OSHA Inspection: GOOD SAMARITAN MEDICAL CENTER

Issued

Jan 23, 1995

Abate by

Apr 30, 1995

Penalty

Initial $4,500 · Current $2,500 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 employees
were exposed to:
(a) On or about August 2,1994, Nurses, Respiratory Therapist, X-Ray
Technicians,
Environmental Service personnel and other employees were exposed to the
hazard of being
infected with tuberculosis (TB) in the performance of their job duties
through repeated,
prolonged, indoor contact with patients who were 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 (e.g.  aerosolized medication treatment, sputum induction
procedures, housekeeping,
medical screening and other duties and procedures) which  may involve
close
contact with these
individuals where:
(1) Patient(s) with suspect or confirmed TB were not placed in negative
pressure rooms
to prevent exposure of employees in the facility to TB.
(2) A protocol for early identification of individuals with active TB was
not implemented.
(3) Worker education and training to ensure employee knowledge of hazards
of TB and
compliance with appropriate controls was not and implemented for all
employees exposed
to TB.
(4) Feasible engineering control measures were not fully implemented and
maintained for
employee protection from hazards of TB.
Feasible and useful abatement methods for reducing this hazard include,
but are not limited to
the following:
(1) Implement a protocol for early identification of individuals with
active TB.
(2) Implement feasible engineering controls as follows on the basis of
qualitative risk
assessment and the ability of each method to provide employee protection:
(i) Place individuals with suspected or confirmed TB disease in AFB (acid
fact
bacilli) isolation/ holding/ interview/rooms./ and perform "high risk"
procedures
such as sputum inductions, bronchoscopy, and other treatments and aerosol
generating procedures.
(ii) Keep AFB isolation rooms / procedures rooms/ under negative pressure
toinduce airflow into the room from all surrounding areas (e.g. adjoining
hallways,
offices, processing areas. ceiling plenums, plumbing chases, etc.)
(iii) Monitor (demonstrate) direction of airflow frequently to assure
maintenance
of negative pressure, frequently, and after adjustment or maintenance is
performed on the systems.
(iv) Employ a combination of controls and workpractices to minimize
spillage of
contaminated air from AFB containment rooms/ isolation rooms/ procedures
rooms when opening and closing doors and to assure door closure.
NOTE: Air flow exhausted from isolation rooms must be transported through
ducts and systems which are recognized as containing "biohazard air" and
which
are designed and operated to ensure maintenance of negative pressure during
normal operations and during interruptions (e.g. power failures and
required
maintenance).
(3) 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
References:
1. Centers for Disease Control and Prevention. Guidelines for preventing
transmission
of tuberculosis in health-care settings, with special focus on HIV related
issues. MMWR
1990;  39(No. RR-17):1-29.
2. American Society of Heating, Refrigeration, and Air Conditioning
Engineers. 1987
ASHRAE handbook: heating ventilating, and air-conditioning systems and
applications.
Atlanta, Georgia: American Society of Heating, Refrigeration, and Air
ConditioningEngineers, Inc. 1987:23 1-23.12.
ABATEMENT NOTE:
MULTI-STEP ABATEMENT PLAN IS AS FOLLOWS;
Step 1:(a) Institutional policy shall be developed and implemented for
early identification of
individuals/patients with active TB.
(b) Employee training shall be developed and implemented.
(c) 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 minimum,
target dates for the following actions which must be consistent with the
abatement dates
required by this citation.
(1) Evaluation of engineering control options;
(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.
Abatement Plan Due (Step 1) 30 days
Step 2:Abatement Shall have been completed by the implementation of
engineering
controls and upon verification of their effectiveness.
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.
Final Abatement Due (Step 2) 90 days

Issued

Jan 23, 1995

Abate by

Jan 31, 1995

Penalty

Initial $4,500 · Current $1,500 Reduced

Issued

Jan 23, 1995

Abate by

Jan 31, 1995

Penalty

Current $500

Hazardous substances 1290

Issued

Jan 23, 1995

Abate by

Feb 9, 1995