OSHA Inspection: FLORIDA MEDICAL CENTER LTD DBA FLORIDA MEDICAL CTR

Issued

Nov 18, 1993

Abate by

Jul 19, 1994

Penalty

Initial $2,275 · Current $1,140 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
employees in that:
On or about May 27, to June 3, 1993, Nurses, Respiratory Therapists and
other employees
were exposed to the hazard of being infected with tuberculosis (TB)
through repeated, prolonged
indoor contact with patients who are infectious, or suspected of being
infectious, with TB in that
employees had potential exposure to the exhaled air of individuals with
suspected or confirmed
TB disease, and/or performed, or were exposed during performance of,
high-hazard procedures
(such as aerosolized medication treatment, bronchoscopy, sputum
induction, endotracheal
entubation, and suctioning procedures, and autopsies which have the
potential to generate
potentially infectious airborne respiratory secretions) performed on
individuals with suspected
or confirmed TB disease where;
(1) A protocol for early identification and treatment of individuals with
active TB was not
developed and implemented.
(2) Periodic employee medical evaluations and PPD tuberculin skin testing
was not of
appropriate frequency for workers with frequent exposure to patients with
TB or who are
involved with high hazard procedures.
(3) Worker education and training to ensure employee knowledge of hazards
of TB and
compliance with appropriate controls was not developed and implemented
for all exposed
employees.
(4) Feasible engineering control measures were not fully implemented and
maintained for
employee protection.
Feasible and useful abatement methods for reducing this hazard, as
recommended by the
Centers for Disease Control, among others, are:
(1) Develop and implement a protocol for early identification of
individuals/patients with active
TB.
(2) Provide medical screening for workers which includes the following:
(i) Periodic evaluations;  provide initial and periodic
employee medical
evaluations which include PPD tuberculin skin testing
every six (6) months for
workers with frequent exposure to patients with TB or who
are involved with
high hazard procedures.  Provide all other workers in the
covered workplace
testing annually.  Note;  workers with a documented
positive TB skin test who
have received documented adequate treatment for disease
or preventative therapy
for infection are exempt unless they develop symptoms.
NOTE:  Evaluations must include Mantoux skin test
free of charge,
conducted in accordance with standard medical
practice, and at a time and
place convenient to the employee.
(ii) Reassessment following exposure or change of health;
additionally, provide
any employee experiencing an unprotected occupational
exposure to a person with
infectious tuberculosis disease a revaluation and repeat
PPD testing in accordance
with current CDC guidelines.
(3) Provide case management which includes appropriate physical,
laboratory, and radiographic
evaluations of new converters to determine whether the employee has TB
disease as soon as
possible, normally within 72 hours, following detection of a PPD
conversion.  Provide
prophylactic therapy in accordance with current CDC guidelines.
(4) Provide medical removal when workers with infectious TB disease are
detected by medical
evaluation.  Remove infectious workers from duty until there is no risk
of transmission of TB.
Return workers on medical removal to work when adequate treatment for TB
disease is
instituted, cough has resolved, and a health care professional certifies
the the employee is no
longer infectious.
(5) Implement feasible engineering controls as follows on the basis of
qualitative risk assessment
and the ability of each method to provide employe protection:
(i) Place individuals with suspected or confirmed TB
disease in AFB (acid fast
bacilli) isolation rooms.  perform high-risk procedures
on individuals with
suspected or confirmed TB disease in designated treatment
room.
(ii) keep AFB isolation and treatment rooms under
negative pressure to induce
airflow into the room from all surrounding areas (e.g.
corridors, ceiling plenums,
plumbing chases, etc).
NOTE:  Air flow exhausted from isolation/treatment rooms
must be transported
through ducts and systems which are recognized as
containing "biohazard air"
and hwich are designed and operated to ensure maintenance
of negative pressure
during normal operations and during interuptions (e.g.
power failures and
required maintenance).
(6) Provide worker education and training prior to initial assignment,
and at least annually,
which includes at least the following elements;
(i)   Nature and transmissibility of TB
(ii)  Risk factors for disease development!
(iii) Signs, symptoms, diagnosis, and treatment of TB
disease
(iv)  Institutional protocols
(v)   Engineering controls
(vi)  Workpractice controls, including personal hygiene
protection
(vii) Personal protective equipment
(7) In laboratories, conduct all aerosol-generating manipulatins of
clinical specimens of (or
containing, or that may potentially contain) Mycobacterium tuberculosis
in appropriate Class
I, II or III biological safety cabinets (BSC).
(a) Recertify BSC annually, at a minimum, and whenever
the HEPA filers are
replaced, the BSC is moved, or maintenance is performed
on the BSC.
(b) Determine appropriate biosafety levels for laboratory
operations from the
advisory guidelines in Biosafety in Microbiological and
Biomedical Facilities
(CDC/NIOSH).
References:
1. Centers for Disease Control and Prevention.
Guidelines for preventing
transmission of tuberculosis in health-care settings,
with special focus on
HIVrelated
issues.  MMWR 1990; 39(NO. RR-17):1-29.
2. Centers for Disease Control and Prevention/NIH.
Biosafety
in Microbiological
and Biomedical facilities.  3rd ed., 1993 (HHS Pub
#(NIH)040-00508-3.
ABATEMENT NOTE:
MULTI-STEP ABATEMENT PLAN IS AS FOLLOWS;
Step 1: (a) Institutional policy shall be drafted and implemented for
early identification of
individuals/patients with active TB.
(b) Employee medical monitoring program shall be revised to
include tuberculin (PPD)
skin testing of appropriate frequency.
(c) Employee training shall be developed and implemented.
(d) A written detailed plan of abatement outlining a schedule for
the implementation of
engineering measures to control or reduce employee exposure to TB
as referenced in this
citation shall be submitted to the Area Director.  This plan
shall include, at a minimum,
target dates for the following actions which must be consistent
with the abatement dates
required by this citation.
(1) Evaluation of engineering control optionsl;
(2) Selection of optimum control methods;
(3) Procurement, installation, and operation of selected control
measures; and
(4) Testing or acceptance or modification/redesign of controls.
NOTE:  All proposed control measures shall be approved by a
competent, technically
qualified person.  Thirty (30) day progress reports are required
during the abatement
period.
Step 2. Abatement shall have been completed by the implementation of
engineering controls and
upon verification of their effectiveness.

Issued

Nov 18, 1993

Abate by

Jan 6, 1994

Penalty

Initial $1,300 · Current $650 Reduced

Issued

Nov 18, 1993

Abate by

Dec 6, 1993

Issued

Aug 11, 1993

Abate by

Oct 15, 1993

Penalty

Initial $1,300 · Current $650 Reduced

Issued

Aug 11, 1993

Abate by

Oct 15, 1993

Issued

Aug 11, 1993

Abate by

Oct 15, 1993

Issued

Aug 11, 1993

Abate by

Sep 13, 1993

Issued

Aug 11, 1993

Abate by

Sep 13, 1993

Issued

Aug 11, 1993

Abate by

Sep 13, 1993