogens. Some summary information for this area includes:

  • Provide Engineering and Work Practice Controls

    • Engineering and work practice controls must be the primary means to eliminate or minimize exposure to bloodborne pathogens. Where engineering controls will reduce employee exposure either by removing, eliminating, or isolating the hazard, they must be used, and changes to the Exposure Control Plan (ECP) must include these engineering controls [29 CFR 1910.1030(c)(1)(iv), 29 CFR 1910.1030(d)(2)(i), and OSHA Directive OSHA Directive CPL 02-02-069].

Employers:



Hazardous Chemicals
Potential Hazard

Employee exposure to hazardous chemicals (e.g., while decontaminating ED patients after a chemical spill) or exposure to hazardous drugs (e.g., during administration).

Possible Solutions

  • A program in place to maximize employee safety during decontamination of patients.

  • A program in place to maximize employee safety during administration, disposal, and preparation of hazardous drugs.

Book For additional information, see Healthcare Wide Hazards - Hazardous Chemicals, and Hospital Pharmacy.



Slips/Trips/Falls
Potential Hazard

Because of the emergency atmosphere, (i.e., high traffic and compact treatment spaces) slips/trips/falls may be a specific concern for ED areas.

There is a potential slip and fall hazard if water is spilled on the floor accidentally, electrical cords run across pathways, and/or if emergency equipment or supplies block passageways.

Possible Solutions

Provide safe clean-up of spills, and keep walkways free of obstruction.

Book For additional information, see Healthcare Wide Hazards - Slips/Trips/Falls.



Latex Allergy
Potential Hazard

Gloves must be worn frequently in the ED, because of occupational exposure to blood and OPIM, creating a potential for employees to develop latex allergy from wearing latex gloves

Possible Solutions
  • Employers must provide appropriate gloves when exposure to blood or other potentially infectious materials (OPIM) exists [29 CFR 1910.1030 - Bloodborne Pathogens Standard].

    • Alternatives shall be readily accessible to those employees who are allergic to the gloves normally provided [29 CFR 1910.1030(d)(3)(iii)].

Book For additional information, see Healthcare Wide Hazards - Latex Allergy.



Equipment Hazards
Potential Hazard

Injury may occur to employees from improper training or use of equipment (e.g., defibrillators). Electric shock may also occur as a result of lack of maintenance or misuse of equipment and/or its controls. Oxygen-enriched atmospheres and water may contribute to hazardous conditions.

Possible Solutions

A program that routinely monitors the status of equipment and proper training of employees to use equipment safely.

Book For additional information, see Healthcare Wide Hazards - Electrical Hazards.



Workplace Violence

Potential Hazard

Workplace violence is an issue in EDs because of the crowded and emotional situations that can occur with emergencies. In addition, ED patients could be involved with crimes, weapons, or violence from other people that could put the ED employee at an increased risk of workplace violence.

Possible Solutions

Good work practice recommends a security management program that addresses workplace violence in the ED and could include:

  • Trained staff to recognize and diffuse violent situations and patients.

    • Be alert for potential violence and suspicious behavior and report it.

    • Provide intervention measures including verbal, social, physical, and pharmacological interventions.

    • Warning Signs of Increasing Anger/Violence include:

      • Pacing and/or restlessness

      • Clenched fist

      • Increasingly loud speech

      • Excessive insistence

      • Threats

      • Cursing
  • Adequate staffing levels, with experienced clinicians on each shift.

  • Counseling and treatment for employees who have experienced workplace violence.

  • The use of appropriate engineering controls to provide security such as:

    • Install concealed panic buttons in the ED, on staff, and at the check-in area, that can be pushed for emergency help. These buttons could notify hospital security as well as directly reach the local Police Department.

    • Improve lighting and video surveillance.

    • Use an escort or buddy system.

    • Limit access to ED area and personnel, by implementing:

      • A waiting room area with controlled access to ED area. Patients must be buzzed in by receptionist from a secure door.

      • ED exits that exit out only, so people off the streets can't access the ED unless they enter through the waiting room area.

      • The use of metal detectors.
  • Provide a "secure" room for patients identified to be violent. This room could include controls such as:

    • Video camera surveillance

    • Visual surveillance: provide a window

    • Door locks on patient rooms

    • Bed with tie down straps

    • Locked cabinets

    • Attach furniture and equipment to the floor so patients can't throw them at employees.

Book For additional information, see Healthcare Wide Hazards - Workplace Violence.



Tuberculosis

Potential Hazard

Exposure to Tuberculosis and other infectious agents from patients in waiting room and treatment areas. Staff may be treating an emergency and be unaware of other pre-existing infectious conditions.

Possible Solutions

  • Provide and practice early patient screening in the ED to identify potentially infectious patients, and provide isolation to prevent employee exposures. Consistent with CDC guidelines: ED employees should treat patients as having suspected infectious TB if they have both a persistent cough lasting at least three weeks, and at least two of the following additional symptoms: bloody sputum, night sweats, weight loss, fever, and anorexia.

  • Provide engineering, work practice, and administrative procedures to reduce the risk of exposure. For example:

    • Patients with a productive cough could be asked to wear a mask to prevent the spread of infection.

      • Post waiting rooms signs that state, "If you are coughing you may be asked to wear a mask."
  • Isolate patient until verification testing is negative.

  • Some EDs provide an isolation room to safely isolate potentially infectious patients. Others can designate an isolation area for infectious patients. Isolation rooms must be respiratory acid-fast bacilli (AFB) rooms that are maintained under negative pressure (1996, February 9)]. AFB isolation refers to a negative-pressure room or an area that exhausts room air directly outside or through HEPA filters if re-circulation is unavoidable. [Enforcement Procedures and Scheduling for Occupational Exposure to Tuberculosis. OSHA Directive CPL 02-00-106 [CPL 2.106], (1996, February 9)].

  • Protect employees from exposure to the exhaled air of an individual with suspected or confirmed TB [29 CFR 1910.134(a)(2)].

  • Isolate patients who have suspected or confirmed TB. [Enforcement Procedures and Scheduling for Occupational Exposure to Tuberculosis. OSHA Directive CPL 02-00-106 [CPL 2.106], (1996, February 9)].

  • Post a warning sign outside the ED respiratory isolation room 29 CFR 1910.145(a)(1) to prevent accidental entry. 29 CFR 1910.145(f)(4) requires that that a signal word (i.e. "STOP", "HALT", or "NO ADMITTANCE") or biological hazard symbol be presented as well as a major message (e.g., "Special respiratory isolation," "Respiratory isolation," or "AFB isolation"). An example of a description of necessary precautions is "Respirators must be donned before entering."

  • Employers must provide suitable respirators when such equipment is necessary to protect the health of the employee [29 CFR 1910.134(d)(1)(i)]. The minimally acceptable level of respiratory protection for TB is the Type N95 Respirator.

  • Establish and maintain a respiratory protective program which includes the requirements outlined in [29 CFR 1910.134(c)].

  • Worker education: OSHA requires worker education and training to ensure employee knowledge of TB including: signs, symptoms, transmission, controls, and post-exposure protocols. [Enforcement Procedures and Scheduling for Occupational Exposure to Tuberculosis. OSHA Directive CPL 02-00-106 [CPL 2.106], (1996, February 9)].

Book For more information, see Healthcare Wide Hazards - Tuberculosis.

Additional Information:



Workplace Stress

Studies suggest work stress may increase a person's risk for cardiovascular disease, psychological disorders, workplace injury, and other health problems. Early warning signs may include headaches, sleep disturbances, difficulty concentrating, job dissatisfaction, and low morale.

Potential Hazard

All hospital employees, especially ED employees, are exposed to many stressors at work that can cause workplace stress, and burnout, due to factors such as shift work, long hours, fatigue, and intense emotional situations, (e.g., the suffering and death of patients).

Possible Solutions

  • Educate employees and management about job stress.

  • Establish programs to address workplace stress, such as: Employee Assistance Programs (EAP) or Organizational Change Programs.

    • An Employee Assistance Program (EAP) can improve the ability of workers to cope with difficult work situations. Stress management programs teach workers about the nature and sources of stress, the effects of stress on health, and personal skills to reduce stress (e.g., time management or relaxation exercises).

    • EAPs also provide individual counseling for employees for both work and personal problems.

    • Organizational Change Programs change hospital policies and procedures to reduce organizational sources of stress.

      • This is done by bringing in a consultant to recommend ways to improve working conditions. This approach is the most direct way to reduce stress at work. It involves the identification of stressful aspects of work (e.g., excessive workload, conflicting expectations) and the design of strategies to reduce or eliminate the identified stressors. Some strategies include:

        • Ensure that the workload is in line with workers' capabilities and resources.

        • Design jobs to provide meaning, stimulation, and opportunities for workers to use their skills.

        • Clearly define workers' roles and responsibilities.

        • Give workers opportunities to participate in decisions and actions affecting their jobs.

Additional Information:

  • Stress At Work. National Institute of Occupational Safety and Health (NIOSH) Workplace Safety and Health Topic Page.

  • Stress...At Work. US Department of Health and Human Services (DHHS), National Institute of Occupational Safety and Health (NIOSH) Publication No. 99-101, (1999).


Methicillin-Resistant Staphylococcus aureus (MRSA)
Potential Hazard
  • Exposure of ED staff to MRSA infections from environmental sources (e.g., homeless patients or IV drug abuse patients). Staff can become infected and then become carriers who can infect other staff members or patients. As MRSA becomes more resistant to antibiotics such as methicillin and potentially vancomycin, it will become more difficult to treat.

Possible Solutions

  • Hospitals in different geographical locations will need to establish their own local MRSA data and provide treatment information to clinicians.

  • Recommendations for vancomycin use as initial empiric therapy for suspected staphylococcal infection for health-care workers exposed to MRSA.

  • Practice Universal Precautions to help protect employees from infection.

  • The CDC's recommendations for preventing transmission of MRSA in hospitals consist of Standard Precautions, which should be used for all patient care. In addition the CDC recommends Contact Precautions in special cases, when the facility (based on national or local regulations) deems the multi-drug-resistant microorganism to be of special clinical and epidemiological significance. For more information about the CDC's standard precautions:

Book For additional information, see Healthcare Wide Hazards - MDR0 - Multidrug-Resistant Organisms, and Infection.

  • Staph BacteriaMethicillin-resistant Staphylococcus aureus (MRSA). OSHA. Provides links with general information, answers specific questions for employers and employees, and offers resources for a variety of workplace settings, including healthcare, school, athletic, and childcare.






Terrorism
Potential Hazard
  • Exposure of ED staff and other hospitals workers to patients exposed to biological agents, chemical agents, and mass causalities as a result of terrorist attacks or events.

Possible Solutions



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