Health and Safety ReportVolume 9, Issue 1

You may have seen the signs posted as you entered a long term care facility warning of an outbreak of Clostridium difficile (C. difficile). As one of the most common diarrheal infections in hospitals and long-term care facilities, this nasty bacterium can cause diarrhea and more serious intestinal conditions like colitis (or inflammation of the colon) among patients or residents. In rare cases, C. difficile can cause death.

The symptoms of C. difficile infection include watery diarrhea, fever, loss of appetite, nausea, and abdominal pain/tenderness.

Who is at risk?

Healthy people are usually not affected by C. difficile. People who are elderly, have serious health conditions (e.g. immune-compromised or cancer) or use antibiotics are at risk. Antibiotics can change the levels of good bacteria found in the intestines. When there are fewer of these good bacteria in the colon and intestines, it creates conditions for C. difficile to grow and produce toxins that lead to infection.

Although C. difficile is commonly found in elderly patients or residents in hospitals and long-term care facilities, a recent study showed an increasing trend of C. difficile infection among hospitalized children, especially those with inflammatory bowel disease or other conditions requiring antibiotics or immunosuppression.

C. diffcile can also pose a risk for infection to health care workers who may be healthy but receiving even short treatments of antibiotics. Workers in health care facilities who are immunocompromised or chronically ill may be at greater risk for C. diffcile infection.

Preventing the spread of C. difficile

C. difficile bacteria are found in feces. When a person is infected, the bacteria in the stool can contaminate surfaces such as toilets, handles, bedpans, or commode chairs. People can become infected if they touch contaminated equipment, objects or surfaces and then touch their eyes or mouth. They can further spread the bacteria if they touch other surfaces with their soiled hands.

C. difficile is most often transferred to patients on the hands of health care workers who have had contact with contaminated patients or feces.

There are steps that everyone can take to control and prevent the spread of C. difficile in health care settings.

EMPLOYERS (health care facilities)

• Along with your joint health and safety committee, conduct a risk assessment of C. difficile in your facility and take measures to protect the employees and patients or residents.

HEALTH CARE WORKERS

• Do not eat or drink in areas where patients are being cared for.


• Take proper "contact precautions" as outlined in the Public Health Agency of Canada guidelines in addition to routine infection control precautions when caring for symptomatic patients.


• Wash hands frequently, especially after using the toilet, before eating, and between entering patients' rooms.
  
• Use gloves during patient's care.
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• Wear a gown if direct contact with patients, their soiled clothing or surfaces of their rooms is likely.
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• Dedicate equipment for use when working with infected patients to avoid cross patient contamination.
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• Continue these precautions for 72 hours after the patient's diarrhea has resolved.
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• Be thorough when cleaning the environment, and be sure to use an approved hospital grade disinfectant.

VISITORS

• Use the alcohol-based hand sanitizer provided.


• If your hands are visibly dirty, use soap and water to wash them.


• Follow infection control procedures that are prescribed by the health care facility.

PATIENTS

• When prescribed antibiotics follow your doctor's instructions and take the full course of the medication as recommended to kill all of the C. difficile bacteria - even after you start to feel better. If even some of the bacteria survive, they may become drug resistant and make treating the infection more difficult.

Resources:

• OSH Answers, CCOHS
  
• C. difficile Fact Sheet, Public Health Agency of Canada
• Clostridium difficile-Associated Diseases (CDAD): Infection Control Guidelines, Manitoba (PDF)
• Clostridium difficile Infection in Hospitalized Children in the United States, Archives of Pediatric and Adolescent Medicine Published online January 3, 2011. doi:10.1001/archpediatrics.2010.282
• FAQs about Clostridium difficile for Healthcare Providers, Centers for Disease Control and Prevention
• Infection Control Guidelines - Hand Washing, Cleaning, Disinfection and Sterilization in Health Care, Public Health Agency of Canada (PDF)
• Download the free CCOHS posters: Prevent the Spread and Get the Upper Hand on Germs.

For many, handling, storing or working with chemical products is a regular part of their job. Knowing how these chemicals may affect their health and safety is not only a legal right for workers, it can also reduce injuries and property damage, and save lives.

Every WHMIS (Workplace Hazardous Materials Information System) controlled product sold for use in Canada must be accompanied by a current material safety data sheet (MSDS). The MSDS must be specific to the individual product or material (both the product name and supplier on the MSDS must match the material in use). Employers are legally responsible to make the MSDS readily available to employees.

An MSDS is a document prepared by the supplier or manufacturer that contains important information about the potential hazards (health, fire and reactivity) of a chemical product and how to work safely with it. The MSDS also describes how to safely use, store and handle the product and what to do in an emergency. It tells how to recognize symptoms of exposure and what first aid and other procedures might be necessary. If a controlled product is made in the workplace, the employer has a duty to prepare an MSDS for this product.

Under WHMIS law, an MSDS for a controlled product must not be more than three years old. If you are still using a product that you bought more than three years ago, you should contact the manufacturer or supplier again and ask for a newer version of the MSDS. If they are unable to provide you with one (for example, if they no longer make or sell the product), then you should obtain or prepare an updated MSDS yourself or discontinue using the product.

There are nine (9) categories of information that must be present on an MSDS in Canada. These categories are specified in the Controlled Products Regulations and include:

1. Product Information (e.g. product identifier (name), manufacturer/ supplier name, address, and emergency phone number)


2. Hazardous Ingredients


3. Physical Data (e.g. physical state and odour threshold)


4. Fire or Explosion Hazard Data


5. Reactivity Data (e.g. the names of substances the product may react with)


6. Toxicological Properties (health effects)


7. Preventive Measures (e.g. engineering controls and personal protective equipment)


8. First Aid Measures


9. Preparation Information (e.g who prepared the MSDS and the date of preparation)

The Controlled Products Regulations prescribes what information must be present in more detail.

Always be familiar with the hazards of a product before you start using it. You should review the MSDS, match the product name on your container to the one on the MSDS, know the hazards, understand safe handling and storage instructions, and what to do in an emergency. In addition, your employer should supplement the MSDS information with site-specific information and training regarding first aid measures, hazard controls (e.g. required ventilation, gloves) and what to do in case of an emergency (e.g. spill or leak).

If significant new information becomes available before the three years has elapsed it's up to the supplier to update the product label and MSDS. Employers must ensure that every controlled product entering the workplace is accompanied by an up-to-date MSDS. The company's MSDS collection must be widely accessible to workers who may be exposed to the controlled products, and to the health and safety committee or representative. They can be stored in a binder, or digitally on a computer network, just as long as everyone in the workplace has easy access to them at all times.

Resources

The Canadian Centre for Occupational Health and Safety (CCOHS) offers more information, support and tools on how to use MSDSs and how to comply with the Controlled Products Regulations:

• MSDS Management Service makes it easy to manage your MSDSs.


• CCOHS' e-course WHMIS: Understanding MSDSs and other WHMIS e-courses can help you understand MSDSs and your responsibilities, as can CCOHS' MSDS publications


• Download the free WHMIS hazards symbols poster and WHMIS fact sheets.


• Do you write MSDSs? Learn how CANWrite can help.

Along with the shortened days and snow, Canadian winter months can bring frigid, sub-zero temperatures. For those who work outdoors without the comfort and protection of a toasty warm building, exposure to the cold can be hazardous and put them at risk for injury.

How do you beat the cold when you work outside? Aside from several layers of protective, dry clothing, and a healthy mix of physical activity, regular warm up periods can help you work safely in, and defend yourself from the cold.
Workers who are cold are more prone to injury because the temperature impacts their performance of complex mental tasks and reduces the sensitivity and dexterity of their fingers. As well, the cold carries its own potentially dangerous side effects. It is critical that workers and supervisors know the symptoms of over exposure to cold, proper clothing requirements, safe work practices, and physical fitness requirements for work in cold as well as emergency procedures in the event of cold injury. Information is the first defense.

To stay safe and dry, workers must insulate themselves against air temperature, air movement (wind speed), and humidity (wetness). A key counter measure is layered clothing. Done right, it will regulate the amount of heat and perspiration generated and lost while on the job. If the work pace is too fast or if the clothing is not properly selected, excessive sweating may occur and the clothing next to the body will become wet. The moisture will dramatically drop the insulation value of the clothing and increase the risk for cold injuries.

Hypothermia

Low body temperature (hypothermia) is the most common cold injury. Prolonged exposure to the cold causes the body to lose energy faster than it is produced, dropping body temperature. Warning signs are numbness, stiffness, drowsiness, poor coordination and sometimes even a lack of desire to get out of the cold. If any symptoms of hypothermia are present, immediately call for emergency assistance (911).

Get the victim out of the cold and cover him or her with warm blankets. If you are unable to get indoors, get the person out of the wind, use a blanket to provide insulation from the cold ground and cover the person's head and neck to help retain body heat. Once inside, remove and replace any wet or constricting clothes with dry clothing. Warm the person using your own body heat if necessary and apply warm compresses to the neck, chest wall, and groin. Stay with the person until medical help arrives.

Frostbite

Frostbite is the second most common cold injury. Noses, ears, cheeks, fingers and toes are most often affected. The freezing constricts blood vessels, which impair blood flow and may cause permanent tissue damage. If only the skin and underlying tissues are damaged, recovery may be complete. However, if blood vessels are affected, the damage is permanent and could result in the amputation of the affected part.

Seek medical attention. If possible, move the victim to a warm area. Give the victim warm drinks to replace lost fluids. Remove any wet clothing and loosen constricting jewelry that may restrict circulation. Loosely cover the affected area with a sterile dressing (keeping fingers or toes separated) and quickly transport the victim to an emergency care facility. DO NOT attempt to rewarm the affected area on site (but do try to stop the area from becoming any colder). Without the proper facilities, tissue that has been warmed may refreeze and cause more damage. DO NOT rub the area or apply dry heat and DO NOT allow the victim to drink alcohol or smoke.

Prevention

Prevention is the best way to deal with cold stress. Some do's and don'ts to help stay safe in a cold environment include:

DON'T

• Do not use alcohol, nicotine or other drugs that may affect blood flow.


• Do not expose yourself to cold temperatures after a recent shower or bath.

DO

• Dress in multiple layers of loose, dry, protective clothing.


• Ensure your hands, feet, face, head and eyes are covered.


• Keep moving.


• Take regular breaks from the cold in warm places.


• Eat properly and frequently to maintain body heat and prevent dehydration.


• Use a buddy system. Look out for one another and be alert for the symptoms of hypothermia.

But when is it just simply too cold to work? There are no legislated limits in Canada. But common sense, and the suggested guidelines outlined in the *Threshold Limit Values For Cold Stress - Work/Warm-up Schedule, should provide sound advice.

Health and Safety To Go!

CCOHS produces free monthly podcasts on a wide variety of topics designed to keep you current with information, tips and insights into the health, safety and well-being of working Canadians. You can download the audio segment to your computer or MP3 player and listen to it at your own convenience...or on the go!

Take 8 minutes and listen to the podcast Working in the Cold or see the complete list of topics.

Put health and safety in your pocket with CCOHS' Cold Weather Workers Safety Guide.

* The Threshold Limit Values for cold stress were developed by the Saskatchewan Department of Labour and later adopted by the American Conference of Governmental Industrial Hygienists (ACGIH).

Arming people with the knowledge they need to work safely can be challenging. CCOHS has over 65 e-courses on almost as many topics to help you educate and inform your staff. Two of the most recent additions to the e-learning program deal with hazard identification, assessment and control, and working at heights.

Hazard Identification, Assessment and Control

Hazards exist in every workplace, but how do you know which ones have the most potential to harm workers? This three hour, three-module course outlines proven techniques for identifying hazards, assessing risks and controlling hazards - each an essential part of an effective occupational health and safety program. This course will help employers, managers and members of health and safety committees improve their health and safety performance. The course covers essential topics such as hazard mapping, workplace inspections, risk assessment techniques, and the hierarchy of controls.

Working at Heights

Many jobs require people to work at heights. This can pose serious hazards, as falls often result in severe injuries or fatalities. In this one hour course, learn to assess hazards and safe working practices related to working at heights, as well as fall prevention techniques, safe use of ladders, scaffolds, lifts and platforms, and emergency preparedness. This introductory course should be supplemented by further instruction and hands-on training that is specific to the job, worksite and equipment.

All e-courses from CCOHS have been developed by subject specialists in the field, and reviewed by representatives from labour, employers and government to ensure the content and approach are unbiased and credible. All you need is a computer, access to the Internet - and you are ready to go! Our courses are designed to help you learn at your own pace and in your own environment at your own convenience.

See the full list of courses from CCOHS.

There are lots of new goodies to check out this month from CCOHS to help you work safely and be healthy at work:

LOOK for the new Day of Mourning posters and pins to help you commemorate this day set aside to remember those who have been injured or killed at work. Download the free poster or order the glossy printed versions, perfect for displaying in your workplace.

LISTEN to the latest free podcasts.

Every month new free podcast episodes are added to the Health and Safety to Go! program. You can listen now or if you can download to your MP3 player and listen when it is most convenient for you.

Working in the Cold Listen now.

Length: 8:13 minutes

The Scoop on How to Safely Shovel Snow Listen now.

Length: 4:03

LEARN and EARN continuing education points with the upcoming live webinar:


A Guide to Challenging Return-to-Work Situations, Feb. 16, 1:00 - 2:30 pm EST

and the latest recorded webinars:

Manual Materials Handling: Risky Business


Best RTW Practices for Workers with Musculoskeletal and Mental Health Conditions


You can see a complete listing of all podcasts, posters, and webinars on the CCOHS website.