OSHA Inspection: MERITER HOSPITAL, INC.

Issued

Aug 6, 1993

Abate by

Oct 23, 1993

Penalty

Initial $2,625 · Current $1,000 Reduced

General-duty citation text

Section 5(a)(1) of the Occupational Safety and Health Act of 1970:  The
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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 in that, employees were exposed to the hazard of being
infected with Mycobacterium tuberculosis through contact with patients
determined by the Centers for Disease Control (CDC) to be at high risk
for tuberculosis:
a) Mantoux skin testing was not provided in accordance
with the most current recommendations of the Centers
for Disease Control (CDC).
The hospital did not ensure that employee skin tests
were provided in the intervals recommended by the CDC.
b) A room in the Emergency Room, designated as an AFB
isolation room (door #0185) was not provided with
ventilation to assure negative pressure with respect
to the hallway.
Feasible and useful abatement methods for reducing
these hazards include:
1. Provision of the Mantoux skin test to all employees
in accordance with Centers for Disease Control
recommendations.
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New employees in the covered workplace must receive a
pre-placement history and health assessment including
a ppd skin test.
2. All AFB isolation rooms must meet the recommendations
of the most current Centers for Disease Control
recommendations.
Isolation and treatment rooms in use by
individuals with suspected or confirmed TB disease shall
be kept under negative pressure to induce airflow into
the room from all surrounding areas (e.g., corridors,
ceiling plenums, plumbing chases, etc.)
The following constitutes the minimal elements of an effective
tuberculosis exposure control plan.
1. Early identification and preventative treatment of
persons who have tuberculosis infection and are at
high risk for active tuberculosis.
2. Early identification and treatment of persons with
active tuberculosis.
3. Prevention of the spread of infectious droplet nuclei
using source-control methods such as local exhaust
ventilation.
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4. Reduction of microbial contamination in the air using
methods such as general ventilation, taking into
consideration
recommended dilution factors, air mixing, HEPA
filtration, and direction of air flow.
Rooms occupied by TB or suspected TB patients must be
under negative pressure exhausted to the outside and
away from air intake vents.
5. Provision of particulate respirators to healthcare
workers exposed to tuberculosis because of contact with
patients at risk for tuberculosis. They should be using
NIOSH approved respirators for at least dust, mist and
fumes. NIOSH approved respirators providing greater
protection
would also be acceptable.
ABATEMENT NOTE: The minimum acceptable respiratory
protection
against airborne Mycobacterium tuberculosis is
currently under review.
6. Provision of training to employees on the hazard and
control of tuberculosis. The training must include the
epidemiology, transmission and pathogenesis of
tuberculosis.
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Reference: CDC MMWR December 7, 1990/Vol. 39. Guidelines for
Preventing the Transmission of Tuberculosis in Health Care Settings,
with Special Focus on HIV Related Issues.

Issued

Aug 6, 1993

Abate by

Jan 6, 1994

Penalty

Initial $2,625 · Current $1,000 Reduced

Issued

Aug 6, 1993

Abate by

Aug 11, 1993

Issued

Aug 6, 1993

Abate by

Jan 6, 1994

Issued

Aug 6, 1993

Abate by

Jan 6, 1994

Issued

Aug 6, 1993

Abate by

Aug 11, 1993