OSHA Inspection: HIGHLAND CARE CENTER

Issued

Jan 31, 1992

Abate by

Feb 18, 1992

Penalty

Initial $1,800 · Current $450 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 employee(s) were expsoed to the
hazard of becoming infected with Hepatitis B virus (HBV) and/or Human
Immunodeficiency Virus (HIV) through possible direct contact with blood or
other body fluids.
(a)  Establishment - Housekeeping and Health Care Depts.
On 11/20/91, Health care workers and housekeeping personnel were
exposed to the hazard of being infected by HBV and/or HIV through
possible direct contact with blood or other body fluids, while
performing patient care and laundry sorting:
(a)   These employees were not offered Hepatitis B Vaccination.
(b)   The infection control Program did not include follow-up
procedures after possible exposure to Hepatitis B Virus
and/or Human Immunodeficiency Virus.
ABATEMENT NOTES:
Among other methods, one feasible abatement method to reduce this hazard, i s
to establish and enforce adequate procedures regarding exposure to and
handling of blood and body fluids,  such as those stipulated by the Centers
for Disease Control (CDC) Guidelines for prevention of transmission of Huma n
Immunodeficiency Virus and Hepatitis B Virus to health care and public
safety workers.
HEPATITIS B VACCINATION
The facility's infection control policy regarding Hepatitis
B vaccinations shall address all circumstances warranting
such vaccinations and shall identify employees of substant-
ial risk of directly contacting blood and body fluids.
All such employees shall be offered Hepatitis B vaccinations
in amounts and at times prescribed by standard medical
practice.
FOLLOW-UP PROCEDURES AFTER POSSIBLE EXPOSURE TO HIV/HBV:
(i)    If a health care worker has a percutane-
ous (needle-stick or cut) or mucous
membrane (splash to the eye, nasal
mucosa, or mouth) exposure to blood or
body fluids or has a cutaneous exposure
to blood or body fluids 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.
(ii)   If patient consent is refused or if the
source patient tests positive, the
health care worker shall be evaluated
clinically 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).
(iii)  Follow-up procedures shall be taken for
health care workers exposed or
potentially exposed to HBV.  The type
of procedures depends on the immuniza-
tion 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 its
recommendations regarding HBV post
exposure prophylaxis in table format
in the June 5, 1985, Morbidity and
Mortality Weekly Report.
(iv)   If an employee refuses to submit to the
procedures in (ii) or (iii) 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.
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 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

Dec 4, 1991

Abate by

Jan 31, 1992

Penalty

Initial $3,150 · Current $1,575 Reduced

Issued

Dec 4, 1991

Abate by

Jan 31, 1992

Penalty

Initial $3,150 · Current $1,575 Reduced

Issued

Dec 4, 1991

Abate by

Jan 31, 1992

Penalty

Initial $3,150 · Current $1,575 Reduced

Issued

Dec 4, 1991

Abate by

Dec 13, 1991

Penalty

Initial $900 · Current $450 Reduced

Issued

Dec 4, 1991

Abate by

Jan 17, 1992

Issued

Dec 4, 1991

Abate by

Jan 17, 1992

Issued

Dec 4, 1991

Abate by

Jan 17, 1992