OSHA Inspection: AMHERST PRESBYTERIAN NURSING CENTER

Issued

Aug 6, 1991

Abate by

Sep 9, 1991

Penalty

Initial $2,125 · Current $1,063 Reduced

General-duty citation text

Section 5(a)(1) of the Occupatiional Safety and Health Act of 1970: The
employer did not furnish employement 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 the
hazard of becoming infected with Hepatitis B Virus (HBV) or Human
Immunodeficiency Virus (HIV) through possible exposure to blood or other
body fluids:
a)   Floors 1, 2, and 3, on or about 3/5/91 - 3/7/91 - Registered
Nurses, Liceensed Practical Nurses, and Nurses Aids were exposed
to blood and/or body fluids while performing health care duties
due to contact with material contaminated with blood and/or
body fluids while changing dressings and linen, and by needle
sticks after administration of drugs.
The hazards of such exposure include, but are not limited to, onset of
clinical symptoms of acute Hepatitis B, anorexia, abdominal pain,
jaundice, the potential for becoming a chronic carrier of the Hepatitis
B virus, or contraction of HIV.
Among other methods, one feasible abatement method to reduce this hazard,
is to establish and enforce adequate procedures regarding employee expo-
sure to blood and body fluids, such as those stipulated by the Centers for
Disease Control (CDC) Guidelines published in Morbidity and Mortality
Weekly Report, June 24, 1988, Volume 37, Number 24, which includes:
1)   Hepatitis B Vaccination - All employees at substantial risk of
directly contacting blood or body fulids shall be offered
hepatitis B vaccinations free of charge in amounts and at times
prescribed by standard medical practices.
2)   Follow-Up Procedures After Possible Exposure to HIV or HBV:
(a)  If a health care worker has a percutaneous (needlestick
or cut) or mucous membrane (splash to eye, nasal mucosa, or
mouth) exposure to body fluids or has a cutaneous exposure to
blood when the worker's skin is chapped, abraded, or otherwise
non-intact, the source patient shall be informed of the incid-
ent and tested for HIV and HBV infections, after consent is
obtained.
(b)  If patient consent is refused or if the source patient
tests positive, the health care worker shall be evaluated
clinically and by HIV antibody testing as soon as possible and
advised to report and seek medical evaluation of any acute
febrile illness that occurs within 12 weeks exposure.  HIV
seronegative workers shall be retested 6 weeks post-exposure
and on a periodic basis thereafter (12 weeks and 6 months after
exposure).
(c)  Follow-up procedures shall be taken for health care
workers exposed to or potentially exposed to HBV.  The types
of procedures depends on the immunization status of the worker
(i.e.; whether HBV vaccination has been received and antibody
response is adequate) and the HBV serologic status of the
source patient.  The CDC Immunization Practices Advisory
Committee published its recommendations regarding HBV postexpo-
sure prophylaxis in table format in June 7, 1985, Morbidity and
Mortality Weekly Report.
(d)  If an employee refuses to submit to the procedures in (b)
or (c) above when such procedures are medically indicated, no
adverse action can be taken on that ground alone since the pro-
cedures are designed for the benefit of the exposed employee.
3) IMPLEMENTATION OF ENGINEERING CONTROLS AND WORK PRACTICES AS
NECESSARY TO REDUCE RISK OF CONTACT WITH BLOOD (E.G., SPLASHES,
AEROSOLS, CUTS) SUCH AS:
A) PLACEMENT OF EMBALMING TABE DRAIN TUBE AND ASPIRATOR DISCHARGE BELOW
WATER SURFACE IN THE EMBALMING SINK.
B) COVERING OF EMBALMING SINK.
C) MAINTENANCE OF REGULATED AREAS TO PRECLUDE ACCESS OF UNPROTECTED
EMPLOYEES TO AREAS OF FACILITY WHERE FIXTURES, EQUIPMENT, ETC., MAY
BE CONTAMINATED WITH BLOOD OR OTHER POTENTIALLY INFECTIOUS MATERIAL.

Issued

Aug 6, 1991

Abate by

Sep 9, 1991

Penalty

Initial $2,125 · Current $1,063 Reduced

Issued

Aug 6, 1991

Abate by

Aug 16, 1991

Issued

Aug 6, 1991

Abate by

Aug 16, 1991

Issued

Aug 6, 1991

Abate by

Aug 16, 1991