OSHA Inspection: BOCA RATON COMMUNITY HOSPITAL

Issued

Nov 17, 1994

Abate by

Sep 30, 1995

Penalty

Initial $4,500 · Current $4,500

General-duty citation text

Section 5(a)(1) of the Occupational Safety and Health Act of 1970:
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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 October 31, 1994, Nurses, Respiratory therapists,
Radiologic Technicians 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) 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.
(2) 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) 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.
(2) 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.
(3) 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.
(4) 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 aerosolized medication treatments and sputum
inductions.
(ii) Keep AFB isolation rooms/procedures rooms under
negative pressure to induce 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 work practices
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).
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 Conditioning Engineers, Inc. 1987:23 1-23.12.
ABATEMENT NOTE:
MULTI-STEP ABATEMENT PLAN IS AS FOLLOWS;
Step 1:(a) Employee medical monitoring program shall be  revised
to include tuberculin (PPD) skin testing of appropriate
frequency.
(b) 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)    15 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

Nov 17, 1994

Abate by

Dec 7, 1994

Penalty

Initial $975 · Current $975

Issued

Nov 17, 1994

Abate by

Nov 30, 1994

Issued

Nov 17, 1994

Abate by

Dec 7, 1994