OSHA Inspection: COMPREHENSIVE MEDICAL SERVICES, INC

Issued

Aug 25, 1994

Abate by

Oct 13, 1994

Penalty

Initial $975 · Current $500 Reduced

General-duty citation text

Section 5(a)(1) of the Occupational Safety and Health Act of 1970:
%%
The employer did not furnish to employees 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:
(a) On or about May 02, 1994, Nurses 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, bronchoscopy, sputum
induction, endotracheal
intubation, and suctioning procedures which have the potential to generate
potentially infectious
airborne respiratory secretions or infectious airborne particles when
performed on individuals
with suspected or confirmed TB disease where;
(1) Periodic employee medical evaluations and PPD tuberculin skin testing
was not
offered and made available to all employees exposed to TB.
Feasible and useful abatement methods for reducing this hazard include,
but are not limited to
the following:
(1) 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 individuals with TB. 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
diseases 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 that the employee is no longer infectious.
(5) 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
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.
ABATEMENT NOTE:
Employee medical monitoring program shall be revised to include tuberculin
(PPD) skin testing
of appropriate frequency.

Issued

Aug 24, 1994

Abate by

Sep 1, 1994

Issued

Aug 24, 1994

Abate by

Sep 1, 1994

Issued

Aug 24, 1994

Abate by

Sep 20, 1994

Issued

Aug 24, 1994

Abate by

Sep 20, 1994