Safety & Security

1. Safety & Security Big Bend Community Based Care, Inc. 2009

2. Welcome & Expectations • This course is designed for the BBCBC system of care. • To move through the course you will need to manually click your mouse to advance the slides. • At the conclusion of the course you will be asked to submit an email of completion to the BBCBC training department. • In addition to the PowerPoint presentation successful completion of this course requires that each participant familiarize themselves with the following BBCBC Operating Policies which can be accessed on the www.bigbendcbc.org site: • Policy 1400: General Health & Safety • Policy 1404: Building Maintenance • Policy 1405: Conflict Resolution & De-Escalation Training • Policy 1406: Driver Safety • Policy 1407: Maintenance of a Safe, Hygienic Environment • Policy 1409: Custody & Issuance of Keys

3. Course Objectives • Participants will be able to recognize and diffuse potentially violent/hostile situations. • Participants will be able to identify how to intervene, seek assistance, make appropriate contacts and document situations that affect worker safety. • Participants will develop an understanding of universal precautions and infectious diseases and learn how to incorporate prevention and appropriate responsiveness in the workplace. • Participants will gain an overview of Office Ergonomics and be able to identify causes and solutions for Cumulative Trauma Disorders .

4. Violence & Threats

5. Workplace Violence • Violence can strike from the outside or from within. • The perpetrator can be a stranger or someone known to all. • It can be the result of a robbery, jealous spouse or over a disgruntled employee or angry client. • The policy at BBCBC is one of zero tolerance toward violence. Because of this, all acts or threats of violence will be taken seriously.

6. Workplace Violence (cont.) BBCBC defines a threat or act of violence as follows: • Including, but not limited to, any act or gesture intended to harass or intimidate another person. • Any act or gesture likely to damage company property. • Any act or gesture likely to leave another person injured or fearing injury. All employees are responsible for helping to maintain a violence free workplace. To that end, each employee is asked to report the act or threat to his or her immediate supervisor and/or a member of the Administrative Management Team. An incident/accident report form should be utilized for this purpose. Reports may be made confidentially or anonymously if the employee feels the need. Each act or threat of violence will be investigated and appropriate action will be taken. Any such act or threat by an employee may lead to discipline, up to and including termination.

7. Precautions and Warning Signs • There are certain precautions that employees of both BBCBC and its contract agencies can use to help protect themselves from danger. • There are warning signs and signals that, when observed and understood, assist in preventing disruptions or physical violence in the workplace.

8. Stage 1/Level 1 (Early potential for violence) Dehumanizing other people, name calling, racial insults or sexual harassment, other verbal abuse Challenging authority, insubordination, refuses to cooperate with immediate supervisor Regularly being argumentative, alienating client or co-workers, consistently argues with co-workers or management Spreads rumors or gossip Stages and Level of Violence Stage 2/Level 2 (Escalated potential for violence) • Ignoring or refusing to obey company policies and procedures • Stealing from the agency or co-workers, sabotaging equipment, client files or agency property • Making threats verbally, in writing, by E-mail or voice mail • Blaming others for all problems, sees self as victimized by management Stage 3/Level 3 (Potential for violence is realized) • Displaying or brandishing a weapon (knife, gun, etc.) • Physical fights, punching, kicking, slapping • Committing assault, arson, murder, suicide

9. De-Escalating Hostile/Violent Situations • Use effective listening and communication techniques such as: • negotiation and mediation • remain calm and listen attentively • maintain eye contact • be courteous and patient • Keep the situation in your control • Involve the person in regaining control and encouraging self-calming behaviors • Separate individuals involved in an altercation • Offer a voluntary escort to guide the person to a safe location • Employ a time out period to allow the person to calm down • Signal a co-worker or supervisor that you need help • Do not make any telephone calls yourself (this could be perceived as threatening and escalate the situation) • Keep talking, but follow instructions of the person with the weapon • Don't risk yourself or others • Never try to grab a weapon • Watch for a safe chance to escape to a safe area

10. Protection in Parking Areas/Outside Buildings • Park within the designated parking areas, especially when working after dark • Do not leave purses, briefcases, or other valuables in sight, as thieves can easily smash a window and steal these items in seconds • Be aware of surroundings at all times when leaving the building, especially in late evening, attempt to leave with another staff member

11. Visitors and ID Badges • Visitors should check in with the receptionist and should be escorted while in the building and not allowed to wander freely. This too applies to children as well as adults, clients and professionals in the service centers as well as the BBCBC administrative office. • Employees should carry their BBCBC picture ID and business cards for presentation when requested for security reasons.

13. Additional Materials-Worker Safety Visit the Child Welfare Information Gateway: • http://www.childwelfare.gov/systemwide/workforce/org_culture/worker_safety.cfm

14. Domestic Violence • Although this is a sensitive area, it is important for BBCBC and its contract providers to know if an employee has reason to fear the non-employee’s significant other, or if there has been any previous physical altercations or threats. With this knowledge, BBCBC and its provider agencies can assist the employee in designing a safety plan to reduce the likelihood of a problem occurring.

15. Medical Issues

16. Infectious Diseases • An infectious disease is a disease caused by bacterial, viral, fungal, or protozoan infection. Though some infectious diseases are not contagious, others may be transmitted from animal to person (bird flu and cat scratch disease) or from person to person. Examples include viral illnesses, HIV/AIDS, meningitis, whooping cough, pneumonia, and tuberculosis.

17. Local Infectious Diseases • The most frequent local infections, including the common cold, occur in the upper respiratory tract. A serious and usually local infection of the respiratory tract is tuberculosis, which is a problem worldwide.

18. Sites for Infectious Diseases • Other common sites of infection include the digestive tract, the lungs, the reproductive and urinary tracts, the eyes or ears. Local infections can cause serious illnesses if they affect vital organs such as the heart, brain or liver. They also can spread through the blood stream to cause widespread symptoms.

19. Infectious Diseases and the Immune System • The outcome of any infection depends on the virulence of infectious agents, the number of organisms in the infecting inoculum and the response of the immune system. A compromised immune system, which can result from diseases such as AIDS or treatment of diseases such as cancer, may allow organisms that are ordinarily harmless to proliferate and cause life-threatening illness.

20. Transmission of Infectious Diseases • Transmission of an infectious disease may occur through one or more of diverse pathways including physical contact with infected individuals. • These infecting agents may also be transmitted through liquids, food, body fluids, contaminated objects, airborne inhalation, or through vector-borne spread. Vectors may be mechanical or biological.

21. Mechanical Vectors and Infectious Diseases • A mechanical vector picks up an infectious agent on the outside of its body and transmits it in a passive manner. An example of a mechanical vector is a housefly, which lands on cow dung, contaminating its appendages with bacteria from the feces, and then lands on food prior to consumption. The pathogen never enters the body of the fly.

22. Biological Vectors and Infectious Diseases • In contrast, biological vectors harbor pathogens within their bodies and deliver pathogens to new hosts in an active manner, usually a bite. Biological vectors are often responsible for serious blood-borne diseases, such as malaria, and viral encephalitis,. Biological vectors are usually, though not exclusively, arthropods, such as mosquitoes, ticks, fleas and lice.

23. Universal Precautions • Work practice controls are designed to change the way in which a task is performed to reduce the likelihood of exposure to bloodborne pathogens. • The most important work practice control is implementation of "universal precautions" which are a set of precautions recommended by the CDC which are designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens when providing first aid or health care. • Under universal precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, HBV and other bloodborne pathogens. • Body Fluids requiring the use of Universal Precautions • Universal precautions apply to blood, other body fluids containing visible blood, vaginal secretions and semen. Universal precautions also apply to tissues and to the following fluids: cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids. • Universal precautions do not apply to feces, nasal secretions, sputum, sweat, tears, urine, and vomit unless they contain visible blood. • Universal precautions do not apply to saliva except when visibly contaminated with blood or in the dental setting where blood contamination of saliva is predictable. • General infection control practices are used to further minimize the already minute risk for salivary transmission of HIV. These infection control practices include the use of gloves for digital examination of mucous membranes and endotracheal suctioning, hand washing after exposure to saliva, and minimizing the need for emergency mouth-to-mouth resuscitation by making mouthpieces and other ventilation devices available for use in areas where the need for resuscitation is predictable.

24. Prevention Efforts in BBCBC Offices Each one of our service centers have a constant flow of traffic by professionals, caretakers and children. An exaggerated effort is made to keep the lobby area clean as well as door handles, phones and conference areas. Special attention is paid to toys in the common areas. Cleaning and good hygiene can also prevent: • Influenza • The common cold • Strep throat • Intestinal disorders • Pneumonia

25. Preventing Infectious Diseases • Wash your hands often/use an alcohol-based hand sanitizer, especially: • After using the bathroom • Before preparing food or eating • After changing diapers • After blowing your nose and/or using hands when sneezing or coughing • After caring for a sick person • After playing with or handling your pet

26. Pandemic Flu BBCBC is dedicated to ensuring that employees needs are met should there be threat of such an event as a Pandemic Flu. The following is an excerpt from the Department of Health regarding an outbreak of a Pandemic Flu (such as Bird Flu). This checklist will help to gather the information and resources you may need in case of a flu pandemic.

27. Flu Precautions & Response 2. To limit the spread of germs and prevent infection : • People with respiratory illness should stay home from work or school to avoid spreading infections, including influenza. • Avoid close contact with people who are coughing or otherwise appear ill. • Avoid touching your eyes, nose and mouth. • Wash hands frequently to lessen the spread of respiratory illness. • People experiencing cough, fever and fatigue, possibly along with diarrhea and vomiting, should contact their physician. • If you think you have influenza, please call your health care provider and discuss whether you need to be seen in their office, emergency department or stay home. 1. To plan for a pandemic: • Store a two week supply of water and food. This can be useful in other types of emergencies, such as power outages and disasters. • Have any nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins. • Volunteer with local groups to prepare and assist with emergency response. • Get involved in your community as it works to prepare for an influenza pandemic.

28. Medical Emergencies • If the injury is minor, provide first aid as necessary with a departmental First Aid Kit. • If the injury or condition is not minor call (9-1-1). Give the operator the following information: • Location of victim • Type of injury • Your name and call back number • Notify your supervisor of the situation. • Follow any further instructions the 911 dispatcher or you supervisor gives you. • Comfort victim until EMS arrives.

29. Office Ergonomics

30. Office Ergonomics • Ergonomics is the science of “designing the job to fit the worker, not forcing the worker to fit the job. Ergonomics covers all aspects of a job, from the physical stresses it places on joints, muscles, nerves, tendons, bones and the like to environmental factors which can affect hearing, vision, and general comfort and health.

31. Cumulative Trauma Disorders • To understand CTDs, it is necessary to understand how the body works. Body Movements are produced by contracting and relaxing muscles. The muscles are attached to bones by tendons. Tendons are smooth, and in some parts of the body they glide back and forth inside tubes called synovial sheaths. The sheath produces a lubricant called synovial fluid to help the tendons glide easily. CTDs result when repeated stress is placed on the tendons, muscles, or nerves causing inflammation or damage.

32. Cumulative Trauma Disorders (cont.) The following are some of the most common CTDs: • Tendonitis – inflammation of the tendons • Ttensynoitis – inflammation of the synovial sheath • Carpal Tunnel Syndrome – results when the median nerve is compressed either form the swelling of tendons and sheaths or from repeated bending of the wrist. Some of the conditions that my lead to CTDs are: • Repetition – long or concentrated hours of typing or using a mouse. • Posture – long hours of sitting in the same position while typing, especially if it is in an uncomfortable or poorly supported position, or if the wrists are bent. • Lack of Rest - intensive hours at the keyboard with few breaks

33. Cumulative Trauma Disorders (cont.) Symptoms of CTDs • Tingling or numbness in the hands or fingers • Pain in fingers, hands, wrists, or even shooting up into the arms or forearms • Loss of strength or coordination in the hands • Numbness or discomfort in the hands which wakes you up at night. Carpal Tunnel Syndrome • Carpal Tunnel Syndrome is a common problem that affects the hand and wrist. This condition, or syndrome has become the focus of much attention in the last few years due to suggestions that it may be linked to occupations that require repetitive use of the hands such as typing.

34. Preventing CTDs to hands and wrists • One of the keys to preventing CTDs is to keep your hands and wrists in a “neutral” position as possible. In other words, you want to avoid typing with your wrist bent to either side, or up or down. You do not want your wrists to be flexed in any direction. • The neutral position may be obtained by adjusting your desk height, chair height, or keyboard position. Here are some tips for preventing hand and wrist CTDs: • The keyboard should be slightly lower than normal desk height. If it not low enough, try raising your chair height. Prevent your legs from dangling by using a footrest. • “Home row” of keys should be at elbow level

35. Preventing CTDs to hands and wrists (cont) • While typing, it is best not to rest your wrists, and they should not be bent up, down or to the side. This may be easier if they back edge of the keyboard is tilted down slightly, away from you. The knuckle, wrist, and top of forearm should form a straight line. Wrist supports or rests give you a place to rest your hands only when pausing from typing, not while you are typing. • Do not pound the keys. Use light touch. • Use two hands to perform double key operations like Ctrl-C or Alt-F instead of twisting one hand to do it. • The elbows should form a 90 degree angle while “hanging” at the sides from the shoulders. They should remain relaxed in a lowered position while typing. • Take lots of breaks to stretch and relax. Take frequent “micro-breaks” (lasting few seconds or so) as well as longer (several minute) breaks every hour or so. • Hold the mouse lightly • Keep your hands and arms warm.

36. Eyestrain • Eyestrain is another ergonomic problem frequently associated with the use of computers and Video Display Terminals (VDTs). Keep in mind that the solutions presented here are only recommendations. • If following these recommendations seem to make matters worse, try something else! • If you aren’t experiencing headaches or eyestrain while you work on the computer, don’t’ worry about making changes; obviously your setup works for you.

37. Symptoms of Eyestrain • Sore, tired, itchy, dry, or burning eyes. • Headaches • Difficulty focusing between the VDT and source documents • Blurred or double vision • Color fringes/after images • Increased sensitivity to light

38. Causes of Symptoms Improper Lighting: if the light in the work area is too bright or too dim, the human eye has to work extra hard to compensate for these harsh environmental factors. People may not even be aware that their eyes are under duress, but over time they may develop symptom of eyestrain. Solution: use indirect, ambient lighting and an adjustable light source at the desk, where extra illumination is required. • Glare: Glare can be caused by sources of light such as windows, lamps , or overhead lighting. • Look at your monitor screen to see if there are any blotches of light. While you may not be conscious of this irritation, it can cause eyestrain over the course of a long day. Glare can also be caused by too much contrast between the screen background and the displayed text. • Solution: Adjust your monitor so that it is not reflecting the light sources. Tilt the monitor down so that it doesn’t reflect overhead light, or move it perpendicular to windows. Close shades or blinds if the computer cannot be moved. Move lamps so that they are not reflected directly in the monitor. Use glare screens.

39. Causes of Symptoms Eyewear: Many computer users wear bifocals or trifocal lenses fitted for reading print and distance viewing. Sometimes these prescriptions may not be adequate for computer work. Solution: If you wear glasses of any sort and frequently experience headaches while working at a computer, you should probably check with your eye doctor to make sure you are wearing the correct prescription for such work. • Viewing angle and distance: If your monitor is too far away, you may have to strain to read the print. Likewise, if it is too close, you may also strain your eyes. If the monitor is too high, you will have to angle your neck to look up at it, which could cause your neck to be sore, and may contribute to headaches. Also, when you are continually looking up, you may not fully close our eyes when you blink, and this can cause your eyes to dry out. • Uninterrupted focus on the screen: When people concentrate, they blink less often. Sometimes they concentrate so hard that they blink only once per minute, instead of the normal once every five seconds. This, too, will cause the eyes to dry out and become irritated. • Solution: Take micro-breaks! Frequently look up from your monitor and focus on an object several feet away. Make a conscious effort to blink. Uninterrupted focus on the screen: When people concentrate, they blink less often. Sometimes they concentrate so hard that they blink only once per minute, instead of the normal once every five seconds. This, too, will cause the eyes to dry out and become irritated. Solution: Take micro-breaks! Frequently look up from your monitor and focus on an object several feet away. Make a conscious effort to blink.

40. Physical Stressors • Include repetitive motions such as those caused by typing or any continuous motion. This could include work that causes vibration or heavy lifting, working in an awkward position, or holding a telephone to your ear with your shoulder. Repetitive motions, vibration, excessive force, and awkward positions are frequently linked to ergonomic disorders; however, the majority to “Cumulative Trauma Disorders “(CTD’s) or “Repetitive Strain Injuries” (RSI’s) are caused by repetitive motions that would not result in undue stress or harm if only performed once. Carpal tunnel syndrome, tendonitis, Tenosynovitis, Dequarvain’s Syndrome, Thoracic Outlet Syndrome, many back injuries, and several other conditions may result from repetitive motions.

41. Environmental Stressors • Could include such things as indoor air quality or excessive noise. “Sick building syndrome, “with its accompanying headaches, congestion, fatigue and even rashes, can result from poor air quality in a building or office. Excessive noise around heavy machinery or equipment can cause permanent haring loss. Improper lighting can cause eyestrain and headaches, especially in conjunction with computer monitors. • It is important to listen to the signals your body gives you. If you suffer pain in the wrists or hands after a long day of typing, examine your work area and work practices to see if they may be causing the problems. Learn to make adjustments. Raise or lower chairs to avoid typing with your wrists at an odd angle. Adjust computer monitors to avoid glare. Take frequent breaks from repetitive tasks to give your body a rest. Always use proper lifting techniques. Sometimes small modifications to work procedures, posture habits, and/or work station design can make a big difference in the way you feel at the end of a day.

42. References • http://en.wikipedia.org/wiki/Infectious_diseases • http://www.idsociety.org/factsaboutid.html • http://www.edcp.org/factsheets/prevent.cfm • http://www.health.state.ri.us/disease/communicable/thingstodo.php For More Information • Visit: www.pandemicflu.gov • The Centers for Disease Control and Prevention (CDC) hotline, 1-800-CDC-INFO (1-800-232-4636), is available in English and Spanish, 24 hours a day, 7 days a week. TTY: 1-888-232-6348. Questions can be e-mailed to cdcinfo@cdc.gov. • Links to state departments of public health can be found at http://www.cdc.gov/other.htm#states.

43. Training Documentation Thank you for completing this online training presentation. • To document your participation please immediately send an email listing your name, position, agency, email address, and circuit to the BBCBC training department at: training@bigbendcbc.org • Please let us know any training topics you would like to be provided with in a classroom training, online presentation or training resource materials. • BBCBC Training Coordinator contact: Carol Edwards 850-694-0728