OSHA Inspection: TRI COUNTY NURSING HOME

Issued

Mar 4, 1991

Abate by

Apr 3, 1991

Penalty

Initial $420 · Current $420

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 WAS
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) HEALTH CARE WORKERS (NURSES, NURSE AIDES, LAUNDRY WORKERS) AT THE
TRI-COUNTY NURSING HOME WERE EXPOSED TO THE HAZARD OF BEING INFECTED
BY HBV AND/OR HIV THROUGH POSSIBLE DIRECT CONTACT WITH BLOOD OR OTHER
BODY FLUIDS DUE TO A LACK OF AN EFFECTIVE INFECTION CONTROL PROGRAM.
FEASIBLE AND USEFUL ABATEMENT METHODS FOR REDUCING THIS HAZARD, AMONG
OTHERS ARE:
1) FOR EMPLOYEES SUCH AS, BUT NOT LIMITED TO, NURSES THAT MUST USE
SYRINGES TO DRAW BLOOD AND INJECT INSULIN:
HEPATITIS B VACCINATION: THE FACILITY'S IC POLICY REGARDING HEPATITIS
B VACCINATIONS SHALL ADDRESS ALL CIRCUMSTANCES WARRANTING SUCH
VACCINATIONS AND SHALL IDENTIFY EMPLOYEES AT SUBSTANTIAL RISK OF
DIRECTLY CONTACTING BODY FLUIDS. ALL SUCH EMPLOYEES SHALL BE OFFERED
HEPATITIS B VACCINATIONS FREE OF CHARGE IN AMOUNTS AND AT TIMES
PRESCRIBED BY STANDARD MEDICAL PRACTICES.
2) FOR EMPLOYEES SUCH AS, BUT NOT LIMITED TO, NURSE AIDES AND LAUNDRY
WORKERS THAT COLLECT SOILED LINEN, TRANSPORT SOILED LINENS, AND
LAUNDER SOILED LINEN:
LINEN: THE IC PROGRAM SHALL HAVE IDENTIFIED ALL LAUNDRY OPERATIONS
INVOLVING SUBSTANTIAL RISK TO DIRECT EXPOSURE TO BODY FLUIDS. LINEN
SOILED WITH BODY FLUIDS SHALL BE HANDLED AS LITTLE AS POSSIBLE AND
WITH MINIMUM AGITATION TO PRVENT CONTAMINATION OF THE PERSON HANDLING
THE LINEN. ALL SOILED LINEN SHALL BE BAGGED AT TH LOCATION WHERE IT
WAS USED; IT SHALL NOT BE SORTED OR RINSED IN PATIENT-CARE AREAS.
SOILED LINEN SHALL BE PLACED AND TRANSPORTED IN BAGS THAT PREVENT
LEAKAGE.
3) FOR EMPLOYEES SUCH AS, BUT NOT LIMITED TO, NURSES, AND NURSE AIDES
WHO MUST STERILIZE AND/OR DISINFECT INSTRUMENTS OR OTHER ITEMS
CONTAMINATED WITH BODY FLUIDS:
REUSABLE EQUIPMENT:  STANDARD STERILIZATION AND DISINFECTION
PROCEDURES CURRENTLY RECOMMENDED FOR HEPATITIS B IN A VARIETY OF
HEALTH CARE SETTINGS ARE ADEQUATE TO STERILIZE OR DISINFECT
INSTRUMENTS, DEVICES, OR OTHER ITEMS CONTAMINATED WITH BLODY FLUIDS.
A RECOMMENDED SOURCE OF INFORMATION IS THE CDC'S GUIDELINES FOR
HOSPITAL ENVIRONMENTAL CONTROL: CLEANING, DISINFECTION AND
STERILIZATION OF HOSPITAL EQUIPMENT.
4) FOR ALL EMPLOYEES THAT HAVE TO HANDLE POTENTIALLY INFECTIOUS MATERIAL
SUCH AS, BUT NOT LIMITED TO, WASTE:
BAGGING OF ARTICLES: OBJECTS THAT ARE CONTAMINATED WITH POTENTIALLY
INFECTIOUS MATERIALS SHALL BE PLACED IN AN IMPERVIOUS BAG. IF OUTSIDE
CONTAMINATION OF THE BAG IS LIKELY, A SECOND BAG SHALL BE ADDED.
5) FOR ALL HEALTH CARE WORKERS POTENTIALLY EXPOSED TO HBV AND/OR HIV:
FOLLOW-UP PROCEDURES AFTER POSSIBLE EXPOSURE TO HIV OR HBV:
A) IF A HEALTH CARE WORKER HAS A PERCUTANEOUS (NEEDLE-STICK OR CUT) OR
MUCOUS MEMBRANE (SPLASH TO EYE, NASAL MUCOSA, OR MOUTH) EXPOSURE TO
BLOOD 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.
B) IF PATIENT CONSENT IS REFUSED OR IF THE SOURCE PATIENT TESTS POSITIVE
THE HEALTH CARE WORKER SHALL BE EVALUATED CLINICALLY AND 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).
C) FOLLOW-UP PROCEDURES SHALL BE TAKEN FOR HEALTH CARE WORKERS EXPOSED
OR POTENTIALLY EXPOSED TO HBV. THE TYPES 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. THE CDC IMMUNIZATION
PRACTICES ADVISORY COMMITTEE HAS PUBLISHED IT RECOMMENDATIONS
REGARDING HBV POSTEXPOSURE PROPHYLAXIS IN TABLE FORMAT IN JUNE 7,
1985, MORBIDITY AND MORTALITY WEEKLY REPORT.
D) IF AN EMPLOYEE REFUSES TO SUBMIT TO THE PROCEDURES IN (B) AND (C)
ABOVE WHEN SUCH PROCEDURES ARE MEDICALLY INDICATED, NO ADVERSE ACTION
CAN BE TAKEN ON THAT GROUND ALONE SINCE THE PROCEDURES ARE DESIGNED
FOR TH BENEFIT OF THE EXPOSED EMPLOYEE.
6) FOR ALL HEALTH CARE WORKERS SUCH AS, BUT NOT LIMITED TO, NURSES,
NURSE AIDES, AND LAUNDRY WORKERS:
TRAINING AND EDUCATION OF HEALTH CARE WORKERS: THE EMPLOYER'S
TRAINING PROGRAM SHALL BE EVALUATED IN ACCORDANCE WITH APPENDIX C.
A) ALL HIGH RISK HEALTH CARE WORKERS SUCH AS THOSE LISTED IN H.1 SHALL
RECEIVE EDUCATION ON PRECAUTIONARY MEASURES, EPIDEMIOLOGY, MODES OF
TRANSMISSION AND PREVENTION OF HIV/HBV. HEALTH CARE WORKERS SHALL BE
COUNSELED REGARDING POSSIBL RISKS TO THE FETUS FROM HIV/HBV AND OTHER
ASSOCIATED INFECTIOUS AGENTS.
B) IN ADDITION, SUCH HIGH RISK WORKERS MUST RECEIVE TRAINING REGARDING
THE LOCATION AND PROPER USE OF PERSONAL PROTECTIVE EQUIPMENT. THEY
SHALL BE TRAINED CONCERNING PROPER WORK PRACTICES AND, IF THE
FACILITY HAS IMPLEMENTED THEM, SHALL UNDERSTAND THE CONCEPT OF
"UNIVERSAL PRECAUTIONS" AS IT APPLIES TO THEIR WORK PRACTICES. THEY
SHALL BE TRAINED ABOUT THE MEANING OF COLOR CODING OR OTHER METHODS
(EXCEPT TAGS) USED TO DESIGNATE CONTAMINATED ARTICLES OR INFECTIOUS
WASTE. WHERE TAGS ARE USED, TRAINING ABOUT TAGS AND PRECAUTIONS TO BE
USED IN HANDLING CONTAMINATED ARTICLES OR INFECTIOUS WASTE IS
GOVERNED BY 29 CFR 1910.145(F). (SEE SECTION M.4) WORKERS SHALL
RECEIVE TRAINING ABOUT PROCEDURES TO BE USED IF THEY ARE EXPOSED TO
NEEDLESTICK OR TO BODY FLUIDS.

Issued

Mar 4, 1991

Abate by

Mar 19, 1991

Penalty

Initial $420 · Current $420

Issued

Mar 4, 1991

Abate by

Mar 19, 1991

Penalty

Initial $420 · Current $420

Issued

Mar 4, 1991

Abate by

Mar 19, 1991

Issued

Mar 4, 1991

Abate by

Apr 3, 1991

Penalty

Initial $180 · Current $180

Issued

Mar 4, 1991

Abate by

Apr 3, 1991

Penalty

Initial $180 · Current $180

Issued

Mar 4, 1991

Abate by

Apr 3, 1991

Penalty

Initial $180 · Current $180

Issued

Mar 4, 1991

Abate by

Mar 19, 1991

Penalty

Initial $60 · Current $60

Issued

Mar 4, 1991

Abate by

Mar 19, 1991

Issued

Mar 4, 1991

Abate by

Mar 19, 1991