OSHA Inspection: FOOTHILL ACRES NURSING HOME

Issued

Dec 13, 1990

Abate by

Feb 28, 1991

Penalty

Initial $490 · Current $340 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
the hazards of working with blood and body fluids thus causing or likely
to cause employee exposure to and contraction of Hepatitis B Virus
(HBV) and/or Human Immunodeficiency Virus (HIV):
a) Health care workers such as nursing staff, supervisors, physicians,
technicians and laundry workers are potentially exposed to bloodborne
pathogens. Condition noted on or about 6/26/90.
Although a written infection control program has been developed, and
some "in-house" training performed, the following inadequacies were
found:
1) The facility's needlestick protocol incorrectly stated that health
care workers shall receive Hepatitis B vaccine as per the medical
director's discretion, when, in fact, all high risk workers should
be offered the Hepatitis B vaccine.
2) Employees at risk must be informed of procedures to be followed after
a needlestick and/or potentially infectious body fluid exposure.
3) Training - Employees were not trained in specific tops recommended
by the CDC Immunization Practices Advisory Committee, which should
include topics below:
Feasible abatement methods for reducing this hazard include, but are not
limited to:
TRAINING AND EDUCATION:
Training and education of employees such as, but not limited to,
supervisors, nurses, technicians and housekeepers.
Such training and education shall be at the time of the initial
employment and at least annually thereafter. The training materials used
shall be appropriate in content and vocabulary to educational level,
literacy and language background of the employees being trained.
The training and education program shall contain as a minimum, the
following elements:
i) A general explanation of the modes of transmission of bloodborne
pathogens;
ii) An explanation of the use and limitations of work practices that
will prevent or reduce employee exposure, including appropriate
engineering controls, work practices and personal protective
equipment;
iii) Information on the Hepatitis B vaccination, including information
on its efficiency, safety and the benefits of being vaccinated;
iv) Information on the appropriate actions to be taken and the person
to contact in an emergency;
v) An explanation of the procedure to follow if an exposure incident
occurs, including the method of reporting the incident and the
medical follow-up that will be made available;
vi) An explanation of the signs and labels and/or color coding used in
the workplace; and
vii) A copy of the Center for Disease Control (CDC) Guidelines.
FOLLOW-UP PROCEDURES AFTER POSSIBLE EXPOSURE TO HIV/HBV:
i) If a health care worker has a percutaneous needlestick or cut, or
mucous membrane, (splash to eye, nasal mucosa or mouth), exposure to
blood or body fluids or has a cutaneous exposure to blood or body
fluids when the worker's skin is chapped, abraded, or otherwise non-
intact; the source patient shall be informed of the incident and
tested for HIV and HBV infections, after consent is obtained.
ii) If patient consent is refused or if the source patient tests
positive, the health care worker shall be evaluated clinically 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).
iii) Follow-up procedures shall be taken for health care workers
exposed or potentially exposed to HBV. The type 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.
iv) If an employees 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.
HEPATITIS B VACCINATION:
The facility's infection control policy regarding Hepatitis B
vaccinations shall address all circumstances warranting such vaccination
and shall identify employees of substantial risk of directly contacting
blood or body fluids.
All such employees shall be offered Hepatitis B vaccinations in amounts
and at times prescribed by standard medical practice.
THE WRITTEN INFECTION CONTROL PROGRAM SHALL INCLUDE THE PREVIOUSLY
DISCUSSED ITEMS.

Issued

Dec 13, 1990

Abate by

Dec 19, 1990

Penalty

Initial $350 · Current $200 Reduced

Issued

Dec 13, 1990

Abate by

Jan 14, 1991

Penalty

Initial $350 · Current $200 Reduced

Issued

Dec 13, 1990

Abate by

Dec 20, 1990

Penalty

Initial $350 · Current $200 Reduced

Issued

Dec 13, 1990

Abate by

Dec 16, 1990

Penalty

Initial $100 · Current $100

Issued

Dec 13, 1990

Abate by

Dec 16, 1990

Issued

Dec 13, 1990

Abate by

Dec 16, 1990

Issued

Dec 13, 1990

Abate by

Dec 16, 1990

Issued

Dec 13, 1990

Abate by

Dec 16, 1990

Issued

Dec 13, 1990

Abate by

Dec 20, 1990

Issued

Dec 13, 1990

Abate by

Feb 28, 1991

Issued

Dec 13, 1990

Abate by

Feb 28, 1991