OSHA Inspection: DR. LEON O. CUMMINGS

Issued

Jul 20, 1992

Abate by

Aug 21, 1992

Penalty

Initial $750 · Current $300 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
subject to conditions that increased the risk of infection from blood-
borne pathogens through occupational exposure to blood or other poten-
tially infective materials (OPIM) as identified by the CDC.
The following conditions contributed to this hazard:
An  infection control program for  bloodborne pathogens had not been
developed nor implemented;
an HBV vaccination program and post-exposure evaluation and  follow-
up procedures were not made available; and
the employer had not developed nor implemented a comprehensive
training and information program relating to bloodborne pathogens to
the following employees exposed to bloodborne pathogens:
(a)  A chairside assistant who assisted in patient treatment pro-
cedures.
(b)  An operatory cleanup person who disposed of contaminated
sharps, transported contaminated instruments to the sterilizer
room, and cleaned contaminated equipment, surface areas, etc.,
following patient treatment procedures.
(c)  A general cleanup person who assisted in cleanup of contaminated
instruments in the sterilizer room.
In accordance with recommended practices from the CDC's guidelines for
protection from bloodborne diseases, elements neccessary to a complete and
effective exposure control plan include, but are not limited to:
(1) An exposure determination identifying all employees who are
directly exposed or whose jobs have the likelihood of exposure to
blood or other potentially infectious materials.  This exposure
determination must be made without regard to the use of personal
protective clothing and equipment.
(2) The recognition that universal precautions, as defined by the
Centers for Disease Control, shall be used as the basis for
infectious disease control protocol throughout the facility.
(3) The identification of specific policies and schedule of implemen-
tation of procedures on-site for the following components:
A. Methods of compliance
- Engineering and work practice controls
- Protective equipment provided and mandated
B. Hepatitis B vaccination
C. Post-exposure evaluation and follow-up
D. Infectious waste disposal
E. All labeling or identification of materials contaminated with
bloodborne pathogens used on site identified.
F. Housekeeping practices--cleaning and the method of decontamina-
tion based on degree of contamination, appropriate sterilization
techniques, etc.
G. Laundry practices
H. Training and information on bloodborne pathogens for affected
employees
I. Recordkeeping
In accordance with recommended practices from the CDC's guidelines for
protection from bloodborne diseases, elements neccessary to a complete
and effective HBV vaccination program include, but are not limited to:
(1) Make available the HBV vaccination  to all employees whose jobs
involve the risk of directly contacting blood or other potentially
infectious materials.  Employees requiring inclusion in an HBV
vaccination program include, but are not limited to, those
employees listed in the instance descriptions.
(2) Make all required medical procedures available to employees at no
cost to employees, available at a reasonable time and place, and
in accordance with the recommendations for standard medical
practice.
(3) If an employee initially declines the HBV vaccination, the
vaccination must still be made available to the employee if
he(she) decides to accept the vaccination later.
In accordance with recommended practices from the CDC's guidelines for
protection from bloodborne diseases, elements neccessary to a complete
and effective post-exposure evaluation and follow-up  program include,
but are not limited to:
(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 for 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 con-
tinued 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) Ensure 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.
In accordance with recommended practices from the CDC's guidelines for
protection from blood-borne diseases, elements neccessary to a complete
and effective bloodborne pathogens training program include, but are
not the limited to:
(1) Ensure that all employees at risk to bloodborne pathogens parti-
cipate in a training and education program.
(2) Ensure that training is conducted by qualified person(s), in-
cludes site-specific information, is conducted at a level appro-
priate for the educational level, literacy and language of the
employee(s).  Training effectiveness is judged by the level of
comprehension of trained employees.
(3) The training program, as a minimum, must include the following
elements:
A.  An explanation of the epidemiology and symptoms of HBV and
HIV.
B.  An explanation on the modes of transmission of HBV/HIV.
C.  An explanation of the employer's infection control plan.
D.  Explanation of the use and limitations of the methods
(engineering controls, work practices, PPE, etc.) to
control occupational transmission of bloodborne pathogens.
E.  Explanation of the basis for selection of personal protec-
tive equipment.
F.  Information on the hepatitis B vaccine, including its
efficacy, safety and the benefits of being vaccinated.
G.  Explanation of the procedure to follow if an exposure
incident occurs, method of reporting the incident, and
medical follow-up (testing and counseling) that will be
made available.
H.  An explanation of labels, signs, and other markings for
contaminated materials (e.g, as instruments, laundry or
dental models).

Issued

Jul 20, 1992

Abate by

Aug 21, 1992

Penalty

Initial $750 · Current $300 Reduced

Issued

Jul 20, 1992

Abate by

Aug 21, 1992

Penalty

Initial $750 · Current $300 Reduced

Issued

Jul 20, 1992

Abate by

Jul 23, 1992

Penalty

Initial $750 · Current $300 Reduced

Issued

Jul 20, 1992

Abate by

Aug 5, 1992

Penalty

Initial $750 · Current $300 Reduced

Issued

Jul 20, 1992

Abate by

Aug 21, 1992

Penalty

Initial $750 · Current $300 Reduced

Issued

Jul 20, 1992

Abate by

Aug 5, 1992

Penalty

Initial $750 · Current $300 Reduced

Issued

Jul 20, 1992

Abate by

Aug 5, 1992

Issued

Jul 20, 1992

Abate by

Aug 21, 1992

Penalty

Initial $750 · Current $300 Reduced

Issued

Jul 20, 1992

Abate by

Aug 21, 1992

Issued

Jul 20, 1992

Abate by

Aug 21, 1992

Penalty

Initial $750 · Current $300 Reduced