OSHA Long Term Care Worker Protection Program

1. OSHA Long Term Care Worker Protection Program

2. Define key terms in Subpart E & L. • Identify the key elements of the regulations. • Discuss the implications of these regulations for long term care settings.

3. 1.45 million fires 2008; 1,348,500 in 2009. • Over 3300 civilian deaths; 16,705 injuries. • Decline in both in 2009. • 15.4 Billion in property loss. • 34% of these fires were in structures. • NFPA, Fire Loss in the United States, 2008; revised September 2009. • NFPA, Fire Loss in the United States, 2009

4. Exit Routes, Emergency Action Plans, and Fire Prevention Plans • 1910.33 – 1910.39

5. 1910.35: An employer who demonstrates compliance with the exit route provisions of NFPA 101-2000, the Life Safety Code, will be deemed to be in compliance with the corresponding requirements in 29 CFR 1910.34, 1910.36, and 1910.37. • For automatic sprinkler systems, may follow NFPA and National Board of Fire Underwriters standard in place at the time of installation. • A resource for many organizations.

6. Triangle Fire March 19, 1911 – New York City. • Killed 146 workers, many jumped from upper floors. • The deadliest accidental industrial building fire in the nation’s history. • December 14, 2010: Fire in a garment factory near Dhaka, the capital of Bangladesh – 30 died, 100 injured.

7. Definitions • Exit Route: a continuous and unobstructed path of exit travel from any point within a workplace to a place of safety. • Exit access: that part of an exit route that leads to an exit (a corridor that leads to a stairway(Exit). • Exit: that part of an exit route that provides a protected way of travel to the exit discharge. • Exit Discharge: the part of the exit route that leads directly outside or to a street, walkway, refuge area, or open area with access to the outside.

8. Exit routes must be permanent. • An exit must be separated by fire resistant materials. • Openings into an exit must be limited. • The number of exit routes must be adequate. • Exit discharge must lead directly outside. • Exit doors must be unlocked from the inside. • A side-hinged exit door must be used. • Exit route: ceiling at least 7’6” high, 28” wide.

9. The danger to employees and patients must be minimized. • Must be free and unobstructed. • Safeguards (sprinklers, alarms, exit lighting) must be in working order at all times. • Lighting and marking of exits must be clearly visible. • Signs must say EXIT, at least 6” high, by ¾”.

11. (b)(1) At least two exit routes must be available in a workplace to permit prompt evacuation during an emergency: • The exit routes must be located as far away as practical from each other so that if one exit route is blocked by fire or smoke, employees can evacuate using the second exit route.

12. Procedures for: * reporting a fire * emergency evacuations * employees who remain to operate critical plant operations before they evacuate * accounting for all employees and patients after evacuation

13. EAP • (b) An emergency action plan must be in writing, kept in the workplace, and available to employees for review. • However, an employer with 10 or fewer employees may communicate the plan orally to employees.

14. Emergency Plans • Emergency care procedures. • Alarm system for employees. • Employer must designate and train employees to assist in a safe and orderly evacuation of other employees. • Review the action plan with employees when they start their job, when their responsibilities in the plan change, or when the plan changes.

15. An employer must designate and train employees to assist in a safe and orderly evacuation of other employees. EAP

16. RACE • R: Rescue • A: Alarm • C: Contain/confine • E: Extinguish or evacuate

17. Emergency Plans • Plans should address emergencies that the organization can reasonably expect in the workplace: * Fire * Toxic chemical release * Hurricanes * Tornadoes * Floods * ?others

18. A fire prevention plan must include: • list of all major fire hazards, • proper handling and storage procedures for hazardous materials, • potential ignition sources and their control, and • the type of fire protection equipment necessary to control each major hazard.

19. Procedures to control accumulations of flammable and combustible waste materials Cans of paint left open, not stored or disposed of upon completion of work

20. Need to assure that an adequate number of employees are available at all times during working hours to act as “evacuation wardens” so that employees can be swiftly moved from the danger location to safe areas. • They must know the correct place to direct employees, trained in workplace layout and alternative escape routes, aware of handicapped employees who may need extra assistance, check all rooms and enclosed spaces for employees, an account for or verify that all employees are in the safe areas.

21. This subpart contains requirements for: • Fire brigades • All portable and fixed fire suppression equipment • Fire detection systems • Fire or employee alarm systems

22. Oxygen source • Fuel source • Ignition mechanism

23. Definitions • "Class A fire" - involves ordinary combustible materials such as paper, wood, cloth, and some rubber and plastic materials. • "Class B fire" - involves flammable or combustible liquids, flammable gases, greases and similar materials, and some rubber and plastic materials. • "Class C fire" – involves energized electrical equipment where safety to the employee requires the use of electrically nonconductive extinguishing media. • “Class D fire”– fire involving combustible metals such as magnesium, titanium, zirconium, sodium, lithium, and potassium.

24. Noted in CAMH (Jan 2009) LS.O2.01.35 • Kitchen grease and oil fires. • Significant risk area. • Avoid splashing. Never pick up a burning pan of grease!

25. (a)Scope: • The placement • Use • Maintenance • Testing of portable fire extinguishers provided for the use of employees • Training and education

26. Fire Extinguishers • Employee Education * General principles of fire extinguisher use * Upon employment, if role or equipment changes, and annually • Inspection, maintenance and testing * Portable extinguishers: inspected every 30 days * Annual maintenance

27. Fire Extinguishers • Always know where they are located. • To use one: * P: Pull the pin * A: Aim low *S: Squeeze the lever *S: Sweep the fire

28. If required: • The employer shall provide portable fire extinguishers and shall mount, locate and identify them so that they are readily accessible to employees without subjecting the employees to possible injury. Any problem here?

29. Visually inspected annually and tagged with date of the inspection.

30. Important! Dates must be recorded, and all extinguishers tagged.

31. * Are selected and distributed based on the classes of anticipated workplace fires and on the size and degree of hazards affecting their use.

32. Travel distance to extinguisher: 75 ft • For Class K (grease fire areas): 30 ft

33. Fires in healthcare settings are never good. • Devastating results. • Need to protect patients and employees from the serious hazard of a fire. • Use of the “defend-in-place” concept from NFPA 101- Life Code.

34. Building construction • Sprinkler system • Detection and alarm systems • Horizontal movement to safety • Compartmentation • Staff training • Key: Provide occupants with enough protection to enable them to survive a fire while remaining in the building.

35. What we have learned….. • What we can do…..

36. April 13th, 1918: Norman, OK, State Hospital – 38 • May 15th, 1929: Cleveland Clinic – 125 • April 5th, 1949: St. Anthony’s Hospital, Illinois – 74 • July 14th, 1960: Guatemala City, Mental Hospital - 235 • December 8, 1961: Hartford Hospital, CT - 15 • May 20th, 1980: Kingston, Jamaica, Residential Care Facility – 157 • Feb 26, 2003: Hartford, CT, Nursing Home – 16 • January 31, 2009: Northwest Russia, Nursing home – 23

37. Kitchen fires • Electrical fires • Waste material fires • Fires due to smoking

38. Talking with patients and families/visitors about fire hazards related to smoking. • Assessing smoking behaviors. • Help all staff to be alert to any obstruction to fire exits/fire routes. • Know where the fire extinguishers are located. • Recognizing every fire drill as a learning/teaching opportunity.

39. What can happen with simple appliances? • How can we prevent this?

40. Recognize the importance of employee education. • Special focus on use of appliances/equipment and smoking. • Reminders. • Debriefing after drills/events.

41. Keys to success: * a clear plan. * employee education and practice. * awareness of fire exits and use/location of fire extinguishers. * awareness/abatement of potential fire hazards. Think Safety, Not Just Compliance!