OSHA Inspection: GOLD CROSS AMBULANCE SERVICE, INC.

Issued

Apr 15, 1991

Abate by

Jun 16, 1991

Penalty

Initial $640 · Current $640

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
blood and body fluids potentially infected with Hepatitis B Virus (HBV)
and/or Human Immunodeficiency Virus (HIV):
a) On or about 11/21/90 to 1/17/91, paramedics and emergency medical
technicians were exposed to blood and body fluids while performing
life saving techniques, such as, administering IV units and
injections, performing first aid, advanced life support, and child
delivery procedures in that employees had not received Hepatitis B
vaccinations, were not properly sterilizing reusable equipment and
work surfaces contaminated with blood and/or body fluids, and were
not performing proper work practices to reduce exposure to blood
and/or body fluids.
The hazards of such exposure include, but are not limited to, the
onset of clinical symptoms of acute Hepatitis B, anorexia, abdominal
pain, jaundice, and the potential for becoming a chronic carrier of
the Hepatitis B and/or Human Immunodeficiency Virus.
Among other methods, one feasible abatement method to reduce this hazard
is to establish and enforce adequate procedures regarding exposure to
and handling of blood and body fluids, such as thos stipulated by the
Centers for Disease Control (CDC) Guidelines, published in Morbidity and
Mortality Weekly Report, June 24, 1988, Volume 37, Number 24. Elements
essential to an Infection Control Program include at a minimum:
1) Hepatitis B Vaccination. The facility's infection control 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) Reusable Equipment. Standard sterilization and disinfection procedure
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 body fluids. A recommended source of
information is the CDC's Guidelines for Hospital Environmental
Control: Cleaning, Disinfection and Sterilization of Hospital
Equipment.
3) Follow-up Procedures After Possible Exposure to HIV or HBV:
a) If a health care worker has a percutaneous (needlestick or cut) or
mucous membrane (splash to eye, nasal mucosa, or mouth) exposure to
body fluids or has a cutaneous exposure to blood when the worker's
skin is chapped, abraded, or otherwise nonintact, 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 vacinnation has
been received and antibody response is adequate) and the HBV
serologic status of the source patient. The CDC Immunization Practice
Advisory Committee had published its recommendations regarding HBV
post-exposure 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) or (c)
above when such procedures are medically indicated, no adverse action
can be taken on that ground alone since the procedures are designed
for the benefit of the exposed employee.
4) Training and Education. Training and education of employees such as,
but not limited to, Paramedics and Emergency medical Technicians.
Such training and education shall be at the time of initial
employment and at least annually thereafter. The training materials
used shall be appropriate in content and vocabulary to educational
level, literacy, and language background of the employees being
trained.
The training and education program shall contain, as a minimum, the
following elements:
i) A general explanation of the modes of transmission of bloodborne
pathogens;
ii) An explanation of the employer's Infection Control Program;
iii) An explanation of the appropriate methods for recognizing tasks
and other activities that may involve exposure to blood or body
fluids and other potentially infectious materials;
iv) An explanation of the use and limitations of work practices that
will prevent or reduce employee exposure, including appropriate
engineering controls, work practices, and personal protective
equipment.
v) An explanation of the basis for selection of personal protective
equipment;
vi) Information on the Hepatitis B vaccination, including information
on its efficacy, safety and the benefits of being vaccinated;
vii) Information of the appropriate actions to be taken and the person
to contact in an emergency;
viii) An explanation of the procedure to follow if an exposure incident
occurs, including the method of reporting the incident and the
medical follow-up that will be made available;
ix) An explanation of the signs and labels and/or color coding used
in the workplace; and
x) A copy of the Center for Disease Control (CDC) Guidelines.
5) Written Infection Control Program. The employer shall design and
implement a written Infection Control Program to minimize or
eliminate employee exposure. This Infection Control Program shall be
reviewed and updated as necessary to reflect significant changes in
tasks or procedures. This program shall contain, as minimum, the
following:
i) A determination of the exposure potential of all employees;
ii) The schedule and method of implementation of the Infection Control
Program.
The written Infection Control Program shall be made available to all
employees during the training program.
6) Handling of Linen. The Infection Control Program shall have
identified all laundry operations involving substantial risk of
direct exposure to blood or body fluids. Linen soiled with blood or
body fluids shall be handled as little as possible and with a
minimum agitation to prevent contamination of the person handling
the linen.
All soiled linen shall be bagged at the 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.

Issued

Feb 11, 1991

Abate by

Feb 21, 1991

Penalty

Initial $640 · Current $445 Reduced

Issued

Feb 11, 1991

Abate by

Feb 28, 1991

Penalty

Initial $640 · Current $445 Reduced

Issued

Feb 11, 1991

Abate by

Feb 21, 1991

Penalty

Initial $640 · Current $445 Reduced

Issued

Feb 11, 1991

Abate by

Feb 21, 1991

Penalty

Initial $420 · Current $290 Reduced

Issued

Feb 11, 1991

Abate by

Mar 18, 1991

Penalty

Initial $490 · Current $340 Reduced

Issued

Feb 11, 1991

Abate by

Feb 28, 1991

Penalty

Initial $420 · Current $290 Reduced

Issued

Feb 11, 1991

Abate by

Feb 28, 1991

Issued

Feb 11, 1991

Abate by

Mar 18, 1991

Penalty

Initial $490 · Current $340 Reduced

Issued

Feb 11, 1991

Abate by

Mar 18, 1991

Penalty

Initial $490 · Current $340 Reduced

Issued

Feb 11, 1991

Abate by

Feb 14, 1991

Penalty

Initial $70 · Current $70

Issued

Feb 11, 1991

Abate by

Mar 1, 1991

Penalty

Initial $350 · Current $300 Reduced