OSHA Inspection: FAMILY MEDICAL CENTER - MINDEN

Issued

Dec 3, 1991

Abate by

Jan 3, 1992

Penalty

Initial $1,500 · Current $900 Reduced

General-duty citation text

Section 5(a)(1) of the Occupational Safety and Health Act of 1970:  The
employer did not furnish employment and a place of employment which
were free from recognized hazards that were causing or likely to cause
death or serious physical harm to employees in that employees were
exposed to:
Health care workers such as nurses, nurse aides, phlebotomists
and housekeepers, facility wide who were exposed to the hazard
of being infected by HBV/HIV through possible direct contact
with blood or other body fluids in that:
1) Linen. The Infection Disease  Control Program  (ICP) did not
identify all laundry operations involving substantial risk of
direct exposure to body fluids.  Linens soiled with  body fluids
were rinsed by nurses before being bagged and transported to the
laundry. This is contrary to the Center for Disease Control (DC)
guidelines published in morbidity and mortality weekly report June
24, 1988, Volumn 37 - Number 24.
2) Nurses had not been trained in follow-up procedures after
possible exposure to HIV or HBV. Specifically the procedures
follwing a percutaneous  (needlestick or cut) or mucous membrane
(splash to eye, nasal mucosa or mouth) exposure to body fluids
or has a cutaneous exposure to blood when the nurses skin is
chapped, abraded or otherwise  nonintact. Among other procedures
nurses were not trained to inform the source patient of the
incident and test him/her for HIV and HBV infections, after
consent is obtained.
Feasible and useful abatement method for reducing the hazard
among others:
1. a) If a health caree worker has a percutaneous (needlestick or
cut) or mucous membrane (splash to eye, nasal mucosa or mouth)
exposure to body fluids or has a cutaneous exposure to blood
when the worker's skin is chapped, abraded or otherwise
nonintact, the source patient shall be informed of the incid-
ent and tested for HIV and HBV infections, after consent is
obtained.
b) If patient consent is refused or if the source patient tests
positive, the health care worker shall be evaluated clinically
and by HIV antibody testing as soon as possible and advised to
report and seek medical evaluation of any acute febrile illness
that occurs within 12 weeks after exposure. HIV seronegative
workers shall be retested 6 weeks post-exposure and on a
periodic basis thereafter (12 weeks and 6 months after ex-
posure).
c) Follow up procedures shall be taken for health care workers
exposed or potentially exposed to HBV. The types of procedures
depends on the immunization status of the worker (i.e., whether
HBV vaccination has been received and antibody response is
adequate) and the HBV serologic status of the source patient.
The CDC Immunization Practices Advisory Committee has published
its recommendations regarding HBV postexposure prohylaxis in
table format in June 7, 1985, Morbidity and Mortality Weekly
Report.
d) If an employee refuses to submit to the procedures in (b)
or (c) above when such procedures are medically indicated, no
adverse action can be taken on that ground alone since the
procedures are designed for the benefit of the exposed employee.
2. Linen. The IC program shall have identified all laundry
operations involving substantial risk of direct exposure to
body fluids. Linen soiled with body fluids shall be handled
as little as possible and with minimum agitation to prevent
contamination of the person handling the linen. All soiled
linen shall be bagged at the location where it was used; it
shall not be sorted or rinsed in patient-care areas. Soiled
linen shall be placed and transported in bags that prevent
leakage.

Issued

Dec 3, 1991

Abate by

Jan 3, 1992

Penalty

Initial $1,500 · Current $900 Reduced

Issued

Dec 3, 1991

Abate by

Jan 31, 1992

Penalty

Initial $600 · Current $360 Reduced

Issued

Dec 3, 1991

Abate by

Dec 9, 1991

Penalty

Initial $300 · Current $180 Reduced

Issued

Dec 3, 1991

Abate by

Dec 9, 1991

Penalty

Initial $300 · Current $180 Reduced