OSHA Inspection: ONCOLOGY/HEMATOLOGY ASSOCIATES OF SPRINGFIELD

Issued

Dec 14, 1990

Abate by

Jan 17, 1991

Penalty

Initial $810 · Current $810

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 HEALTH CARE WORKERS WERE
EXPOSED TO THE HAZARD OF BEING POTENTIALLY INFECTED BY HBV AND/OR HIV
THROUGH DIRECT CONTACT WITH BLOOD OR OTHER BODY FLUIDS:
A) EXAM ROOMS #1 - #8: IN THAT NURSES AND LAB TECHNICIANS CARRIED
LINEN SOILED WITH BODY FLUIDS FROM THE EXAM ROOMS, WHERE THE LINEN
WAS USED, THROUGH PATIENT-CARE AREAS AND BACK TO THE LAUNDRY ROOM
WITHOUT BAGGING THE SOILED LINEN PRIOR TO TRANSPORT.
B) CHEMOTHERAPY AREA: IN THAT NURSES CARRIED LINEN SOILED WITH BODY
FLUIDS FROM THE CHEMOTHERAPY TREATMENT STATIONS, WHERE THE LINEN
WAS USED, THROUGH PATIENT-CARE AREAS AND BACK TO THE LAUNDRY
ROOM WITHOUT BAGGING THE SOILED LINEN PRIOR TO TRANSPORT.
C) LABORATORY: IN THAT NURSES AND LAB TECHNICIANS WORE LAB COATS
SOILED WITH BODY FLUIDS OUTSIDE OF THE LABORATORY AND LAUNDERED
THE SOILED LAB COATS AT HOME.
WHILE ULTIMATE RESPONSIBILITY FOR CORRECTING THE HAZARD RESTS WITH THE
EMPLOYER, GIVEN HIS/HER SUPERIOR KNOWLEDGE OF THE WORKPLACE, FEASIBLE
AND ACCEPTABLE METHODS TO CORRECT THE HAZARD IDENTIFIED IN INSTANCES
(A), (B), AND (C), AMONG OTHERS ARE:
1) THE IC PROGRAM SHALL HAVE INDENTIFIED 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. THE BAGS MUST BE TAGGED OR OTHERWISE IDENTIFIED AS
CONTAINING ARTICLES CONTAMINATED WITH POTENTIALLY INFECTIOUS
MATERIAL.
D) EXAM ROOMS #1 -#8: IN THAT NURSES AND LAB TECHNICIANS CARRIED
ARTICLES CONTAMINATED WITH BODY FLUIDS FROM THE EXAM ROOMS, WHERE
THE ARTICLES WERE USED, THROUGH PATIENT-CARE AREAS AND BACK TO THE
LABORATORY OR CHEMOTHERAPY AREA FOR DISPOSAL WITHOUT BAGGING THE
CONTAMINATED ARTICLES PRIOR TO TRANSPORT.
WHILE ULTIMATE RESPONSIBILITY FOR CORRECTING THE HAZARD RESTS WITH THE
EMPLOYER, GIVEN HIS/HER SUPERIOR KNOWLEDGE OF THE WORKPLACE, FEASIBLE
AND ACCEPTABLE METHODS TO CORRECT THE HAZARD IDENTIFIED IN INSTANCE (D)
AMONG OTHERS ARE:
1) OBJECTS THAT ARE CONTAMINATED WITH POTENTIALLY INFECTIOUS
MATERIALS SHALL BE PLACED IN AN IMPERVIOUS BAG AT THE LOCATION
WHERE THEY WERE USED. IF OUTSIDE CONTAMINATION OF THE BAG IS
LIKELY, A SECOND BAG SHALL BE ADDED. THE BAGS MUST BE TAGGED
OR OTHERWISE IDENTIFIED AS CONTAINING ARTICLES CONTAMINATED
WITH POTENTIALLY INFECTIOUS MATERIAL.
E) IN THAT APPROPRIATE MEDICAL FOLLOW-UP PROCEDURES AFTER POSSIBLE
HIV/HBV EXPOSURE INCIDENTS WERE NOT IMPLEMENTED FOR HEALTH CARE
WORKERS INCLUDING, BUT NOT LIMITED TO, PHYSICIANS NURSES AND LAB
TECHNICIANS WHO WERE ENGAGED IN PROCEDURES INCLUDING, BUT NOT
LIMITED TO, PERFORMING AND ASSISTING WITH INVASIVE PROCEDURES,
DRAWING BLOOD, PREPARING AND PROCESSING SPECIMANS, PREPARING AND
ADMINISTERING CHEMOTHERAPEUTIC AGENTS, AND HANDLING INFECTIOUS
WASTES.
WHILE ULTIMATE RESPONSIBILITY FOR CORRECTING THE HAZARD RESTS WITH THE
EMPLOYER, GIVEN HIS/HER SUPERIOR KNOWLEDE OF THE WORKPLACE, FEASIBLE
AND ACCEPTABLE METHODS TO CORRECT THE HAZARD IDENTIFED IN INSTANCE (E)
AMONG OTHERS ARE:
1) IMPLEMENTATION OF FOLLOW-UP PROCEDURES AFTER POSSIBLE EXPOSURE TO
HIV OR HBV:
A) IF A HEALTH CARE WORKER HAS A PERCUTANEOUS (NEEDLE-STICK 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 INCIDENT 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 EXPOSURE).
C) NO FURTHER FOLLOW-UP OF A HEALTH CARE WORKER EXPOSED TO INFECTION AS
DESCRIBED ABOVE IS NECESSARY IF THE SOURCE PATIENT IS SERONEGATIVE
UNLESS THE SOURCE PATIENT IS AT HIGH RISK OF HIV INFECTION. IN THE
LATTER CASE, A SUBSEQUENT SPECIMAN (E.G., 12 WEEKS FOLLOWING
EXPOSURE) MAY BE OBTAINED FROM THE HEALTH CARE WORKERS FOR ANTIBODY
TESTING.
D) 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 PROPHYLAXIS IN TABLE FORMAT IN JUNE 17,
1985, MORBIDITY AND MORTALITY WEEKLY REPORT.
E) IF AN EMPLOYEE REFUSES TO SUBMIT TO THE PROCEDURES IN (B), (C), OR
(D) 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.
F) IN THAT TRAINING ON "UNIVERSAL PRECAUTIONS" WAS NOT PROVIDED FOR
HEALTH CARE WORKERS INCLUDING, BUT NOT LIMITED TO, PHYSICIANS,
NURSES AND LAB TECHNICIANS WHO WERE ENGAGED IN PROCEDURES INCLUDING,
BUT NOT LIMITED TO, PERFORMING AND ASSISTING WITH SPECIMENS,
PREPARING AND AMINISTERING CHEMOTHERAPEUTIC AGENTS, AND HANDLING
INFECTIOUS WASTES.
WHILE ULTIMATE RESPONSIBILITY FOR CORRECTING THE HAZARD RESTS WITH THE
EMPLOYER, GIVEN HIS/HER SUPERIOR KNOWLEDGE OF THE WORKPLACE, FEASIBLE
AND ACCEPTABLE METHODS TO CORRECT THE HAZARD INDENTIFIED IN INSTANCE
(F), AMONG OTHERS ARE:
1) IMPLEMENTATION OF A TRAINING AND EDUCATION PROGRAM FOR ALL HIGH RISK
HEALTH CARE WORKERS:
A) THEY SHALL RECEIVE EDUCATION ON PRECAUTIONARY MEASURES, EPIDEMIOLOGY,
MODES OF TRANSMISSION AND PREVENTION OF HIV/HBV. HEALTH CARE WORKERS
SHALL BE COUNSELED REGARDING POSSIBLE RISKS TO THE FETUS FROM HIV/HBV
AND OTHER ASSOCIATED INFECTIOUS AGENTS.
B) IN ADDITION, SUCH HIGH RISK WORKERS MUST RECEIVE TRAINING REGARDING
THE LOCATION AND PROPER USE OF PERSONAL PROTECTIVE EQUIPMENT. THEY
SHALL BE TRAINED CONCERNING PROPER WORK PRACTICES AND, IF THE
FACILITY HAS IMPLEMENTED THEM, SHALL UNDERSTAND THE CONCEPT OF
"UNIVERSAL PRECAUTIONS" AS IT APPLIES TO THEIR WORK PRACTICES. THEY
SHALL BE TRAINED ABOUT THE MEANING OF COLOR CODING OR OTHER METHODS
(EXCEPT TAGS) USED TO DESIGNATE CONTAMINATED ARTICLES OR INFECTIOUS
WASTE. WHERE TAGS ARE USED, TRAINING ABOUT TAGS AND PRECAUTIONS TO
BE USED IN HANDLING CONTAMINATED ARTICLES OR INFECTIOUS WASTE IS
GOVERNED BY 29 CFR 1910.145(F). WORKERS SHALL RECEIVE TRAINING ABOUT
PROCEDURES TO BE USED IF THEY ARE EXPOSED TO NEEDLESTICK OR TO BODY
FLUIDS.

Issued

Dec 14, 1990

Abate by

Dec 26, 1990

Penalty

Initial $640 · Current $640

Issued

Dec 14, 1990

Abate by

Dec 26, 1990

Penalty

Initial $640 · Current $640

Issued

Dec 14, 1990

Abate by

Jan 17, 1991

Penalty

Initial $300 · Current $300

Issued

Dec 14, 1990

Abate by

Jan 17, 1991

Penalty

Initial $300 · Current $300

Issued

Dec 14, 1990

Abate by

Jan 17, 1991

Penalty

Initial $300 · Current $300

Issued

Dec 14, 1990

Abate by

Jan 17, 1991

Penalty

Initial $300 · Current $300

Issued

Dec 14, 1990

Abate by

Jan 17, 1991

Issued

Dec 14, 1990

Abate by

Dec 26, 1990

Issued

Dec 14, 1990

Abate by

Jan 17, 1991

Issued

Dec 14, 1990

Abate by

Jan 17, 1991

Issued

Dec 14, 1990

Abate by

Jan 17, 1991

Issued

Dec 14, 1990

Abate by

Jan 17, 1991