OSHA Inspection: N. R. WAGENER, S.C. AKA NICHOLAS WAGENER, M.D.

Issued

Jul 25, 1991

Abate by

Aug 29, 1991

Penalty

Initial $750 · Current $350 Reduced

Hazardous substances 8880

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 following condition which increases the risk of
contracting bloodborne diseases (e.g., HBV and/or HIV) through possible
direct contact with blood or other infective body fluids identified by
the CDC:
An HBV vaccination program was not made available to the following
employees:
(a) A nurse assistant who assisted in direct patient care and
laboratory procedures.
(b) A housekeeping employee responsible for cleaning surfaces
contaminated with blood and the collection and transfer of sharps
and blood-contaminated waste.
In accordance with recommended practices from the CDC's guidelines
for protection from blood-borne diseases, feasible methods of
abatement include, but are not limited to:
(1) A reevaluation of exposure potential based on job duties
leading to exposure to infectious materials as a universal
precaution rather than according to the patient group.
Employees requiring inclusion in an HBV vaccination program
shall include but not be limited to those employees listed
in the instance descriptions.
(2) Make available Hepatitis B (HBV) vaccinations to all
potentially exposed employees (e.g., instances listed).
(3) Initiate a complete medical surveillance program to allow
early identification of HBV infection in non-immunized
personnel, track immunization status and provide booster
HBV vaccinations as necessary.
(4) Assure that all evaluations, procedures, vaccinations and
post-exposure management are offered to employees at a
reasonable time and place, according to standard
recommendations of medical practice, and at no charge to
the employee.

Issued

Jul 25, 1991

Abate by

Oct 29, 1991

Penalty

Initial $750 · Current $350 Reduced

Hazardous substances 8880

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 following condition which increases the risk of
contracting bloodborne diseases (e.g., HBV and/or HIV) through possible
direct contact with blood or other infective body fluids identified by
the CDC:
A complete and effective training and information program on the
hazards of bloodborne diseases and effective precautions for
reducing the risk of infection was not made readily available to
the following employees:
(a) A nurse assistant who assisted in direct patient care and
laboratory procedures.
(b) A housekeeping employee responsible for cleaning surfaces
contaminated with blood and the collection and transfer of sharps
and blood contaminated waste.
In accordance with recommended practices from the CDC's guidelines
for protection from blood-borne diseases, feasible methods of
abatement include, but are not limited to, the provision of
training and information in the following categories:
(1) Hazards -- e.g., risk factors, illness descriptions,
epidemiology and potential for fetal risk.
(2) Protective Measures - e.g., engineering controls, personal
protective equipment, biohazard labeling.
(3) Emergency or Non-routine Procedures -- e.g., precautions
for CPR, spill cleanup and exposure incidence reports and
tracking.
(4) Medical Procedures -- e.g., medical treatment, surveillance
and records.

Issued

Jul 25, 1991

Abate by

Aug 29, 1991

Penalty

Initial $750 · Current $350 Reduced

Hazardous substances 8880

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 following condition which increases the risk of
contracting bloodborne diseases (e.g., HBV and/or HIV) through possible
direct contact with bood or other infective body fluids indentified by
the CDC:
A complete and effective post-exposure evaluation and followup
had not been developed nor implemented for the following
employees:
(a) A housekeeping employee who received a puncture wound from
a potentially contaminated syringe during regular trash collection
and disposal on 2/13/91.
In accordance with recommended practices from the CDC's guidelines
for protection from blood-borne diseases, feasible methods of
abatement include, but are not limited to, the following:
(1) Implement a determination and documentation of the exposure
incident describing:
- route of exposure
- source patient's antibody status (positive, negative
or unknown)
- circumstances under which exposure occurred
(2) Request permission from the source patient for antigen/
antibody testing HBV or HIV infection status.  Such testing
is voluntary for the source patient.
(3) Offer blood collection and antibody testing to the exposed
employee as soon as possible after the exposure incident.
Blood testing is voluntary for the employee.  Actual anti-
body/antigen testing may be done at the time of collection
or at a later date if the employee so requests.  Follow-up
testing should be continued according to current standard
medical procedures.
(4) Provide ready access to counseling and illness reporting
advice to the exposed employee.
(5) Make available information on the exposed employee's job
duties as relates to the exposure and on the exposure
incident to the evaluating physician.  Any medical assess-
ment or written opinion from the evaluating physician must
be kept as a medical record, with a copy made available to
the employee within 15 working days.
(6) Assure that all evaluations, procedures, vaccinations and
post-exposure management are offered to employees at a
reasonable time and place, according to standard
recommendations of medical practice, and at no charge to
the employee.
(7) Coordinate all elements of post-exposure evaluation and
follow-up procedures through a competent person or persons
who can provide ready access to exposed employees.

Issued

Jul 25, 1991

Abate by

Aug 5, 1991

Penalty

Initial $750 · Current $350 Reduced

Hazardous substances 8880

Issued

Jul 25, 1991

Abate by

Aug 29, 1991

Penalty

Initial $750 · Current $350 Reduced

Hazardous substances 8880

Issued

Jul 25, 1991

Abate by

Aug 5, 1991

Penalty

Initial $450

Issued

Jul 25, 1991

Abate by

Aug 5, 1991

Issued

Jul 25, 1991

Abate by

Oct 29, 1991

Penalty

Initial $450 · Current $200 Reduced

Hazardous substances 136116601953

Issued

Jul 25, 1991

Abate by

Sep 30, 1991

Penalty

Initial $450 · Current $200 Reduced

Hazardous substances 136116601953

Issued

Jul 25, 1991

Abate by

Oct 29, 1991

Penalty

Initial $450 · Current $200 Reduced

Hazardous substances 1361166019530170