Appendix B: Resident Safety Policy: Pediatric Emergency Medicine
Preamble
Residents have the right to work in a safe environment during training.
The purpose of this document is to provide a policy regarding workplace safety for
postgraduate trainees in Pediatric Emergency Medicine at the University of Toronto, and to
demonstrate the commitment of the residency program in the protection and safety of its
postgraduate clinical trainees. It is recognised that the responsibility for resident safety is
jointly shared between the resident and residency program.
This policy is in accordance with the RCPSC general standards of accreditation (January
2011) B1.3.9:
The residency program committee must have a written policy governing resident safety
related to travel, patient encounters, including house calls, after-hours consultations in
isolated departments and patient transfers (i.e. Medevac). The policy should allow resident
discretion and judgement regarding their personal safety and ensure residents are
appropriately supervised during all clinical encounters.
This policy does not supersede any established university-wide policy.
Scope
This policy covers resident safety in the areas of travel, patient encounters, and on-call
duties. It also includes occupational health and safety as well as workplace environmental
health and safety.
For the purposes of this policy, postgraduate trainee includes residents and clinical fellows.
These policies apply only during residents’ activities that are related to the execution of
residency duties.
PEM Program-specific policies
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Residents should not assess violent or psychotic patients without the backup of security
or a supervisor and also an awareness of accessible exits. Residents should call for
security to be present outside the room if needed.
Residents are not expected to make unaccompanied land or air transports.
Residents must observe universal precautions and isolation procedures when indicated.
International electives must occur in a stable political environment with a qualified
preceptor to provide appropriate supervision. Additionally there must be a Canadian
Consulate in that country.
Pregnant residents can have specific risks to themselves and the fetus. Therefore their
training environment and their duties may be modified to minimize these risks.
Responsibility of the resident
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The resident/fellow must participate in required safety sessions including Fire Safety,
infection control orientation sessions, and N-95 mask-fitting. The resident/fellow must
follow the safety codes of the site where they are training.
The resident/fellow must report any situation where personal safety is threatened and
should be aware of the contact for security at participating training sites.
Residents must keep their immunizations and TB skin testing up to date on an annual
basis.
Overseas travel immunizations and advice should be organized well in advance when
traveling abroad for electives or meetings.
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If the resident has determined that it is unsafe to travel (i.e. due to extreme weather
concerns) they may elect not to attend their clinic, their clinical consultation duties, their
other rotations, or academic curriculum sessions. In such circumstances, it is expected
that the resident will inform the chief resident, their clinical/rotational supervisor, and
the program director immediately. Taxi chits are available if the subway is closed.
Residents leaving from and arriving at the hospital after hours should be aware of their
environment and have a cellphone available to contact security if it is deemed an escort
is required while entering the building.
Attachments:
Appendix 1 – Hospital for Sick Children Safe Work Environment Policy
http://kidweb.sickkids.ca/healthyworkplace/section.asp?s=Safe+Work+Environment&sID=2
0672
Appendix 2: Hospital for Sick Children Occupational Health and Safety Information
http://kidweb.sickkids.ca/ohss/
Appendix 3: Hospital for Sick Children Biological Exposure Protocol
http://kidweb.sickkids.ca/ohss/section.asp?s=occupational+health&sid=16873&ss=biologic
al+exposure+protocol&ssid=16883
Appendix 4: Routine Practices Policy and Procedure (Lotus Notes)
Appendix 5: University of Toronto Faculty of Medicine Resident Health and Safety Guidelines
www.pgme.utoronto.ca/pande/Policies.htm
Adapted from ‘Resident Safety Policy Peds ID’ Updated Feb 2012
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Appendix 1 – Hospital for Sick Children Safe Work Environment Policy
http://kidweb.sickkids.ca/healthyworkplace/section.asp?s=Safe+Work+Environment&sID=2
0672
Safe Work Environment
SickKids is committed to the elimination of all workplace injuries and illnesses.
SickKids recognizes that a healthy environment addresses the health and safety of
the workforce and meets or exceeds responsibilities in relation to health and safety
legislation. SickKids fosters and supports a safe work environment through a number
of policies and programs.
Biological Safety
SickKids has implemented many policies and offers training sessions to keep staff
safe when dealing with biological matter. Exposure to biologicals can come in many
forms, including needles and sharps, patient samples, and research organisms.
Some of the steps taken to minimize risk and protect workers include:
 N95 respirator fit testing
 Staff immunizations and surveillance
 Hand hygiene stations disperse throughout the hospital
 Mandatory use of eye and/or face protection when there is a potential for
injury
Chemical Safety
Initiatives in place to keep workers and the environment safe when dealing with
chemicals include:
 WHMIS training for new employees and annual re-training for returning
employees
 Chemical removal program that takes place every month
Employee Incident Reporting
SickKids policy and legal obligations under the Workplace Safety and Insurance Act
and the Occupational Health and Safety Act require that all work-related incidents be
reported, whether or not they lead to personal injury or illness. This may include,
but is not limited to, slips, trips, falls, strains, sprains, chemical exposures or
splashes, biological exposures or splashes, sharps injuries, and any other situation
which resulted or may have resulted in employee injury or illness. The online safety
reporting system can be acessed here.
Ergonomics
Input to workplace design
Occupational Health and Safety Services (OHSS) has complied information from
various sources on the ideal workstation set-up to help prevent and lower the risk of
injury in the workplace. Occupational hygienists are always willing to offer input into
better workplace design. Documents to help setting up a more ergonomicallyfriendly workstation can be accessed through OHSS.
Assessments
Assessments of workstations can be done by OHSS at the request of employees.
Repetitive motions and bad workstation setup can lead to workplace-related injuries.
These injuries can often be prevented or minimized with some adjustments. An
ergonomic assessment helps determine factors that are or can in the future lead to
injury.
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Indoor Air Quality
Indoor air quality (IAQ) entails the study, evaluation and control of indoor air related
to temperature, humidity, and airborne contaminants to assess occupant comfort.
Under Occupational Health and Safety in Policies and Procedures, staff can access the
“Resolution of Indoor Air Quality Issues and Smell/Odour Incidents” for information
on the process of resolving any IAQ issues that may be present. In addition, OHSS
hygienists can be contacted in inspect IAQ issues.
Joint Occupational Health and Safety Committee (JOHSC)
The JOHSC is comprised of managerial and non-managerial personnel with the
following goals:
 to assist SickKids in the creation, maintenance of a safe and healthful work
environment for all its employees
 to conduct hospital-wide workplace inspections annually in compliance with the
Occupational Health and Safety Act
There are three committees: 555 University committee, 123 Edward/180 Dundas
committee, and 525 University committee. JOHSC representatives can be contacted
with concerns or suggestions, who act as liaisons between your department and other
departments. For more information about the Joint Occupational Health and Safety
Committee click here.
Onsite Occupational Health Clinic
The Occupational Health clinic is open Monday-Friday 7:00 AM-4:00 PM. For more
information on the services offered by the clinic to staff please refer to the
Occupational Health Clinic website.
Safe Patient Transfer and Lift Program
SickKids has in place a safe patient transfer and lift program with the central aim to
reduce the risk of injury to staff and to help improve the safety of the patients. The
hospital offers staff with hands-on training as well as online instructional videos. For
more information please visit the safe patient transfer and lift website.
Workplace Inspections
It is the policy of The Hospital for Sick Children to create, promote and maintain a
safe and healthy work environment for its employees. This is accomplished by
monitoring the workplace to locate, report and remove or isolate actual or potential
hazards, arising from or existing in the workplace, that have the capacity to
adversely affect the health and well being of any SickKids employee. The workplace
inspections are conducted in accordance with the Occupational Health and Safety Act,
Sections 9 (20) through 9 (30).
Appendix 2: Hospital for Sick Children Occupational Health and Safety Information
Occupational Health & Safety Services (Internal)
The purpose of this Web site is to provide the SickKids community with relevant
occupational health and safety information to promote and support occupational
health, safety and wellness for hospital staff.
On the Occupational Health & Safety Services Web site, you will be able to find
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information about the following:
Occupational Hygiene & Safety
This section of the Web site provides staff with information on health and safety
hazards in the hospital and safe work practices to prevent exposure and ensure
compliance with health and safety law.
Occupational Health Clinic
This section of the Web site gives staff information on the services provided, location
and hours of the clinic.
*NEW* information availabile regarding staff accommodation requests based on
communicable disease exposure.
Wellness
This section contains information about wellness programs offered by SickKids, as
well as information about our Employee Assistance Program.
Health Absence Management Program (HAMP)
This section details the roles and responsibilities of staff, managers and the HAMP
team during an employee's absence from work due to injury or illness, as well as
during a return to work.
Occupational Health and Safety Services Training
This section provides information about the training topics available to staff, the
schedule of training, the target audience, the frequency and duration of training. The
list of training described in this section is not exhaustive and staff are encouraged to
contact Occupational Health and Safety for further information.
Check back regularly for additional information which will be added to our Web site in
the future.
Appendix 3: Hospital for Sick Children Biological Exposure Protocol
http://kidweb.sickkids.ca/ohss/section.asp?s=occupational+health&sid=16873&ss=biologic
al+exposure+protocol&ssid=16883
Biological exposure protocol
What is a biological exposure?
A biological exposure is when a person’s eyes, mouth, mucous membrane or non intact skin surface comes into contact with human blood, body fluids and other
potentially infectious material. Other potentially infectious material are defined as,
semen or vaginal secretions; cerebrospinal, synovial, pleural, peritoneal, pericardial
or amniotic fluids; and human or animal tissues. This may occur as a needlestick
injury or a splash to eyes, nose or mouth.
What should I do if this happens to me?
Procedure to follow when the Occupational Health Clinic is open: Weekdays
0700hr to 1600hr
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Immediately wash and allow wound to bleed freely.
Flush exposed eyes/mouth/non-intact skin with water for 15 minutes.
Cleanse wound with soap and water.
Report incident to Manager.
Report to the Occupational Health Clinic, Room 5309.
Document incident on the on-line Safety Reporting System.
Procedure to follow when the Occupational Health Clinic is closed: Weekdays
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1600hr to 0700hr and Weekends and Holiday: 24 Hours
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Immediately wash and allow wound to bleed freely.
Flush exposed eyes/mouth/non-intact skin with water for 15 minutes.
Cleanse wound with soap and water.
Report incident to Manager and have Manager page CHS Administrator.
If no manager page CHS Administrator.
Document incident on the on-line Safety Reporting System.
Report to the Occupational Health Clinic on the next business day
If post exposure prophylaxis (PEP) is required it should be started
immediately to be most effective, preferably within one to two hours of the
exposure.
For more information you may reach an Occupational Health Nurse at extension 8696
during our regular hours 0700 to 1600 Monday to Friday.
The Biological Exposure/Needlestick Injuries Policy can be found in Lotus Notes under
Occupational Health & Safety, Incident/Injury Response, Biological
Exposures/Needlestick Injuries.
Appendix 4: Lotus Notes, Policies and Procedures, Routine Practices
Routine Practices
1.0 Introduction
Two strategies are in place to prevent the transmission/acquisition of infections at The
Hospital for Sick Children. First are "Routine Practices" designed for the care of all
patients in the hospital regardless of diagnosis or presumed infection status. Next are
"Additional Precautions", required to interrupt the routes of transmission of infectious
agents which are known or suspected to be spread by the airborne, contact, or droplet
routes.
Routine Practices refer to infection prevention and control practices to be used with ALL
patients during ALL care, to prevent and control transmission of microorganism in ALL
health care settings. Routine practices involve the use of barrier techniques to decrease the
risk of transmission of microorganisms. Because all human blood, moist body substances,
and non-intact skin are capable of harbouring infectious pathogens without causing
apparent symptoms, barrier techniques are utilized for all patients receiving care in the
hospital regardless of diagnosis or presumed infection status. Routine practices are applied
when handling blood, body fluids, secretions and excretions (except sweat), breast milk,
non-intact skin, mucous membranes, undiagnosed rashes, and to items or environmental
surfaces contaminated by any of these. Routine practices presuppose that most infections
are transmitted by either direct or indirect contact. Routine practices emphasize the need
for informed decision making in the use of barriers in conjunction with handwashing, based
upon individual assessment of the degree of exposure personnel expect to have with body
substances, mucous membranes, non-intact skin or undiagnosed rashes.
2.0 Policy
2.1 Routine practices will be applied to all patients at all times in all health care settings.
2.2 All Health Care Providers (HCP) will instruct patients, families and visitors as to
appropriate routine practices and transmission based precautions.
2.3 All HCPs will initiate and communicate transmission based precautions based on
patients' symptoms as soon as possible when symptoms are recognized.
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3.0 Guidelines
3.1 Risk Assessment
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HCWs should perform a Routine Practices Risk Assessment before each interaction
with a patient or their environment in order to determine which interventions are
required to prevent transmission during the interaction.
3.2 Hand Hygiene
1. The single most important process in the prevention of infection transmission. The
use of waterless hand rinses is preferred unless hands are wet, grossly soiled, or if
directed otherwise by Infection Prevention & Control. Indications for hand hygiene
include but are not limited to the “4 Moments of Hand Hygiene”:
2. Before initial patient/patient environment contact
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Before entering the patient room or the patient’s space
To protect the patient/ patient environment from harmful organisms carried
on your hands.
3. Before aseptic procedure
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Before starting IVs, inserting urine catheters, dressing changes, etc.
To protect the patient against harmful organisms, including the patient’s own
organisms, entering his or her body.
4. After body fluid exposure risk
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To protect yourself and the health care environment from harmful patient
organisms.
ALWAYS wash hands after removing gloves
5. After patient/patient environment contact
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Before leaving the room
To protect yourself and the health care environment from harmful patient
organisms.
See Hand Hygiene and Hand Care ==>
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3.3 Gloves
The type of glove chosen depends on the degree of exposure and type of procedure (e.g.
sterile versus clean). Gloves are used to:
 Provide a protective barrier and to prevent gross contamination of health care
workers’ hands by blood, body secretions and excretions or non-intact skin.
 Reduce the likelihood of transfer of microorganisms present on the hands of
personnel to patients during invasive procedures or other patient care
procedures that involve touching patients’ mucous membranes or non-intact
skin.
 Gloves can become contaminated from the environment and pose a risk of
transfer of organisms to patients so, when indicated, gloves should be put on
directly before contact with the patient or just before the task or procedure
requiring gloves.
 Reduce the likelihood that hands of personnel contaminated with
microorganisms from a patient or a fomite can transmit these organisms to
another patient.
Guidelines for Glove Use:
 Clean hands before putting on gloves for aseptic/sterile procedures.
 Change gloves between patients.
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3.4 Gowns
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3.5 Masks
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Wear gloves only when required. Do not wear gloves during the preparation
of tasks.
Change gloves between tasks and procedures on the same patient after
contact with material that may contain a high concentration of
microorganisms.
Remove gloves promptly after use and before touching non-contaminated
items and environmental surfaces.
Wash hands after removing gloves.
A gown is recommended for use when it is anticipated that a procedure or
care activity is likely to generate splashes or sprays of body fluids.
Yellow gowns should only be used when providing care for patients.
Do not re-use gowns (either for the same patient or for other patients).
Gowns should be worn when anticipating direct, close contact with a child
(e.g. holding or feeding.)
A mask is to be used by the HCP (typically along with eye protection) to
protect the mucous membranes of the nose and mouth when performing
activities that are likely to generate splashes or sprays of body fluids.
The mask should cover both the mouth and nose.
Change the mask if it becomes wet.
Do not allow the mask to hang round the neck.
An N95 Respirator may be indicated for aerosol-generating procedures. See
N95 Respiratory Protection Program ==>
3.6 Protective Eye Wear
 Eye protection is used by the HCP to protect the mucous membranes of the
eyes when performing activities that are likely to generate splashes or sprays
of body fluids.
 Face shields are intended for single use, and are to be discarded immediately
after use.
 Multi-use goggles are to be cleaned with the hospital approved disinfectant
after use.
 Note that eyeglasses are never considered eye protection unless they are
certified safety glasses and have been approved by Occupational Health and
Safety.
3.7 Patient Placement
 Patients who are likely to contaminate the environment or who do not/cannot
be expected to assist in maintaining appropriate hygiene or environmental
control require a single room.
 If a single room is not available, consult the Infection Prevention and Control
Programme (IPC).
 Infectious Diseases Screening forms should be completed on admission for all
patients to determine the need for transmission based precautions. Patient
and Visitor Screening and Placement ==>
3.8 Linen and Laundry
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All soiled linen should be contained in clear plastic bags to prevent leakage.
Double bagging is unnecessary unless the initial bag becomes torn or visibly
soiled.
3.9 Handling and Disposal of Sharps: Specimen Collection, Holding and Transport
 All specimens should be handled in the same safe manner.
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Sharps must be discarded in the puncture-resistant sharps container provided
at the point of use.
All needle and syringe combinations must be disposed of as a single unit.
Needles should not be recapped. If unavoidable, use one-handed method of
recapping.
Containment of the specimen should be assured before using the pneumatic
tube transport system.
Specimen containers should be securely closed and clean on the outside (if
not, they should be wiped with alcohol).
All specimens should be enclosed in individual zip lock plastic bags and
requisitions placed in the outside envelope of the bag.
Specimens should be held in the designated holding area until pickup.
Do not send specimens with needles attached to any lab as they will not be
processed.
3.10 Patient Care Equipment
 Soiled patient care equipment should be handled in a manner that prevents
contact with skin and mucous membranes and contamination of clothing and
the environment.
 Any equipment that is shared between patients must be cleaned after use
with EVERY patient. This includes stethoscopes. Equipment should be cleaned
with the hospital approved cleaner. Alcohol swabs can be used for
stethoscopes. Shared patient equipment should be kept to a minimum.
 Place items for central reprocessing/sterilization in Central Services at the
designated area for pickup.
 Equipment that is visibly soiled should be cleaned and disinfected.
 Personal care supplies (e.g. lotions, soaps, creams) should not be shared
between patients.
 Generally, patient charts/clipboards should not be stored in patient rooms. If
storage in room is necessary, the chart should be appropriately cleaned with
the hospital approved low level disinfectant once removed from the room.
3.11 Environmental Cleaning
 Routine cleaning of environmental surfaces and non-critical patient care items
is performed according to a predetermined schedule.
 All surfaces should be kept clean and dust free.
 Surfaces that are frequently touched by the hands of health care providers
and clients (e.g. call bells, surfaces of medical equipment, knobs) should be
frequently cleaned.
 All surfaces should be cleaned and disinfected when soiled.
3.12 Waste Management
 All non-biomedical waste should be discarded in clear plastic bags in patient
care areas/rooms.
 Biomedical waste should be discarded in yellow bags found in "soiled utility
rooms" or designated areas.
3.13 Family and Visitors
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Refer to Family and Other Visitor Access = = >
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