Hospital Safety Manual

What Should a Hospital Safety Manual Include?

The contents of a Hospital Safety Manual should reflect the hospital’s departments, services, employee duties, equipment, chemicals, and occupational hazards.

Depending on operations, the manual may address:

• Hospital safety management.
• Hazard assessments.
• Safety inspections.
• Incident investigation.
• Safe Patient Handling and Mobility.
• Workplace Violence Prevention.
• Bloodborne Pathogens.
• Needlestick and sharps safety.
• Infectious Disease Exposure Control.
• Respiratory Protection.
• Personal Protective Equipment.
• Hazard Communication.
• Hazardous drugs.
• Chemical safety.
• Emergency Department safety.
• Patient Care Unit safety.
• Pharmacy safety.
• Central Sterile Processing.
• Surgical Suite safety.
• Laboratory safety.
• Imaging and radiation safety.
• Environmental Services.
• Facilities Management and Engineering.
• Food Services.
• Laundry.
• Materials handling and receiving.
• Hospital waste handling.
• Heliport safety when applicable.
• Emergency Action Planning.
• Fire Prevention.

Programs should be selected according to the hospital’s actual departments, services, employee duties, and workplace hazards.

Hospital Safety Program

An effective Hospital Safety Program establishes responsibilities and procedures for identifying hazards, controlling occupational exposures, preventing employee injuries and illnesses, responding to emergencies, and maintaining safe working conditions throughout the facility.

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

Managers, supervisors, department leaders, and designated safety personnel should:

• Identify and evaluate workplace hazards.
• Maintain applicable written safety programs.
• Conduct workplace inspections.
• Evaluate employee exposures.
• Provide required PPE.
• Maintain equipment in safe condition.
• Implement appropriate engineering and work-practice controls.
• Investigate occupational injuries and exposures.
• Correct identified hazards.
• Coordinate safety requirements between departments.
• Provide employee training.
• Maintain applicable records.

Employees should follow established safety procedures, use required controls and PPE, operate equipment safely, and promptly report unsafe conditions, injuries, exposures, equipment defects, threats, assaults, and other workplace hazards.

Hospital-Wide Safety Management

Hospital safety requires coordination across departments whose hazards and operations can differ substantially.

An effective hospital-wide safety system should establish methods for:

• Management leadership.
• Employee participation.
• Hazard identification.
• Hazard assessment.
• Hazard prevention and control.
• Employee education and training.
• Program evaluation.
• Communication between departments.
• Corrective action.

Safety responsibilities should be assigned to personnel with sufficient authority and resources to implement them.

Hospital Hazard Assessments

Hazard assessments should consider each department, employee job classification, task, chemical, process, and piece of equipment that may expose employees to occupational hazards.

Potential hazards may include:

• Patient lifting and movement.
• Workplace violence.
• Blood and body fluids.
• Needles and sharps.
• Infectious diseases.
• Hazardous drugs.
• Cleaning chemicals.
• Disinfectants.
• Sterilants.
• Anesthetic gases.
• Surgical smoke.
• Medical gases.
• Radiation.
• Lasers.
• Machinery.
• Electrical systems.
• Heat.
• Noise.
• Slips, trips, and falls.

Assessments should be reviewed when departments, equipment, chemicals, services, work practices, or other conditions change significantly.

Hospital Safety Inspections

Periodic inspections should evaluate workplace conditions throughout clinical and non-clinical areas.

Inspections may include:

• Patient Care Units.
• Emergency Departments.
• Operating Rooms.
• Pharmacies.
• Laboratories.
• Central Sterile Processing.
• Imaging areas.
• Environmental Services areas.
• Kitchens.
• Laundry.
• Maintenance areas.
• Mechanical rooms.
• Loading docks.
• Storage areas.
• Employee work areas.
• Exterior areas.

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

Job Safety Analysis (JSA/JHA)

Hospitals may use a Job Safety Analysis (JSA/JHA) to evaluate higher-risk or complex tasks.

Potential JSAs/JHAs may address:

• Patient transfers.
• Patient repositioning.
• Bariatric patient handling.
• Resident/patient fall recovery.
• Blood and body-fluid cleanup.
• Hazardous drug spills.
• Medical gas cylinder handling.
• Equipment maintenance.
• Chemical handling.
• Loading and unloading.
• Heliport operations.
• Other higher-hazard work.

Safe Patient Handling and Mobility

Patient lifting, transferring, repositioning, and movement can expose hospital employees to significant musculoskeletal stress.

The hospital should establish procedures for reducing unnecessary manual patient handling and using appropriate assistive equipment.

Potential patient-handling activities include:

• Bed-to-chair transfers.
• Bed-to-stretcher transfers.
• Repositioning.
• Toileting.
• Ambulation assistance.
• Patient transport.
• Bariatric patient handling.
• Fall recovery.
• Emergency movement.

Patient Handling Assessments

Patient-handling needs should be evaluated so employees can determine the appropriate equipment, assistance, and procedure.

Considerations may include:

• Patient mobility.
• Weight-bearing ability.
• Ability to follow instructions.
• Medical condition.
• Cognitive status.
• Body size.
• Equipment required.
• Number of employees needed.

Changes affecting safe handling should be communicated to affected employees.

Mechanical Patient Lifts

Mechanical lifting equipment should be used where appropriate to reduce unnecessary manual lifting.

Equipment may include:

• Ceiling lifts.
• Mobile full-body lifts.
• Sit-to-stand devices.
• Lateral-transfer devices.
• Repositioning aids.
• Other patient-handling equipment.

Employees should receive appropriate training before independently operating equipment.

Patient Lift Inspection

Patient-handling equipment should be inspected and maintained according to manufacturer instructions and hospital procedures.

Employees should report:

• Damaged slings.
• Worn straps.
• Defective controls.
• Damaged wheels.
• Low batteries.
• Missing components.
• Other defects.

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

Lateral Patient Transfers

Moving patients between beds, stretchers, examination tables, and other surfaces can create substantial physical demands.

Where appropriate, employees should use:

• Lateral-transfer devices.
• Friction-reducing devices.
• Powered transfer equipment.
• Slide sheets.
• Other suitable aids.

Employees should obtain additional assistance when required.

Bariatric Patient Handling

Bariatric patient handling should be planned before movement occurs whenever possible.

Planning may consider:

• Equipment capacity.
• Bed capacity.
• Lift capacity.
• Number of employees.
• Room dimensions.
• Doorway clearance.
• Transport equipment.
• Emergency procedures.

Employees should not improvise unsafe manual lifting methods because appropriate equipment is unavailable or inconvenient to obtain.

Patient Fall Recovery

Employees may be injured attempting to catch or manually lift a falling patient.

Hospital procedures should address safe response and recovery, including use of appropriate equipment and additional personnel.

Patient Transport

Employees transporting patients should consider:

• Patient condition.
• Equipment condition.
• Oxygen or medical equipment.
• Elevators.
• Ramps.
• Doorways.
• Walking surfaces.
• Required assistance.

Wheelchairs, stretchers, and other transport equipment should be maintained in safe operating condition.

Ergonomics

In addition to patient handling, hospital employees may experience ergonomic stress from:

• Computer work.
• Repetitive tasks.
• Pushing carts.
• Stocking.
• Housekeeping.
• Laundry.
• Food Service.
• Laboratory work.
• Pharmacy work.
• Materials handling.

Engineering controls, equipment, workstation design, and work practices should be considered to reduce unnecessary ergonomic stress.

Hospital Workplace Violence Prevention

Hospital employees may encounter violence or threats from patients, visitors, family members, or other persons.

Risk factors may include:

• Patients with a history of violence.
• Behavioral-health conditions.
• Drug or alcohol use.
• Weapons.
• Long waiting periods.
• Overcrowding.
• Working alone.
• Inadequate security.
• Poor lighting.
• Unrestricted public access.
• Understaffing.

The hospital should maintain a Workplace Violence Prevention Program appropriate to its size, services, patient population, and identified risks.

Workplace Violence Risk Assessment

Work areas should be evaluated for violence-related hazards.

Particular attention may be appropriate for:

• Emergency Departments.
• Behavioral Health Units.
• Admissions.
• Waiting rooms.
• Patient Care Units.
• Pharmacies.
• Parking areas.
• Isolated work areas.
• After-hours operations.

Controls should reflect identified risks.

Engineering Controls for Workplace Violence

Potential controls may include:

• Panic or duress alarms.
• Video surveillance.
• Improved lighting.
• Access control.
• Secure work areas.
• Appropriate room design.
• Security barriers.
• Metal detection where appropriate.
• Employee escape routes.

Controls should be selected according to the hazards of the particular hospital.

Behavioral Warning Signs

Employees should be trained to recognize behavior that may indicate escalating aggression.

Potential warning signs may include:

• Pacing.
• Restlessness.
• Clenched fists.
• Increasingly loud speech.
• Threats.
• Cursing.
• Increasing agitation.

Employees should know how to obtain assistance before conditions escalate further.

De-Escalation

Employees whose duties involve contact with potentially aggressive patients or visitors should receive appropriate training in recognizing and de-escalating volatile situations.

Employees should understand:

• Communication techniques.
• Personal positioning.
• Maintaining escape routes.
• Obtaining assistance.
• Security procedures.
• Reporting requirements.

Panic and Duress Alarms

Where panic or duress alarms are provided, employees should know:

• Their location.
• How to activate them.
• Who receives the alarm.
• Expected response procedures.

Alarm systems should be inspected and maintained as appropriate.

Security Personnel

Hospital security procedures should define the role of security personnel in preventing and responding to workplace violence.

Coordination may be necessary among:

• Clinical personnel.
• Security.
• Management.
• Emergency responders.
• Law enforcement.

Weapons

Hospital security procedures should address foreseeable risks involving firearms, knives, or other weapons.

Employees should understand appropriate notification and response procedures and should not place themselves in unnecessary danger attempting to physically control an armed person.

Workplace Violence Incident Reporting

Employees should promptly report:

• Assaults.
• Threats.
• Verbal abuse.
• Weapons incidents.
• Near misses.
• Other aggressive behavior.

Employees should not be discouraged from reporting violence merely because the aggressor is a patient.

Post-Incident Response

Employees involved in violent incidents should receive appropriate medical evaluation and other support.

Significant incidents should be reviewed to identify contributing factors and corrective actions.

Emergency Department Safety

Emergency Departments combine multiple occupational hazards within a fast-moving and unpredictable environment.

Potential employee hazards include:

• Workplace violence.
• Bloodborne Pathogens.
• Needles and sharps.
• Unknown infectious diseases.
• Respiratory exposure.
• Combative patients.
• Intoxicated patients.
• Weapons.
• Patient handling.
• Hazardous drugs.
• Chemical exposure.

Emergency Department procedures should reflect the particular hazards created by patient volume, facility design, staffing, and services.

Emergency Department Workplace Violence

Emergency Department employees may encounter patients or visitors affected by:

• Violence.
• Criminal activity.
• Drugs.
• Alcohol.
• Behavioral-health conditions.
• Fear.
• Pain.
• Long waits.

Employees should have rapid access to assistance and appropriate security resources.

Emergency Department Sharps Safety

Emergency procedures can increase the risk of needlestick and sharps injuries.

Employees should follow established sharps procedures even during urgent care whenever circumstances permit.

Appropriate sharps containers should be readily accessible.

Unknown Infectious Disease Exposure

Emergency Department employees may encounter infectious patients before a diagnosis or specific hazard is known.

Procedures should address appropriate:

• Screening.
• PPE.
• Respiratory protection.
• Isolation.
• Employee exposure response.

Bloodborne Pathogens

Employees with reasonably anticipated occupational exposure to human blood or other potentially infectious materials should be covered by the hospital’s Bloodborne Pathogens Exposure Control Plan.

The program should address applicable requirements involving:

• Exposure determination.
• Universal Precautions.
• Engineering controls.
• Work-practice controls.
• PPE.
• Hepatitis B vaccination.
• Exposure incidents.
• Training.
• Recordkeeping.

Needlestick and Sharps Safety

Hospital employees may encounter:

• Needles.
• Lancets.
• Scalpels.
• Surgical sharps.
• IV equipment.
• Blood-collection devices.
• Broken contaminated glass.
• Other sharps.

Appropriate engineering and work-practice controls should be used to reduce exposure.

Safer Sharps Devices

Where required, appropriate engineering controls such as safer medical devices should be evaluated and used.

Frontline employees involved in patient care should participate as required in evaluating and selecting appropriate engineering controls.

Sharps Containers

Sharps containers should be:

• Closable.
• Puncture resistant.
• Leak resistant as required.
• Appropriately labeled or color coded.
• Accessible.
• Maintained upright.
• Replaced before overfilling.

Employees should not reach into sharps containers.

Sharps Injury Log

Where required, the hospital should maintain a sharps injury log containing the required information while protecting employee confidentiality.

Sharps injury trends should be reviewed to identify opportunities for prevention.

Needlestick and Exposure Response

Employees should immediately report occupational exposure incidents.

Procedures should provide prompt access to:

• First aid.
• Medical evaluation.
• Post-exposure evaluation.
• Follow-up.
• Required documentation.

Employees should know how to obtain assistance during all shifts.

Infectious Disease Exposure Control

Hospital employees may encounter infectious agents through:

• Patient contact.
• Respiratory exposure.
• Blood and body fluids.
• Contaminated surfaces.
• Specimens.
• Waste.
• Laundry.

Infection-exposure procedures should reflect the hazards associated with employee duties.

Respiratory Infections

Employees may require controls such as:

• Isolation procedures.
• Ventilation.
• PPE.
• Respiratory protection.
• Exposure reporting.

Controls should be selected according to the particular occupational hazard.

Tuberculosis Exposure Control — When Applicable

Hospitals with occupational exposure to tuberculosis should evaluate and implement applicable infection-control measures.

Procedures may include:

• Risk assessment.
• Identification of suspected cases.
• Airborne isolation.
• Respiratory protection.
• Employee training.
• Exposure evaluation.

Respiratory Protection

When respirators are required, the hospital should maintain an appropriate Respiratory Protection Program.

Applicable elements may include:

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

Employees should not substitute surgical masks for required respiratory protection when a respirator is necessary.

Personal Protective Equipment

PPE should be selected according to employee hazards.

Depending on the task, PPE may include:

• Gloves.
• Gowns.
• Eye protection.
• Face protection.
• Respirators.
• Chemical-resistant PPE.
• Hearing protection.
• Protective footwear.
• Other equipment.

Employees should receive training on required PPE use and limitations.

Eye and Face Protection

Employees should use appropriate eye or face protection where exposure to splashes, sprays, flying particles, chemicals, or other hazards is reasonably anticipated.

Face shields should supplement rather than replace required primary eye protection when both are necessary.

Hand Protection

Gloves should be selected according to the hazard.

Different gloves may be required for:

• Patient care.
• Chemical handling.
• Housekeeping.
• Hot materials.
• Maintenance.
• Other tasks.

Employees should understand that one glove type may not protect against every chemical or physical hazard.

Hazard Communication

Hospitals use hazardous chemicals in clinical and non-clinical departments.

Potential products include:

• Cleaning chemicals.
• Disinfectants.
• Sterilants.
• Laboratory chemicals.
• Maintenance chemicals.
• Pesticides.
• Hazardous drugs.

The hospital should maintain an applicable Hazard Communication Program addressing chemical inventories, Safety Data Sheets, labeling, employee training, and non-routine tasks.

Safety Data Sheets

Safety Data Sheets should be readily accessible to employees.

Employees should know how to obtain information concerning:

• Chemical hazards.
• PPE.
• Exposure controls.
• Storage.
• Spill response.
• First aid.

Hazardous Drug Exposure Control

Hospitals may use hazardous drugs in pharmacies, patient-care areas, operating rooms, clinics, and other departments.

Potential exposure can occur during:

• Receiving.
• Storage.
• Compounding.
• Preparation.
• Administration.
• Spill cleanup.
• Waste handling.
• Environmental cleaning.
• Handling contaminated patient materials.

The hospital should identify hazardous drugs used within the facility and establish appropriate controls.

Hazardous Drug Receiving

Employees who receive packages containing hazardous drugs should receive appropriate information and training.

Procedures should address damaged or leaking packages and employee exposure.

Hazardous Drug Storage

Hazardous drugs should be stored according to applicable requirements and manufacturer information.

Storage procedures should consider:

• Security.
• Segregation.
• Ventilation where required.
• Spill response.
• Employee access.

Hazardous Drug Preparation and Compounding

Employees preparing or compounding hazardous drugs should use appropriate engineering controls, work practices, and PPE.

Controls should reflect the drug, process, dosage form, and potential exposure.

Hazardous Drug Administration

Employees administering hazardous drugs should use appropriate controls to reduce exposure from:

• Connections.
• Tubing.
• Spills.
• Leaks.
• Aerosols.
• Patient body fluids where relevant.

Hazardous Drug Spills

Appropriate spill kits and procedures should be available where hazardous drugs are handled.

Employees expected to respond should receive training in:

• Area control.
• PPE.
• Spill cleanup.
• Waste handling.
• Exposure reporting.

Employees should not attempt cleanup beyond their training and available protection.

Hazardous Drug Waste

Hazardous-drug-contaminated materials should be collected and handled according to applicable procedures.

Employee protection should be considered during:

• Collection.
• Transport.
• Storage.
• Disposal preparation.

Pharmacy Safety

Hospital pharmacies may involve occupational hazards associated with:

• Hazardous drugs.
• Chemicals.
• Sharps.
• Repetitive work.
• Lifting.
• Slips and falls.
• Workplace violence.

Pharmacy safety procedures should reflect actual compounding and medication-handling activities.

Pharmacy Ergonomics

Pharmacy employees may perform repetitive tasks involving:

• Computer entry.
• Packaging.
• Labeling.
• Reaching.
• Standing.
• Medication preparation.

Workstations and processes should be arranged to reduce unnecessary ergonomic stress.

Central Sterile Processing Safety

Central Sterile Processing employees may handle contaminated instruments and operate cleaning, disinfection, and sterilization equipment.

Potential hazards include:

• Sharps.
• Blood and body fluids.
• Cleaning chemicals.
• High-level disinfectants.
• Sterilants.
• Steam.
• Heat.
• Equipment.
• Ergonomic stress.

Receiving Contaminated Instruments

Employees handling contaminated instruments should use appropriate precautions and PPE.

Procedures should minimize unnecessary manual handling of exposed sharps.

Instrument Cleaning

Manual cleaning procedures should reduce employee exposure to:

• Sharps.
• Splash.
• Aerosols.
• Chemicals.

Employees should use tools and methods appropriate to the instruments being cleaned.

Sterilizers and Autoclaves

Employees operating sterilizers and autoclaves should be trained in equipment-specific procedures.

Potential hazards include:

• Heat.
• Steam.
• Burns.
• Pressure.
• Chemicals.
• Mechanical hazards.

Employees should allow loads to cool appropriately before handling.

High-Level Disinfectants and Sterilants

Employees using chemical disinfectants or sterilants should follow applicable Hazard Communication and exposure-control procedures.

Engineering controls, ventilation, PPE, and exposure monitoring should be provided where required.

Surgical Suite Safety

Operating Rooms and Surgical Suites can expose employees to:

• Blood and body fluids.
• Needles and surgical sharps.
• Surgical smoke.
• Waste anesthetic gases.
• Medical gases.
• Hazardous drugs.
• Lasers.
• Ionizing radiation.
• Fire.
• Patient-handling hazards.

Controls should reflect the procedures and equipment used.

Surgical Sharps Safety

Operating-room procedures should reduce sharps exposure through appropriate engineering and work-practice controls.

Potential measures may include:

• Safer devices.
• Neutral or no-pass zones.
• Appropriate sharps containers.
• Safe instrument handling.
• Blunt-tip suture needles where clinically appropriate.

Surgical Smoke

Procedures that generate smoke or plume may expose employees to airborne contaminants.

Where surgical smoke is generated, appropriate smoke evacuation or local exhaust controls should be considered according to the procedure and equipment used.

Waste Anesthetic Gases

Employees may be exposed to waste anesthetic gases from leaks, equipment, connections, or patient exhalation.

Controls may include:

• Scavenging.
• Ventilation.
• Equipment inspection.
• Leak detection.
• Maintenance.
• Work practices.

Medical Gas Safety

Hospitals may use oxygen, nitrous oxide, carbon dioxide, and other medical gases.

Procedures should address:

• Cylinder handling.
• Storage.
• Securing cylinders.
• Regulators.
• Connections.
• Leaks.
• Fire hazards.
• Oxygen-enriched environments.

Surgical Fire Prevention

Operating Rooms can contain the elements necessary for fire: an ignition source, oxidizer, and fuel.

Procedures should address:

• Electrosurgical equipment.
• Lasers.
• Oxygen.
• Nitrous oxide.
• Flammable products.
• Drapes and other combustible materials.
• Emergency response.

Laser Safety — When Applicable

Where medical lasers are used, the hospital should evaluate hazards involving:

• Direct and reflected laser energy.
• Eye exposure.
• Skin exposure.
• Surgical plume.
• Fire.
• Electrical equipment.

Appropriate controlled areas, PPE, training, and other controls should be established.

Laboratory Safety

Hospital clinical laboratories may expose employees to biological, chemical, physical, and equipment hazards.

Potential programs may address:

• Bloodborne Pathogens.
• Biological materials.
• Sharps.
• Chemical Hygiene.
• Hazard Communication.
• Centrifuges.
• Compressed gases.
• Cryogenic materials.
• Formaldehyde.
• PPE.
• Laboratory waste.

Laboratory procedures should reflect the testing and materials actually used.

Laboratory Specimen Handling

Employees handling blood, tissue, cultures, and other clinical specimens should use appropriate precautions.

Specimen procedures should address:

• Containers.
• Labeling.
• Transport.
• Leakage.
• Centrifugation.
• Spill response.
• Waste.

Centrifuge Safety

Centrifuges should be operated and maintained according to manufacturer instructions.

Employees should address:

• Rotor condition.
• Balancing.
• Lid interlocks.
• Tube breakage.
• Aerosol hazards.
• Cleaning.

Formaldehyde — When Applicable

Departments using formaldehyde or formalin should evaluate employee exposure and comply with applicable requirements.

Potential controls may include:

• Closed containers.
• Local exhaust ventilation.
• Spill procedures.
• PPE.
• Exposure monitoring.

Imaging and Radiology Safety

Hospital imaging operations may involve occupational exposure to ionizing radiation and other specialized hazards.

Potential areas include:

• Diagnostic X-ray.
• CT.
• Fluoroscopy.
• Interventional radiology.
• Portable X-ray.
• C-arms.
• Nuclear medicine.
• Other imaging services.

Safety procedures should reflect the equipment and procedures used.

Ionizing Radiation

Employees working with ionizing radiation should follow applicable radiation-safety procedures.

Controls may include:

• Time.
• Distance.
• Shielding.
• Restricted areas.
• Warning signs.
• Monitoring.
• Protective equipment.

Portable Imaging

Portable X-ray equipment can expose employees outside conventional imaging rooms.

Procedures should address:

• Employee positioning.
• Distance.
• Shielding.
• Communication.
• Restricted access.

Lead Protective Equipment

Lead aprons, shields, and other protective equipment should be properly stored, inspected, and used according to applicable procedures.

Damaged protective equipment should be removed from service when it no longer provides appropriate protection.

MRI Safety — When Applicable

MRI systems create powerful magnetic fields that can present hazards involving ferromagnetic objects and equipment.

Procedures should address:

• Restricted access.
• Screening.
• Equipment compatibility.
• Medical equipment.
• Compressed gas cylinders.
• Emergency response.

Unauthorized or incompatible equipment should not be brought into controlled MRI areas.

Environmental Services Safety

Environmental Services employees may work throughout the hospital and can encounter:

• Blood and body fluids.
• Sharps.
• Hazardous drugs.
• Cleaning chemicals.
• Disinfectants.
• Waste.
• Isolation rooms.
• Wet floors.
• Manual material handling.

Employees should receive training appropriate to the areas they clean.

Sharps in Environmental Services

Housekeeping employees should never reach blindly into waste containers, linen, or areas where hidden sharps may be present.

Sharps found outside approved containers should be handled according to hospital procedures.

Cleaning and Disinfection Chemicals

Employees should follow applicable procedures for:

• Dilution.
• Dispensing.
• Ventilation.
• PPE.
• Storage.
• Spill response.

Chemicals should not be mixed unless specifically authorized by product instructions and hospital procedures.

Isolation Room Cleaning

Employees cleaning isolation rooms should receive information concerning required precautions and PPE before entering.

Procedures should address safe PPE removal and waste handling.

Hospital Housekeeping

Floors, corridors, stairs, work areas, and walking-working surfaces should be maintained in safe condition.

Spills should be corrected or controlled promptly.

Equipment, cords, carts, and supplies should not unnecessarily obstruct walkways or emergency exits.

Facilities Management and Engineering

Hospital facilities and engineering employees may encounter industrial hazards that differ substantially from clinical hazards.

Potential hazards include:

• Electrical systems.
• Hazardous energy.
• Boilers.
• HVAC systems.
• Emergency generators.
• Medical gas systems.
• Compressed gases.
• Confined spaces.
• Ladders.
• Elevated work.
• Hot work.
• Machinery.
• Chemicals.

Lockout/Tagout

Employees servicing or maintaining equipment where unexpected energization or release of stored energy could cause injury should follow applicable energy-control procedures.

Procedures should address:

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

Electrical Safety

Only qualified employees should perform electrical work requiring specialized knowledge or training.

Employees should report:

• Damaged wiring.
• Electrical shocks.
• Broken receptacles.
• Exposed conductors.
• Defective equipment.

Electrical rooms and panels should remain appropriately accessible.

Confined Space — When Applicable

Hospital facilities may contain spaces requiring evaluation under applicable confined-space requirements.

Potential locations may include:

• Tanks.
• Pits.
• Utility spaces.
• Certain mechanical areas.
• Other enclosed spaces.

Spaces should be evaluated according to their actual configuration and hazards rather than assumed to be permit-required confined spaces.

Hot Work

Welding, cutting, brazing, soldering, and other hot work should be controlled to prevent fire and employee exposure.

Procedures may address:

• Hot work authorization.
• Combustible materials.
• Fire extinguishers.
• Fire watch.
• Ventilation.
• Gas cylinders.
• PPE.

Emergency Generators

Employees operating or maintaining emergency generators should be protected from hazards involving:

• Electrical energy.
• Fuel.
• Exhaust.
• Hot surfaces.
• Moving parts.
• Noise.

Maintenance should follow appropriate hazardous-energy controls.

Contractor Safety

Hospitals frequently use outside contractors for construction, maintenance, equipment servicing, and specialized work.

Contractor procedures should address:

• Hazard communication.
• Infection-control restrictions where applicable.
• Work-area isolation.
• Hot work.
• Lockout/Tagout coordination.
• Electrical work.
• Confined spaces.
• Emergency procedures.
• Hospital security.

Food Services Safety

Hospital kitchens and dietary departments may expose employees to:

• Knives.
• Slicers.
• Mixers.
• Ovens.
• Fryers.
• Steam.
• Hot liquids.
• Cleaning chemicals.
• Wet floors.
• Manual material handling.

Appropriate machine guarding, PPE, housekeeping, and safe work practices should be maintained.

Knife and Cutting Safety

Employees should use knives appropriate to the task and maintain safe cutting practices.

Knives should be stored safely when not in use.

Employees should not attempt to catch falling knives.

Commercial Kitchen Equipment

Mixers, slicers, processors, and other powered kitchen equipment should have required guards in place.

Employees should follow appropriate energy-control procedures during servicing and maintenance when Lockout/Tagout applies.

Burn Prevention

Employees should use appropriate procedures and PPE when handling:

• Hot pans.
• Steam.
• Hot liquids.
• Fryers.
• Ovens.
• Other heated equipment.

Laundry Safety

Hospital laundry operations may expose employees to:

• Contaminated linens.
• Blood and body fluids.
• Hazardous-drug contamination.
• Chemicals.
• Heat.
• Machinery.
• Repetitive work.
• Manual material handling.

Procedures should separate contaminated-linen handling from clean-linen operations where appropriate.

Contaminated Laundry

Employees should handle contaminated laundry with minimum agitation and appropriate PPE.

Laundry should be bagged or containerized according to applicable procedures.

Employees should not manually sort contaminated laundry in a manner that creates unnecessary exposure.

Laundry Equipment

Washers, dryers, presses, conveyors, and other equipment should have appropriate guards and safety devices.

Employees should follow Lockout/Tagout procedures during servicing and maintenance when applicable.

Materials Handling and Receiving

Hospital receiving and materials departments may handle:

• Medical supplies.
• Chemicals.
• Hazardous drugs.
• Compressed gas cylinders.
• Equipment.
• Food.
• Other materials.

Employees should receive training appropriate to the products and equipment they handle.

Loading Dock Safety

Loading docks may expose employees to:

• Trucks.
• Trailers.
• Dock edges.
• Material-handling equipment.
• Falling materials.
• Slips and falls.

Appropriate dock procedures and controls should be maintained.

Forklifts and Powered Industrial Trucks — When Used

Employees operating forklifts or other powered industrial trucks should receive required training and authorization.

Procedures should address:

• Inspections.
• Pedestrians.
• Loading docks.
• Trailer entry.
• Load stability.
• Charging or fueling.

Manual Material Handling

Employees should use appropriate equipment and methods for moving supplies and equipment.

Carts, pallet jacks, lift devices, and other mechanical aids should be used where appropriate.

Hospital Waste Handling

Hospital employees may handle multiple waste streams with different hazards.

Potential waste may include:

• Regulated medical waste.
• Sharps.
• Chemical waste.
• Hazardous-drug waste.
• Pharmaceutical waste.
• Laboratory waste.
• General waste.

Employees should be trained to recognize the waste streams they handle and use appropriate containers and PPE.

Regulated Medical Waste

Employees handling regulated medical waste should follow applicable procedures for:

• Collection.
• Container closure.
• Transport.
• Storage.
• Spill response.

Containers should be appropriate for the material being handled.

Chemical and Hazardous Waste

Chemical waste should be identified, segregated, stored, and handled according to applicable requirements.

Employees should not combine incompatible waste streams.

Heliport Safety — When Applicable

Hospitals with helicopter landing facilities should maintain procedures for protecting employees involved in aircraft arrival, departure, and patient transfer.

Potential hazards include:

• Rotors.
• Propellers.
• Noise.
• Wind.
• Flying debris.
• Fuel.
• Fire.
• Patient-handling hazards.

Aircraft Approach

Employees should approach helicopters only according to established procedures and instructions from appropriate personnel.

Employees should remain clear of hazardous aircraft areas and maintain control of loose objects.

Heliport Patient Transfer

Patient-transfer procedures should coordinate:

• Aircraft personnel.
• Hospital employees.
• Transport equipment.
• Medical equipment.
• Communication.

Employees should consider rotor hazards and environmental conditions during transfer.

Heliport Hearing and Eye Protection

Appropriate hearing and eye protection should be used where required by employee exposure and facility procedures.

Loose materials should be controlled before aircraft arrival.

Slips, Trips and Falls

Hospital employees may encounter:

• Wet floors.
• Cords.
• Equipment.
• Carts.
• Clutter.
• Uneven surfaces.
• Outdoor conditions.

Hazards should be corrected or controlled promptly.

Walking-Working Surfaces

Floors, stairs, ramps, platforms, loading docks, and other walking-working surfaces should be maintained in safe condition.

Appropriate fall protection should be provided where required.

Occupational Stress and Fatigue

Hospital work may involve:

• Emergency situations.
• Long or irregular shifts.
• Patient deaths.
• High workloads.
• Staffing shortages.
• Violence.
• Complex equipment.
• Time-sensitive decisions.

Fatigue and occupational stress can affect employee safety and should be considered when evaluating work organization and hazards.

Extended and Irregular Shifts

Hospitals should consider how long hours, night work, overtime, and emergency response can contribute to fatigue-related safety risks.

Employees should be encouraged to report fatigue-related safety concerns.

Emergency Action Plan

The hospital should maintain emergency procedures appropriate to its size, services, hazards, and facility configuration.

Potential emergencies may include:

• Fire.
• Severe weather.
• Utility failure.
• Power failure.
• Chemical release.
• Workplace violence.
• Medical emergencies affecting employees.
• Other events requiring evacuation, shelter, or emergency action.

Hospital Evacuation

Hospital evacuation planning should account for employees responsible for assisting patients who may:

• Be non-ambulatory.
• Require life-support equipment.
• Require oxygen.
• Require isolation precautions.
• Require specialized transport.
• Be unable to follow instructions.

Employee assignments and communication procedures should be established in advance.

Fire Prevention

Hospital fire-prevention procedures should address hazards associated with:

• Oxygen.
• Medical gases.
• Electrical equipment.
• Kitchens.
• Laboratories.
• Operating Rooms.
• Flammable chemicals.
• Hot work.
• Storage.

Employees should understand fire reporting and emergency procedures.

First Aid and Employee Injuries

Employees should promptly report occupational injuries and illnesses.

Potential incidents include:

• Needlesticks.
• Blood exposures.
• Patient-handling injuries.
• Assaults.
• Chemical exposures.
• Burns.
• Falls.
• Respiratory exposures.
• Electrical injuries.

Prompt reporting allows appropriate medical evaluation and helps identify hazards requiring corrective action.

Incident Investigation

Occupational injuries, illnesses, exposures, violent incidents, equipment failures, spills, fires, and significant near misses should be investigated as appropriate.

Investigations should identify:

• Immediate causes.
• Contributing factors.
• Root causes.
• Corrective actions.

Corrective actions may involve equipment, staffing, engineering controls, work practices, procedures, training, or other measures.

Hospital Employee Safety Training

Training should reflect each employee’s assigned duties and occupational exposures.

Depending on responsibilities, training may address:

• Hospital safety procedures.
• Safe Patient Handling.
• Workplace Violence Prevention.
• Bloodborne Pathogens.
• Sharps safety.
• Infectious diseases.
• Respiratory Protection.
• PPE.
• Hazard Communication.
• Hazardous drugs.
• Chemical safety.
• Emergency procedures.
• Department-specific hazards.

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

New Employee Safety Orientation

New employees should receive appropriate safety orientation before independently performing assigned duties.

Orientation may address:

• General hospital hazards.
• Injury reporting.
• Emergency procedures.
• Workplace violence.
• Bloodborne Pathogens.
• PPE.
• Hazard Communication.
• Department-specific hazards.

Additional training should be provided according to job responsibilities.

Department-Specific Safety Training

Employees assigned to specialized departments may require additional training for hazards involving:

• Hazardous drugs.
• Sterilants.
• Surgical smoke.
• Anesthetic gases.
• Radiation.
• Lasers.
• Medical gases.
• Laboratory chemicals.
• Machinery.
• Lockout/Tagout.
• Confined spaces.
• Heliport operations.

Training requirements should be based on actual employee duties and exposures.

Hospital Safety Meetings

Periodic safety meetings can reinforce safe work practices and address emerging hazards.

Potential topics include:

• Patient handling.
• Workplace violence.
• Needlestick prevention.
• Infectious diseases.
• Hazardous drugs.
• PPE.
• Chemical safety.
• Slips and falls.
• Emergency procedures.
• Department-specific incidents.

Recordkeeping

Hospitals should maintain occupational safety and health records required for their operations.

Records may include:

• Injury and illness records.
• Employee training.
• Exposure records.
• Sharps injury logs.
• Respiratory Protection records.
• Medical surveillance records.
• Workplace-violence incidents.
• Safety inspections.
• Equipment inspections.
• Incident investigations.

Employee medical and exposure records should be maintained according to applicable requirements.

Additional Safety Programs

Depending on hospital departments, services, equipment, and employee exposures, additional safety programs may be necessary for:

• Safe Patient Handling.
• Workplace Violence Prevention.
• Bloodborne Pathogens.
• Needlestick & Sharps Safety.
• Infectious Disease Exposure Control.
• Tuberculosis Exposure Control.
• Respiratory Protection.
• Personal Protective Equipment.
• Eye & Face Protection.
• Hand Protection.
• Hazard Communication.
• Chemical Safety.
• Hazardous Drugs.
• Laboratory Safety.
• Formaldehyde.
• Ionizing Radiation.
• Laser Safety.
• Compressed Gas Cylinders.
• Medical Gas Safety.
• Ergonomics.
• Manual Lifting & Material Handling.
• Slips, Trips & Falls.
• Walking-Working Surfaces.
• Housekeeping.
• Lockout/Tagout.
• Electrical Safety.
• Machine Guarding.
• Hand & Power Tools.
• Confined Space.
• Ladder & Stairway Safety.
• Fall Protection.
• Welding, Cutting & Hot Work.
• Food Service Safety.
• Emergency Action Plan.
• Fire Prevention.
• First Aid.
• Spill Prevention & Response.
• Hazardous Waste Management.
• Workplace Security.
• Subcontractor Management.

Programs should be included when hospital operations and employee exposures make them applicable.

Building a Hospital Safety Manual

A useful Hospital Safety Manual should reflect the actual departments and services operated by the hospital.

A smaller community hospital may require a different combination of programs than a large medical center with an Emergency Department, operating rooms, intensive care units, pharmacy compounding, clinical laboratories, interventional radiology, MRI, Central Sterile Processing, behavioral health, engineering operations, commercial kitchens, laundry, and a heliport.

The manual should therefore consider both hospital-wide hazards and department-specific operations.

This allows the hospital to maintain a comprehensive safety manual without filling it with procedures unrelated to its services.

Customized Hospital Safety Manuals

A Hospital Safety Manual can be developed around the hospital’s departments, patient population, clinical services, equipment, chemicals, employee exposures, maintenance operations, emergency services, and other workplace hazards.

The finished manual may incorporate applicable programs for Safe Patient Handling, Workplace Violence Prevention, Bloodborne Pathogens, Needlestick and Sharps Safety, Infectious Disease Exposure Control, Respiratory Protection, Hazardous Drugs, Hazard Communication, PPE, Laboratory Safety, Radiation Safety, Lockout/Tagout, Emergency Action Planning, Fire Prevention, and other hazards present within the facility.

This provides hospitals with a practical occupational safety manual organized around the work their employees actually perform.