OSHA Inspection: ST. JOSEPH'S HOSPITAL

Issued

May 2, 1994

Abate by

Jul 1, 1994

Penalty

Initial $2,000 · Current $2,000

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:
(a)  St. Joseph Hospital, Chicago, exposed psychiatric
employees to a risk of injury from violent or aggressive
patients.
(1)Develop and aggression management training
program relating to management of an aggressive
situation, including safe application of restraints.
(2)Develop a training program relating to the
recognition of aggression escalation behavior,
verbal interventions and prevention of aggression,
including discussion of countertransference behavior
as it relates to patient aggression.
(3)Completion of aggression management training
program will be mandatory condition of
employment for all Psychiatric Department
employees.
(4)Management of aggression will become a basic
competency for working in the Psychiatric
Department.  All staff will have a baseline
assessment for competency.  This competency will
evaluated annually.
(5)New employees must demonstrate competency in
aggression management in order to pass the
introductory period and become permanent
employees.
(6)All security staff will attend the aggression
management training.
(7)Only staff who have completed the aggression
management training program and have
demonstrated competency in the management of
aggression will be allowed to lead a Code Purple.
(8)Only staff who have completed the aggression
management training program and havedemonstrated competency in the
management
of
aggression will be allowed to participate in the
takedown.
(9)Staff who have not been trained in aggression
management and/or who have not yet demonstrated
competency (new employees) may be delegated, by
Code Purple leader, specific tasks during a code
purple.
(10)The review of the process and the outcome of Code
Purple will be developed as a hospital wide quality
improvement indicator.  100of Code Purple will
be audited.
(11)Education for staff on therapeutic Milieu and
groups.  Nursing staff will be given the opportunity
to participate in the process of developing an
enhanced milieu structure.  The staff's job
expectation will be amended to include conducting
group and milieu activities during days, evenings
and on weekends.
(12)Set goals for each unit to work on improving
"Customer Service", which includes staff being out
interacting with patients for majority of shift.
(13)The patient telephones will be modified so that the
cords and handpieces are nondetachable.
(14)The windows in the Psychiatry Unit will be
replaced with safety glass.
(15)St. Joseph will adopt administrative procedures to
assure compliance with its policy to log all instances
in which patients are placed in restraints.  The
restraint procedure audit will be modified to
required verification that restrain incidents are
recorded in the restrain

Issued

May 2, 1994

Abate by

Jun 15, 1994

Penalty

Initial $1,250 · Current $1,200 Reduced

Issued

May 2, 1994

Abate by

Jul 15, 1994

Issued

May 2, 1994

Abate by

Dec 1, 1994

Penalty

Initial $2,000 · Current $2,000

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:
(a)  Employees of St. Joseph hospital, Chicago, including
but not limited to physicians, nurses, mental health
specialists, mental health technicians, social workers,
activity therapists, security, laundry workers, phebotomists,
unit secretaries, and transport personnel were exposed to
the hazard of being infected with tuberculosis through
contact with psychiatric patients who had or were suspected
of having tuberculosis.
Feasible and useful abatement methods for reducing this
hazard, as recommended by the United States Public Health
Service Centers for Disease Control among others are
included for your review and enhancement of program as
necessary:
1. Review of protocol to ensure early identification of
individuals with active tuberculosis.
2. Provision of medical surveillance including preplacement
evaluation, Administration and interpretation of  TB
Mantoux skin tests, and periodic evaluations shall be
offered to employees as follows:  An initial baseline
screening at the time of employment for all employees in
areas of potential exposure; with a minimum of annual
retesting thereafter. Employees who may be frequently
exposed to patients with TB or who are involved with
potentially high-risk procedures (e.g., Bronchoscopy,
sputum induction, or aerosol treatments given to patients
that may have TB) should be retested at least every 6
months.  Data on skin test conversions should be
periodically reviewed so that the risk of acquiring new
infection may be estimated for watch area of the facility.
On the basis of this analysis, the frequency of retesting
may be altered accordingly.  A PPD should also be given
after a TB exposure; that is, after a worker has been
exposed to a potentially infectious TB patient for whom
infection control procedures have not been taken.  This will
not be required when an employee's last skin test was
within the previous 3 months.  If negative, the skin test
shall be repeated 12 weeks after exposure.3. Evaluation and management of
employees with a
positive skin test, or with skin test conversion on repeat
testing, or who are exhibiting symptoms of TB, including
work restrictions for infectious employees.  Workers who
experience incident (exposure to a patient with infectious or
suspect TB for whom infection control precautions have not
been taken) shall also be managed according to CDC
recommendations.
4. Placement of individuals with suspect or confirmed TB
in an AFB (acid-fast bacilli) isolation room.  AFB
infectious TB and areas in which high hazard procedures
are performed on such individuals must be maintained
under negative pressure and appropriately exhausted (either
directly to the outside away from intake vents or through
properly designed, installed, and maintained HEPA filters).
5. Training and education to ensure that exposed employees
have knowledge of such issues as the hazard of TB
transmission, the difference between TB infection and TB
disease, the significance of a positive PPD test, signs and
symptoms of TB, predisposing factors for TB, patient
populations at higher risk for TB (i.e., the homeless, HIV
positive, nursing home residents, etc.), medical
surveillance and therapy, and site-specific protocols
including the purpose and proper use of

Issued

May 2, 1994

Abate by

Sep 1, 1994

Issued

May 2, 1994

Abate by

May 2, 1994

Issued

May 2, 1994

Abate by

Jul 1, 1994

Issued

May 2, 1994

Abate by

Jul 1, 1994

Issued

May 2, 1994

Abate by

Jul 1, 1994

Issued

May 2, 1994

Abate by

Jun 1, 1994

Issued

May 2, 1994

Abate by

Jun 1, 1994

Issued

May 2, 1994

Abate by

Jun 1, 1994

Issued

May 2, 1994

Abate by

Jun 1, 1994

Issued

May 2, 1994

Abate by

May 2, 1994

Issued

May 2, 1994

Abate by

May 15, 1994

Issued

May 2, 1994

Abate by

May 15, 1994

Issued

May 2, 1994

Abate by

May 6, 1994