OSHA Inspection: SAINT AGNES HOSPITAL

Issued

Sep 4, 1992

Abate by

Dec 6, 1992

Penalty

Initial $4,500 · Current $900 Reduced

General-duty citation text

Section 5(a)(1) of the Occupational Safety and Health Act of 1970:  The
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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:
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Employees including but not limited to staff nurses, respiratory
therapists, maintenance mechanics, and environmental services
personnel who were exposed to the hazard of being infected by
tuberculosis through repeated prolonged indoor contact with
patients/prisoners who may be infected with tuberculosis
in that:
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(a) Room 303 and 401: Isolation rooms used to patients with active
TB were not provided with ventilation to assure negative pressure
with respect to the hallway.  On or about 3/22/92.
(b) Department of Corrections Unit: Seven of eight rooms on the
floor were used for patients suspected of having TB and were not
provided with ventilation to assure negative pressure with
respect to the hallway.  On or about 5/04/92.
(c) Department of Corrections Unit:  Environmental Service
Personnel who enter and clean rooms occupied by active TB
patients and those suspected of TB are not provided ppd skin
patch tests at 6 month intervals.  On or about 5/04/92.
(d) Hospital Wide:  Respiratory therapists who treat active TB
patients without the protection of a containment booth or
negative pressure are not provided ppd skin patch tests at
6 months intervals.  On or about 4/14/92.
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Feasible and use abatement methods for reducing this hazard
as recommended by the CDC include but are not limited to
the following:
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1. Medical Screening
A.  All employees in the facilities covered must be offered
the Mantoux skin test free of charge and at a time and place
convenient to the employee.
All test procedures shall be conducted in accordance with
standard medical practice.
Frequency of testing shall be as follows:
-  At time of employment, unless there is a previous positive
test or documented completion of adequate preventive therapy.
- Every six (6) months for workers with frequent exposure to
patients with TB or are involved with high hazard procedures.
- annual testing for other workers.
- After a TB exposure: that is, if a worker has been
exposed to a potentially infectious TB patient for whom
infection control procedures have not been taken.  This will not
be required when an employee's last skin test was within the
previous three (3) months.  If negative, the skin test shall be
repeated twelve (12) weeks after exposure.
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2. Work Removal
When an employee is found to have current pulmonary or laryngeal
TB, they shall be excused from work until adequate treatment
is instituted, their cough is resolved and physician certifies
that the person is no longer infectious.
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3. Training and Education
Employees shall be trained regarding the hazards and control of
tuberculosis.  At a minimum, the following subjects shall be
discussed.
- The cause and transmission of TB
- Definition of "infectious'
- The distinction between TB skin disease and TB infection
- The purpose and interpretation of TB skin testing, including
the significance of skin test conversion
- The signs and symptoms of TB
- The reporting mechanism of the signs and symptoms
- The purpose of preventive therapy
- The risk factors for TB disease development
- The treatment of TB and the origin and prognosis of
multi-drug resistant TB
- The purpose of surveillance, and the recommended
following up of positive skin tests
- Site specific protocols
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Training for employees also includes:
- The engineering controls in use in the person's work area
- The critical role directly observed therapy (DOT) plays
in preventing the emergence of multiple drug resistant
strains of TB.
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The training shall be given to all employees in covered facilities upon
initial employment and should be repeated annually thereafter.
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4.  Respiratory Isolation
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All covered facilities providing health care services to confirmed
infectious TB patients must keep these patients in pulmonary
isolation rooms.  The pulmonary isolation room must be under
negative pressure and exhausted to the outside away from intake vents,
people and animals.  If venting directly to outside is not possible
the air must be exhausted through properly designed, installed
and maintained HEPA facilities.
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Issued

Sep 4, 1992

Abate by

Oct 7, 1992

Penalty

Initial $4,500 · Current $900 Reduced

Issued

Sep 4, 1992

Abate by

Oct 7, 1992

Penalty

Initial $1,800 · Current $360 Reduced

Issued

Sep 4, 1992

Abate by

Oct 7, 1992

Penalty

Initial $1,800 · Current $360 Reduced

Issued

Sep 4, 1992

Abate by

Oct 7, 1992

Issued

Sep 4, 1992

Abate by

Oct 7, 1992

Penalty

Initial $1,350 · Current $270 Reduced

Issued

Sep 4, 1992

Abate by

Oct 7, 1992

Penalty

Initial $1,800 · Current $360 Reduced

Issued

Sep 4, 1992

Abate by

Dec 7, 1992

Issued

Sep 4, 1992

Abate by

Oct 7, 1992

Issued

Sep 4, 1992

Abate by

Nov 7, 1992

Issued

Sep 4, 1992

Abate by

Oct 7, 1992

Issued

Sep 4, 1992

Abate by

Nov 7, 1992