Ambulatory Surgery Center Safety Manual

What Should an Ambulatory Surgery Center Safety Manual Include?

The contents of an Ambulatory Surgery Center Safety Manual should reflect the facility’s surgical specialties and actual workplace hazards.

Depending on operations, the manual may address:

• ASC safety responsibilities.
• Hazard assessments.
• Safety inspections.
• Bloodborne Pathogens.
• Needlestick and sharps safety.
• Instrument processing.
• Sterilization and disinfection.
• Hazard Communication.
• Personal Protective Equipment.
• Waste anesthetic gases.
• Surgical smoke.
• Medical gases.
• Operating-room fire prevention.
• Hazardous drugs.
• Laser safety.
• Radiation safety.
• Safe patient handling.
• Recovery-area safety.
• Workplace violence.
• Emergency procedures.

Programs should be selected according to employee duties and actual exposures rather than automatically adding programs unrelated to the procedures performed at the facility.

Ambulatory Surgery Center Safety Program

An effective Ambulatory Surgery Center Safety Program establishes responsibilities and procedures for identifying hazards, preventing occupational exposures, maintaining safe surgical and support operations, protecting employees from injuries, and responding to emergencies.

Management should provide the engineering controls, equipment, PPE, training, procedures, and other resources necessary for employees to perform assigned work safely.

Managers, supervisors, and designated safety personnel should:

• Evaluate workplace hazards.
• Maintain applicable written programs.
• Conduct safety inspections.
• Maintain appropriate engineering controls.
• Provide required PPE.
• Maintain equipment in safe condition.
• Evaluate blood and sharps exposures.
• Evaluate chemical and anesthetic-gas exposures.
• Maintain emergency procedures.
• Investigate occupational injuries and exposures.
• Correct identified hazards.
• Provide employee training.
• Maintain applicable records.

Employees should follow established procedures, use required engineering controls and PPE, report unsafe conditions, and promptly report injuries, needlesticks, exposure incidents, chemical spills, equipment defects, threats, and other workplace hazards.

ASC Hazard Assessments

Hazard assessments should consider the work performed throughout the facility.

Potential exposures may include:

• Blood and other potentially infectious materials.
• Needles and surgical sharps.
• Contaminated instruments.
• Sterilants and disinfectants.
• Anesthetic gases.
• Surgical smoke.
• Hazardous medications.
• Medical gases.
• Ionizing radiation.
• Lasers.
• Electrical equipment.
• Patient handling.
• Cleaning chemicals.
• Slippery floors.
• Waste handling.

Assessments should be reviewed when procedures, equipment, chemicals, medications, anesthesia methods, or workplace conditions change significantly.

ASC Safety Inspections

Periodic safety inspections may include:

• Operating rooms.
• Procedure rooms.
• Preoperative areas.
• Recovery areas.
• Instrument-processing areas.
• Sterile storage.
• Medication areas.
• Medical-gas storage.
• Utility rooms.
• Housekeeping areas.
• Offices.
• Electrical equipment.
• Emergency exits.

Identified hazards should be documented and corrected in a timely manner.

Job Safety Analysis (JSA/JHA)

JSAs/JHAs may be useful for selected surgery-center tasks where step-by-step hazard evaluation can improve employee protection.

Potential JSAs/JHAs may address:

• Instrument decontamination.
• Autoclave operation.
• Chemical disinfectant use.
• Medical-gas cylinder handling.
• Surgical-smoke equipment.
• Hazardous-drug spill cleanup.
• Patient transfers.
• Blood and body-fluid cleanup.
• Waste handling.

Bloodborne Pathogens

Surgical-center employees may have occupational exposure to human blood and other potentially infectious materials.

Where occupational exposure exists, the facility should maintain an appropriate Exposure Control Plan and implement applicable Bloodborne Pathogens requirements.

The program should address:

• Exposure determination.
• Universal Precautions.
• Engineering controls.
• Work-practice controls.
• PPE.
• Needlestick and sharps prevention.
• Hepatitis B vaccination.
• Exposure incidents.
• Post-exposure evaluation.
• Employee training.
• Recordkeeping.

Exposure Determination

The facility should identify job classifications and tasks involving reasonably anticipated occupational exposure.

Potentially exposed employees may include:

• Nurses.
• Surgical technologists.
• Physicians and other practitioners.
• Anesthesia personnel.
• Instrument-processing employees.
• Housekeeping employees.
• Other personnel whose duties create occupational exposure.

Exposure determination should reflect actual assigned duties.

Universal Precautions

Employees should treat human blood and other potentially infectious materials according to applicable Universal Precautions.

Engineering and work-practice controls should be used as the primary methods for eliminating or minimizing occupational exposure.

Engineering Controls

Engineering controls may include:

• Sharps with engineered sharps-injury protection.
• Needleless systems.
• Appropriate sharps containers.
• Splash barriers.
• Other devices that isolate or remove bloodborne-pathogen hazards.

Engineering controls should be examined and maintained or replaced on a regular schedule to ensure effectiveness.

Work-Practice Controls

Work-practice controls should reduce employee exposure during surgical and clinical activities.

Procedures may address:

• Sharps handling.
• Specimen handling.
• Instrument passing.
• Instrument processing.
• Blood cleanup.
• Waste disposal.
• Hand hygiene.

Employees should avoid unnecessary handling of contaminated sharps.

Needlestick and Surgical Sharps Safety

Needles, scalpels, suture needles, trocars, lancets, guidewires, and other surgical sharps can cause serious occupational exposure.

Sharps procedures should be designed to reduce handling and prevent injuries before, during, and after surgical procedures.

Safer Medical Devices

Where required and appropriate, safer medical devices should be evaluated and used to eliminate or minimize employee exposure.

Potential devices include:

• Safety-engineered needles.
• Needleless IV systems.
• Protected scalpels.
• Blunt-tip suture needles where appropriate.
• Other sharps-injury-prevention devices.

Employee input should be incorporated as required when evaluating safer devices.

Surgical Sharps Passing

Passing sharp instruments between members of the surgical team can create injury hazards.

Procedures may include:

• Clear verbal communication.
• Consistent passing techniques.
• Hands-free or neutral-zone techniques when appropriate.
• Avoiding simultaneous handling of the same sharp instrument.

Employees should receive training in the procedures used by the facility.

Neutral Zone — When Appropriate

A designated neutral zone may be used to reduce hand-to-hand passing of sharps.

The method should be appropriate to the procedure and surgical team’s work practices.

The neutral zone should be clearly understood by participating employees.

Sharps Containers

Sharps containers should be:

• Closable.
• Puncture resistant.
• Leak resistant as appropriate.
• Accessible.
• Maintained upright.
• Replaced before overfilling.

Containers should be located as close as feasible to the immediate area where sharps are used.

Recapping Needles

Contaminated needles should not be bent, removed, or recapped except when permitted under applicable Bloodborne Pathogens requirements.

Where recapping is necessary for a specific procedure and permitted, an appropriate mechanical device or one-handed technique should be used.

Sharps Injury Reporting

Needlesticks and other sharps injuries should be reported immediately.

Applicable post-exposure procedures should begin promptly.

Employees should know how to obtain assistance whenever procedures are being performed.

Blood and Body-Fluid Exposure

Employees should use appropriate PPE when blood or OPIM exposure is reasonably anticipated.

Depending on the procedure, PPE may include:

• Gloves.
• Gowns.
• Face shields.
• Masks.
• Eye protection.
• Other protective clothing.

Contaminated PPE should be removed and handled according to established procedures.

Exposure Incidents

Needlesticks, cuts, mucous-membrane splashes, and other occupational exposures should be promptly reported and evaluated.

Post-exposure procedures should address:

• Immediate first aid.
• Reporting.
• Exposure documentation.
• Source evaluation where applicable.
• Employee medical evaluation.
• Follow-up.
• Required records.

Specimen Handling

Blood, tissue, and other potentially infectious specimens should be placed in appropriate containers that prevent leakage during collection, handling, processing, storage, transport, or shipping.

Employees should use appropriate PPE when handling specimens.

Instrument Processing Safety

Contaminated surgical instruments can expose employees to bloodborne pathogens, sharps, chemicals, heat, steam, and ergonomic hazards.

Instrument-processing procedures should address the entire workflow from receipt of contaminated instruments through cleaning, disinfection, sterilization, and storage.

Receiving Contaminated Instruments

Contaminated instruments should be transported and received in a manner that minimizes employee exposure.

Employees should use appropriate PPE and avoid reaching blindly into trays or containers containing contaminated sharps.

Sharps During Instrument Processing

Reusable sharp instruments can cause injuries during sorting and cleaning.

Employees should:

• Use appropriate tools or methods to reduce direct handling.
• Maintain visibility of sharps.
• Avoid blindly reaching into sinks or containers.
• Use required PPE.
• Report injuries immediately.

Manual Instrument Cleaning

Manual cleaning can expose employees to splashes, aerosols, chemicals, and sharps.

Procedures should address:

• PPE.
• Appropriate brushes and tools.
• Chemical use.
• Splash control.
• Sharps handling.
• Workstation arrangement.

Employees should avoid placing hands into containers when sharp instruments cannot be clearly seen.

Ultrasonic Cleaners — When Applicable

Ultrasonic cleaners should be operated according to manufacturer instructions.

Employees should be trained regarding:

• Loading.
• Chemical solutions.
• Lid use.
• Electrical safety.
• Cleaning.
• Maintenance.

Servicing should follow applicable hazardous-energy-control procedures.

Enzymatic Cleaners

Enzymatic cleaners and other instrument-processing chemicals should remain properly labeled.

Employees should have access to applicable Safety Data Sheets and use required PPE.

Solutions should be prepared according to manufacturer instructions.

High-Level Disinfectants — When Applicable

Some procedures may require high-level disinfectants or chemical sterilants.

Employee exposure controls should reflect the chemicals used and may include:

• Closed systems.
• Ventilation.
• Appropriate containers.
• PPE.
• Spill procedures.
• Exposure monitoring where applicable.

Sterilization Safety

Sterilization processes may expose employees to heat, steam, pressure, chemicals, or other hazards.

Employees should receive training appropriate to the sterilization equipment and methods used.

Autoclave Safety

Autoclaves can create hazards involving:

• Steam.
• Heat.
• Pressure.
• Hot liquids.
• Hot instruments.
• Door operation.

Employees should follow manufacturer instructions and allow equipment and loads to cool appropriately before handling.

Defective autoclaves should be removed from service or otherwise controlled until repaired.

Chemical Sterilants — When Applicable

Chemical sterilants can create inhalation, skin, eye, and spill hazards.

Controls should be based on the specific chemical and may include:

• Ventilation.
• Closed processing systems.
• PPE.
• Safe transfer procedures.
• Spill-response procedures.
• Exposure monitoring.

Hazard Communication

The surgery center should maintain a Hazard Communication Program where employees may be exposed to hazardous chemicals.

The program should address:

• Chemical inventory.
• Safety Data Sheets.
• Container labeling.
• Employee training.
• Non-routine tasks.
• Contractor communication where applicable.

Secondary Container Labeling

Chemicals transferred from original containers into secondary containers should be labeled as required.

Unidentified chemical containers should not remain in use.

Employees should understand the facility’s labeling system.

Cleaning and Disinfecting Chemicals

Employees may use:

• Surface disinfectants.
• Instrument cleaners.
• Detergents.
• Sterilants.
• Alcohol products.
• Other chemical agents.

Employees should follow label and SDS instructions and use required PPE.

Unauthorized chemical mixing should be prohibited.

Chemical Spill Response

Employees should know how to respond to chemical spills within the limits of their training and available protection.

Procedures should address:

• Area control.
• PPE.
• Spill kits.
• Ventilation.
• Cleanup.
• Waste disposal.
• Emergency assistance.

Employees should not attempt to control releases requiring emergency-response capabilities beyond their training.

Personal Protective Equipment

PPE should be selected according to employee hazards.

Depending on duties, PPE may include:

• Examination gloves.
• Surgical gloves.
• Chemical-resistant gloves.
• Gowns.
• Aprons.
• Masks.
• Safety glasses.
• Goggles.
• Face shields.
• Respiratory protection.
• Laser protective eyewear.
• Radiation protective equipment.

PPE should be readily available where employees need it.

Eye and Face Protection

Appropriate eye and face protection should be used when splashes, sprays, droplets, chemical exposures, or other hazards can affect the eyes or face.

Protection should be selected according to the task and anticipated exposure.

Hand Protection

Glove selection should reflect the hazard.

Different gloves may be necessary for:

• Patient care.
• Blood exposure.
• Chemical handling.
• Instrument processing.
• Cleaning.
• Hot equipment.

Employees should understand the limitations of the gloves they use.

Respiratory Protection — When Required

When respirators are required to protect employees from occupational respiratory hazards, the facility should maintain an appropriate Respiratory Protection Program.

Applicable elements may include:

• Hazard evaluation.
• Respirator selection.
• Medical evaluation.
• Fit testing.
• Training.
• Inspection.
• Maintenance.
• Program evaluation.

Waste Anesthetic Gases

Employees may be exposed to anesthetic gases and vapors that escape into operating rooms, procedure rooms, and recovery areas.

Exposure sources may include:

• Leaking connections.
• Anesthesia equipment.
• Improper work practices.
• Anesthetic spills.
• Patient exhalation during recovery.

The facility should evaluate exposures associated with its anesthesia practices.

Anesthetic Gas Scavenging

Appropriate scavenging systems should be used to capture and remove waste anesthetic gases where inhalation anesthetics are administered.

Scavenging systems should be maintained in effective operating condition.

Employees should report suspected leaks or system malfunctions.

Ventilation

Ventilation is an important component of controlling waste anesthetic gases.

Operating and recovery areas should have ventilation appropriate to the services performed and applicable facility requirements.

Ventilation systems should be maintained in proper operating condition.

Anesthesia Equipment Inspection

Anesthesia equipment should be inspected and maintained by qualified personnel.

Potential problems include:

• Leaking hoses.
• Loose connections.
• Damaged seals.
• Defective valves.
• Scavenging-system problems.

Employees should report suspected leaks immediately.

Recovery-Area Anesthetic Exposure

Patients may exhale residual anesthetic gases during recovery.

Employees working near patients in post-anesthesia care areas may therefore experience occupational exposure even though anesthesia is no longer being administered.

Appropriate ventilation and work practices should be maintained.

Surgical Smoke

Lasers, electrosurgical units, and other devices that thermally destroy tissue can create surgical smoke or plume.

Surgical smoke can contain airborne particles, gases, vapors, and biological material and may irritate employees’ eyes and respiratory systems.

Exposure should be controlled through appropriate engineering and work-practice controls.

Smoke Evacuation

Local smoke evacuation should capture plume as close as practical to its source.

Equipment may include:

• Portable smoke evacuators.
• Local exhaust systems.
• Room suction systems with appropriate filtration where suitable.

Smoke-evacuation equipment should be maintained according to manufacturer instructions.

Smoke-Evacuation Equipment

Employees should understand:

• Equipment setup.
• Positioning.
• Activation.
• Filter replacement.
• Tubing replacement.
• Disposal.
• Inspection.

Systems should be checked to ensure they function effectively.

Electrosurgical Procedures

Electrosurgical equipment can create surgical smoke, burns, electrical hazards, and ignition sources.

Employees should follow manufacturer instructions and facility procedures.

Damaged cords, accessories, or equipment should not be used.

Operating Room Fire Prevention

Surgical environments may contain all three elements necessary for fire:

• Oxidizers.
• Ignition sources.
• Fuels.

Procedures should address the interaction of these hazards during surgical and procedural activities.

Oxygen-Enriched Environments

Oxygen can increase the ease and intensity of combustion.

Employees should understand the fire hazards created when oxygen accumulates around:

• Surgical drapes.
• Patient hair.
• Clothing.
• Bedding.
• Other combustible materials.

Procedures should minimize unnecessary oxygen accumulation near ignition sources.

Ignition Sources

Potential operating-room ignition sources include:

• Electrosurgical units.
• Lasers.
• Fiber-optic light sources.
• Electrical equipment.
• Hot equipment.

Ignition sources should be managed carefully when oxygen or flammable materials are present.

Alcohol-Based Skin Preparations

Alcohol-based preparation solutions can be flammable.

Employees should follow manufacturer instructions and facility procedures regarding:

• Application.
• Pooling.
• Drying time.
• Draping.
• Ignition sources.

Ignition sources should not be activated while flammable prep solution remains inadequately dried.

Drapes and Combustible Materials

Drapes and other combustible materials should be managed to reduce fire risk, particularly in oxygen-enriched environments.

Employees should understand the facility’s surgical-fire prevention procedures.

Surgical Fire Response

Employees working in surgical areas should understand their responsibilities if a surgical fire occurs.

Procedures should address:

• Stopping the procedure when appropriate.
• Controlling ignition sources.
• Controlling oxidizer flow when appropriate.
• Removing burning materials.
• Extinguishing the fire.
• Facility emergency response.

Training should reflect employee roles.

Medical Gas Safety

Surgery centers may use oxygen, nitrous oxide, carbon dioxide, and other compressed medical gases.

Hazards may include:

• Fire.
• Explosion.
• High pressure.
• Cylinder movement.
• Gas leaks.
• Oxygen enrichment.

Medical-gas systems and cylinders should be maintained and handled safely.

Compressed Gas Cylinders

Cylinders should be:

• Secured.
• Protected from damage.
• Stored appropriately.
• Transported using suitable equipment.
• Kept away from inappropriate heat or ignition sources.

Employees should not roll, drag, or intentionally drop cylinders.

Cylinder Transport

When cylinders are transported, appropriate carts or carriers should be used.

Valve-protection caps should be used where applicable.

Employees should avoid lifting heavy cylinders manually when safer equipment is available.

Oxygen Safety

Oxygen equipment should be protected from ignition sources and contamination.

Employees should understand that oxygen itself is not flammable but can greatly accelerate combustion.

Smoking and open flames should be controlled as required.

Nitrous Oxide — When Applicable

Facilities using nitrous oxide should evaluate employee exposure and maintain appropriate equipment, scavenging, ventilation, and work practices.

Suspected leaks should be investigated.

Carbon Dioxide — When Applicable

Carbon dioxide may be used during certain procedures.

Employees should understand hazards associated with compressed gas and potential accumulation in poorly ventilated areas.

Hazardous Drugs — When Applicable

Some surgery centers may handle medications classified as hazardous drugs.

Where employee exposure is reasonably foreseeable, appropriate controls should address:

• Receiving.
• Storage.
• Preparation.
• Administration.
• Spills.
• Waste.
• Contaminated materials.

The extent of the program should reflect the drugs and activities present.

Hazardous Drug PPE

Appropriate PPE should be selected according to the drug, task, and anticipated exposure.

Employees should understand that ordinary examination gloves or other general PPE may not provide adequate protection against every hazardous drug.

Hazardous Drug Spill Response

Employees who may encounter hazardous-drug spills should receive appropriate training.

Suitable spill supplies and PPE should be available where needed.

Employees should not perform cleanup beyond their training and protection.

Laser Safety — When Applicable

Surgery centers using medical lasers should maintain appropriate laser-safety procedures.

Potential hazards include:

• Eye injury.
• Skin injury.
• Fire.
• Surgical plume.
• Electrical hazards.

Access to laser-use areas should be controlled as appropriate.

Laser Eye Protection

Protective eyewear should be appropriate for the laser wavelength and exposure involved.

Employees should use required eye protection whenever laser hazards are present.

Damaged protective eyewear should be removed from service.

Laser-Controlled Areas

Warning signs, access controls, barriers, and other measures may be necessary during laser procedures.

Only appropriately trained personnel should operate laser equipment.

Laser Plume

Laser procedures that destroy tissue can generate smoke plume.

Appropriate smoke evacuation should be used to control employee exposure.

Ionizing Radiation — When Applicable

Some surgery centers use C-arms, fluoroscopy, portable X-ray equipment, or other sources of ionizing radiation.

Where radiation is used, the facility should maintain appropriate radiation-safety procedures consistent with applicable federal and state requirements.

Fluoroscopy and C-Arms

Employees working around fluoroscopy or C-arm equipment should use appropriate methods to minimize unnecessary occupational radiation exposure.

Controls may include:

• Time.
• Distance.
• Shielding.
• Equipment positioning.
• Protective apparel.

Only appropriately trained personnel should operate radiation-producing equipment.

Radiation Protective Equipment

Where required, protective equipment may include:

• Lead aprons.
• Thyroid shields.
• Protective eyewear.
• Mobile barriers.
• Other shielding.

Protective equipment should be maintained in serviceable condition.

Dosimetry — When Required

Employee radiation monitoring should be provided when required by applicable regulations or facility exposure assessments.

Employees should use monitoring devices according to established procedures.

Electrical Safety

Operating rooms and procedure areas may contain numerous electrically powered devices.

Employees should report:

• Damaged cords.
• Broken plugs.
• Exposed wiring.
• Damaged equipment.
• Sparking.
• Shocks.
• Other electrical defects.

Defective equipment should be removed from service or otherwise controlled until repaired.

Medical Equipment Safety

Employees should use medical equipment according to manufacturer instructions and facility procedures.

Potential equipment includes:

• Electrosurgical units.
• Anesthesia machines.
• Patient monitors.
• Infusion pumps.
• Suction equipment.
• Surgical tables.
• Warming equipment.
• Endoscopic equipment.

Equipment defects should be reported promptly.

Equipment Inspection and Maintenance

Medical and surgical equipment should receive inspection, preventive maintenance, and repair appropriate to the equipment and manufacturer recommendations.

Only qualified personnel should perform specialized repairs.

Lockout/Tagout — When Applicable

Certain maintenance and servicing activities may expose employees to hazardous energy.

Where applicable, energy-control procedures should address:

• Shutdown.
• Energy isolation.
• Lockout or tagout.
• Stored energy.
• Verification.
• Return to service.

Safe Patient Handling

Surgery-center employees may transfer patients who are sedated, anesthetized, mobility impaired, or unable to assist.

Safe patient-handling procedures should reduce unnecessary manual lifting and awkward postures.

Patient Transfers

Transfers may occur between:

• Stretchers.
• Beds.
• Operating tables.
• Procedure chairs.
• Wheelchairs.
• Recovery recliners.

Employees should evaluate the patient, equipment, environment, and required assistance before beginning the transfer.

Lateral Transfers

Lateral transfer devices, slide sheets, air-assisted systems, or other equipment may reduce employee musculoskeletal stress.

Employees should receive appropriate instruction before using unfamiliar transfer devices.

Sedated and Anesthetized Patients

Sedated or anesthetized patients may be unable to assist during transfers.

Adequate personnel and appropriate transfer equipment should be available.

Employees should not attempt unsafe manual lifting because a procedure schedule is behind.

Bariatric Patients — When Applicable

Facilities should evaluate whether equipment and procedures are adequate for bariatric patients.

Considerations may include:

• Table capacity.
• Stretcher capacity.
• Transfer equipment.
• Wheelchairs.
• Available staff.
• Emergency procedures.

Equipment should never be used beyond its rated capacity.

Ergonomics

Employees may experience ergonomic stress from:

• Patient transfers.
• Moving equipment.
• Standing during procedures.
• Static postures.
• Awkward surgical positions.
• Instrument processing.
• Material handling.
• Computer work.

Engineering controls, equipment, work practices, and job design should be considered where feasible.

Post-Anesthesia Care Unit Safety

Employees working in PACU or other recovery areas may encounter:

• Sedated patients.
• Patient falls.
• Blood and body fluids.
• Sharps.
• Oxygen.
• Waste anesthetic gases.
• Patient agitation.
• Emergency events.

Procedures should reflect these hazards.

Recovery-Area Patient Falls

Sedated patients may be unstable or disoriented.

Employees should follow procedures for:

• Patient assistance.
• Bed or stretcher positioning.
• Side rails where appropriate.
• Transfer assistance.
• Ambulation.
• Discharge movement.

Employees should obtain assistance when necessary.

Patient Agitation and Confusion

Patients emerging from anesthesia may become confused, combative, or unpredictable.

Employees should have a practical method for obtaining assistance.

Employee safety should be considered when responding to agitated patients.

Workplace Violence Prevention

Workplace violence can involve patients, family members, visitors, coworkers, or other individuals.

Procedures should address:

• Threat reporting.
• Patient aggression.
• Visitor aggression.
• Security.
• Emergency communication.
• Staff assistance.
• Incident reporting.

Employees should not be expected to remain in an immediately dangerous situation when safe withdrawal is possible.

Security

Facility-security procedures may address:

• Access control.
• Visitors.
• Restricted clinical areas.
• Medication areas.
• Parking areas.
• After-hours access.
• Suspicious activity.
• Emergency assistance.

Security measures should not interfere with required emergency egress.

Slips, Trips and Falls

Potential fall hazards may include:

• Fluids.
• Cleaning activities.
• Cords.
• Tubing.
• Equipment.
• Supplies.
• Uneven flooring.
• Clutter.

Spills and trip hazards should be corrected or controlled promptly.

Housekeeping

Housekeeping employees may encounter:

• Blood and OPIM.
• Sharps.
• Chemicals.
• Waste.
• Wet floors.
• Electrical equipment.
• Manual lifting.

Housekeeping employees should receive safety training appropriate to their occupational exposures.

Regulated Waste

Waste contaminated with blood or OPIM should be handled and disposed of according to applicable Bloodborne Pathogens requirements.

Employees should use appropriate containers and PPE.

Waste bags should not be manually compressed when sharps may be present.

Emergency Action Plan

The surgery center should maintain emergency procedures appropriate to its operations.

The Emergency Action Plan may address:

• Fire.
• Surgical fire.
• Severe weather.
• Power failure.
• Medical emergencies.
• Chemical releases.
• Gas leaks.
• Workplace violence.
• Evacuation.
• Shelter-in-place.

Employees should understand alarms, communication methods, evacuation procedures, and assigned responsibilities.

Emergency Exits and Egress

Required exit routes should remain unobstructed.

Equipment, carts, supplies, waste, and other materials should not block required exits or corridors.

Employees should understand facility evacuation routes.

Fire Prevention

Fire-prevention procedures should address:

• Medical gases.
• Oxygen.
• Flammable chemicals.
• Electrical equipment.
• Surgical ignition sources.
• Storage.
• Hot work when applicable.

Fire-protection equipment should remain accessible.

Power Failure

Loss of electrical power can affect:

• Surgical equipment.
• Patient monitoring.
• Lighting.
• Ventilation.
• Medical-gas systems.
• Recovery operations.
• Communication.

Employees should understand emergency procedures and backup systems applicable to their work.

Medical Emergencies

Employees should understand their responsibilities during patient medical emergencies.

Emergency procedures should address:

• Communication.
• Emergency equipment.
• Employee roles.
• Outside emergency services where applicable.
• Transfer procedures.

First Aid and Employee Injuries

Employees should promptly report occupational injuries and illnesses, including:

• Needlesticks.
• Sharps injuries.
• Blood exposures.
• Chemical exposures.
• Eye splashes.
• Musculoskeletal injuries.
• Burns.
• Falls.
• Workplace violence.

Prompt reporting allows appropriate evaluation and corrective action.

Incident Investigation

Occupational injuries, exposures, near misses, chemical spills, equipment failures, and other significant safety events should be evaluated.

Investigations should focus on identifying contributing causes and corrective actions rather than simply assigning blame.

Potential corrective actions may involve:

• Equipment.
• Engineering controls.
• Procedures.
• Training.
• Staffing.
• Maintenance.
• PPE.
• Work practices.

ASC Safety Training

Employee training should reflect assigned duties and occupational exposures.

Depending on responsibilities, training may address:

• Bloodborne Pathogens.
• Needlestick and sharps safety.
• Instrument processing.
• Chemical hazards.
• PPE.
• Waste anesthetic gases.
• Surgical smoke.
• Medical gases.
• Hazardous drugs.
• Lasers.
• Radiation.
• Patient handling.
• Emergency procedures.

Employees should receive task-specific training before independently performing higher-hazard work.

New Employee Safety Orientation

New employees should receive safety orientation appropriate to their assigned duties.

Orientation may address:

• General ASC hazards.
• Bloodborne Pathogens.
• Sharps.
• PPE.
• Hazard Communication.
• Emergency procedures.
• Injury reporting.
• Workplace violence.
• Facility-specific hazards.

Additional training should be provided before employees perform specialized tasks.

ASC Safety Meetings

Periodic safety meetings can reinforce procedures and address current facility concerns.

Potential topics include:

• Needlestick prevention.
• Sharps handling.
• Surgical smoke.
• Waste anesthetic gases.
• Chemical safety.
• PPE.
• Patient handling.
• Operating-room fire prevention.
• Emergency response.

Recordkeeping

Ambulatory surgery centers should maintain occupational safety and health records required for their operations.

Records may include:

• Employee training.
• Injury and illness records.
• Exposure Control Plan documentation.
• Sharps injuries.
• Employee medical records.
• Respiratory Protection records.
• Exposure monitoring.
• Equipment inspections.
• Safety inspections.
• Incident investigations.

Confidential employee medical information should be maintained according to applicable requirements.

Additional Safety Programs

Depending on the surgery center’s procedures and employee exposures, additional safety programs may be necessary for:

• Bloodborne Pathogens.
• Needlestick & Sharps Safety.
• Personal Protective Equipment.
• Hazard Communication.
• Chemical Safety.
• Respiratory Protection.
• Infectious Disease Exposure Control.
• Surgical Smoke.
• Waste Anesthetic Gases.
• Compressed Gas Cylinders.
• Hazardous Drugs.
• Ionizing Radiation.
• Laser Safety.
• Ergonomics.
• Safe Patient Handling.
• Electrical Safety.
• Lockout/Tagout.
• Slips, Trips & Falls.
• Walking-Working Surfaces.
• Housekeeping.
• Workplace Violence Prevention.
• Workplace Security.
• Emergency Action Plan.
• Fire Prevention.
• First Aid.
• Spill Prevention & Response.
• Hazardous Waste Management.
• Contractor Safety.

The applicable programs should be selected according to procedures, equipment, chemicals, anesthesia methods, medications, and other employee hazards present at the facility.

Building an Ambulatory Surgery Center Safety Manual

A useful Ambulatory Surgery Center Safety Manual should reflect the actual procedures performed rather than simply adapting a generic medical-office or healthcare manual.

A center performing ophthalmic procedures may require a different combination of programs than an orthopedic, gastrointestinal, pain-management, cosmetic, urologic, or multispecialty surgery center.

The manual should consider:

• Surgical specialties.
• Blood and sharps exposure.
• Instrument processing.
• Sterilization methods.
• Anesthesia methods.
• Surgical-smoke generation.
• Medical gases.
• Hazardous chemicals.
• Hazardous drugs.
• Laser use.
• Radiation equipment.
• Patient-handling requirements.
• Emergency operations.

Selecting programs based on actual hazards creates a comprehensive manual without filling it with procedures unrelated to the facility.

Customized Ambulatory Surgery Center Safety Manuals

An Ambulatory Surgery Center Safety Manual can be developed around the facility’s surgical specialties, employee duties, blood and sharps exposures, instrument-processing methods, sterilization systems, anesthesia practices, surgical-smoke hazards, medical gases, chemicals, medications, lasers, radiation equipment, patient-handling activities, and other occupational exposures.

The finished manual may incorporate applicable programs for Bloodborne Pathogens, Needlestick and Sharps Safety, PPE, Hazard Communication, Chemical Safety, Respiratory Protection, Surgical Smoke, Waste Anesthetic Gases, Medical Gases, Hazardous Drugs, Laser Safety, Radiation Safety, Safe Patient Handling, Emergency Action Planning, Fire Prevention, and other hazards present within the operation.

This provides ambulatory surgery centers and outpatient surgical facilities with a practical safety manual organized around the work their employees actually perform.