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Those First Few Moments Are Critical
By Sara Freiberg

The eye is a magnificent, complex, delicate organ and the second most powerful body part, after the brain.In fact the eye uses about 65% of our brainpower, more than any other part of the body, processing about 36,000 bits of information an hour. Each eye contains 107 million cells and more than two million working parts, and while fingerprints have 40 unique characteristics, the iris has 256. The muscles that control the eye are continually active 24/7. Seven million cones in our eyes help us to see color and detail, and the 100 million rods help us distinguish between black and white. The eye is a scientific wonder.1

Ophthalmologists have the ability to transplant a cornea but have yet to find a way to transplant an entire eye; therefore, as we depend on our sight to do our everyday tasks, the most important thing we can do to protect our eyes at work is to always wear the appropriate protective eyewear to help prevent most serious eye injuries. In addition to incorporating eye protection, shouldn’t we also have a game plan if something has the potential to cause damage to them?

OSHA and ANSI/ISEA guidelines
Per the Occupational Safety and Health Administration (OSHA) guidelines, all workers have the right to a safe workplace. OSHA’s primary regulation concerning eyewash and shower stations can be found in 29 CFR 1910.151(c).This regulation states, “Where the eyes or body of any person may be exposed to injurious corrosive materials, suitable facilities for quick drenching or flushing of the eyes and body shall be provided within the work area for immediate emergency use.” Although the OSHA regulation regarding emergency equipment does not define what constitutes suitable facilities for drenching the eyes or body, in 1981, the American National Standards Institute (ANSI) established a standard, covering emergency eyewash and shower equipment. This standard, ANSI Z358.1, was revised several times and the current 2014 standard “is intended to serve as a guideline for the proper design, certification, performance, installation, use, and maintenance of emergency equipment.”3

Photo Credit – Staff Sgt. Alan Wilkinson

Following is a summary of the ANSI/ISEA Z358.1 Compliance Checklist for eyewashes.

  • Location: Emergency equipment must be installed within 10 seconds walking time (approximately 55 feet) from the location of a hazard (i.e., damaging chemicals, corrosive cleaning solutions, etc.). The equipment must be installed on the same level as the hazard. In other words, it should eliminate the need to go up or down stairs, and the path of travel from the hazard to the eye wash equipment should be free of any obstructions and as straight as possible.A door is considered an obstruction; however, if the hazard or chemical is not a corrosive, one intervening door may be present between the hazard and eyewash emergency equipment provided the door opens in the same direction of travel as the person attempting to reach the emergency equipment, and the door is equipped with a closing mechanism that cannot be locked to impede access to the emergency equipment.4
  • Identification: An eyewash station should be identified in a location with a highly visible sign in a well-lit area.
  • Proper placement of nozzles: The flow nozzles of the eyewash station must be mounted a minimum of 33 inches and a maximum of 45 inches above the floor, and a minimum of 6 inches from any wall, post, or other barrier.
  • Water temperature: Water delivered by eyewash station should be tepid (60–100°F).
  • Water flow: Eyewash units should provide 0.4 gallons of water per minute continuously for at least 15 minutes, be designed to flush both eyes simultaneously, and remain on without use of the operator’s hands until intentionally shut off.
  • Employee training: The standard requires that employees be fully trained in the use of eyewash stations.
  • Proper maintenance: Routine testing should be performed on a weekly basis and documented. An annual inspection is required to determine conformance to installation and that requirements are maintained.5

In 2016, The Healthcare Facilities Accreditation Program (HFAP) released an annual quality report, much like reports from The Joint Commission, listing the most commonly cited standards found during its 2016 surveys. Regarding physical environment deficiencies, 11.01.10/03.01.02 Eye-wash Stations noted that eyewash stations were cited for not being tested on a weekly basis, they did not meet ANSI Z358.1-2014 requirements, and were not located within 55 feet of hazardous materials.6

In 2018, OSHA listed their Top 10 Most Frequently Cited Standards, and Eye and Face Protection (29 CFR 1926.102) was on their list.7

The Joint Commission looks for compliance with healthcare workers wearing their PPE as a standard precaution. During a Joint Commission survey, a surveyor may ask what personal protection equipment is available to you. Employees should confirm and respond that their facility has face shields, gowns, masks, shoe covers, safety glasses, and gloves, as well as hazardous spill kits available for staff. Staff members should know the location of PPE items and wear them daily.

Make eye protection a workplace priority
Blinking can remove dust or debris that touches our eye; however, blinking to wipe away debris is vastly different than what our eyes are capable of when presented with a chemical splash. The first few moments of an eye splash are extremely critical and an acidic or an alkaline chemical sprayed or splashed in the eye can cause severe damage to the delicate tissue of the eye. An acidic chemical will cause damage to the surface of the eye while alkaline chemicals can quickly penetrate the inner chambers of the eye. Contact lenses can cause additional problems as the contact lenses can further trap the chemical.8

Eyewash stations are a form of first aid equipment to be used in the event of an emergency; however, they are not a substitute for wearing our PPE or for safe protocols on handling hazardous materials. Our best line of defense is to wear the proper PPE that is provided for us and to protect our eyes from potential harm because blinking may not be quick enough or provide enough eye protection. Remember, OSHA mandates that all workers have the right to a safe workplace, but we each bear the responsibility to incorporate the proper protection for our eyes.

Resources
ANSI/ISEA Z358.12014 Edition

This standard is intended to provide uniform minimum requirements for the performance, use, installation, test procedures, maintenance, and training of emergency eyewash and shower equipment.

Another critical factor is having access to safety data sheets (SDSs) for each chemical used in your department. Safety data sheets identify the chemical properties of a substance or mixture and list the potential to cause damage to the eye. The first aid section will refer to the treatment that should be used for exposure of the eyes to the chemical.

References

  1. https://brightside.me/article/40-incredible-facts-about-your-eyes-which-you-never-imagined-were-true-24555/
  2. https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=9806&p_table=STANDARDS
  3. http://www.gesafety.com/downloads/ANSIGuide.pdf
  4. http://www2.mdanderson.org/depts/cpm/standards/Guides/D201001-M.pdf
  5. https://keyeslifesafety.com/more-on-eye-wash-stations/
  6. http://www.hospitalsafetycenter.com/content/330861/topic/WS_HSC_HSC.html
  7. https://www.osha.gov/Top_Ten_Standards.html
  8. https://www.selectsafetysales.com/t-effects-of-chemical-splashes-in-the-eyes.aspx

Sara Freiberg, CST, CBSPDT, CER, has more than 15 years experience working as a certified surgical technologist, with five of those years spent traveling to various operating rooms across the U.S. Following Sara’s time in the clinical arena, she worked as a surgical technology didactic and lab instructor at Rasmussen College. Sara holds bachelor degrees in science and business and marketing, which led to her work with various medical device companies as a clinical specialist, product manager, and clinical training manager. She has experience working on quality and regulatory teams, monitoring patient-adverse events, and postmarket surveillance activities.

 

Sara currently works for Northfield Medical as a clinical education manager where she provides education which is based on current manufacturer and regulatory guidelines regarding various healthcare topics for SPD, OR, and GI staff. Training entails the care and handling of medical devices to ensure patient safety, as well as targeted education addressing departmental cost concerns. Her passion is working with SPD, OR, and GI departments; providing assessments; and sharing best practices with respect to patient and staff safety, surgical instruments, and medical devices. Sara is a voting member of the AAMI ST/WG84, ST91 flexible endoscope committee, and she has developed several CEU presentations approved through CBSPD, CBRN, NCCT, and IAHCSMM. Sara also authors a biweekly healthcare article for Ultra Clean Systems.

Sara is currently studying for the Certification Infection Control (CIC) exam through APIC.

 

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