OSHA Inspection: ROCKVILLE LABORATORIES CORP.

Issued

Apr 5, 1991

Abate by

May 8, 1991

Penalty

Initial $210 · Current $100 Reduced

General-duty citation text

Section 5(a)(1) of the Occupational Safety and Health Act of 1970: The
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 employee(s) were exposed
to the hazard of becoming infected with Hepatitis B Virus (HBV) and/or
Human Immunodeficiency Virus (HIV) through possible direct contact with
blood or other body fluids.
a) Laboratory Area; on or about 2/22/91; Employees with job titles of
medical laboratory technicians received no training on universal
precautions and infection control as outlined in the CDC Guidelines
(1988). Employees were not instructed nor did they receive training
or an explanation of work practices that will prevent or reduce
exposure to blood or other body fluids including engineering controls
and appropriate Personal Protective Equipment (PPE).
b) Laboratory Area; on or about 2/22/91; Employees with job titles of
medical laboratory technicians who were potentially subject to
exposure incidents resulting from either a skin puncture from
contaminated sharps or splashes to mucous membrane of blood or other
body fluids, were not provided with training and information
concerning the hazards of such exposures. Employees were not advised
of nor were they offered Hepatitis B Vaccination and the opportunity
to particpate in follow-up procedures established by the Center for
Disease Control (CDC) 1985 Guidelines after an exposure incident.
The hazards of such exposure include, but are not limited to, the
onset of clinical symptoms of acute Hepatitis B, anorexia, abdominal
pain, jaundice and the potential for becoming a chronic carrier of
the Hepatitis B and/or Human Immunodeficiency Virus.
ABATEMENT NOTES:
Among other methods, one feasible abatement method to reduce this
hazard, is to establish and enforce adequate procedures regarding
exposure to and handling of blood or other body fluids, such as those
stipulated ny the Centers for Disease Control (CDC) Guidelines published
in Morbidity and Mortality Weekly Report, June 24, 1988, Volume 37,
Number 24. Elements essential to an Infection Control Program include at
a minimum:
ENGINEERING, ADMINISTRATIVE, AND WORKPRACTICE CONTROLS
Sharp instruments and disposable items. Needles shall not be recapped
purposely bent or broken by hand, removed from disposable syringes,
or otherwise manipulated by hand. Resheathing instruments self-
sheathing needles, or forceps shall be used to prevent recapping
needles by hand.
Reusable Equipment. Standard sterilization and disinfection
procedures currently recommended for Hepatitis B in a variety of
health care settings are adequate to sterilize or disinfect
instruments, devices, or other items contaminated with blood or
other body fluids. A recommended source of information is the CDC's
Guidelines for Hospital Environmental Control: Cleaning, Disinfection
and Sterilization of Hospital Equipment.
Bagging of articles. Objects that are contaminated with potentially
infectious materials shall be placed in a fluid resistant bag. If
outside contamination of the bag is likely, a second fluid
resistan bag shall be added.
Handwashing. After removing gloves, or other contaminated personal
protective equipment, hands or other skin surfaces shall be washed
thoroughly and immediately after contact with blood or other
body fluids.
TRAINING AND EDUCATION
Training and Education of employee(s) such as, but not limited to,
medical laboratory technicians.
Such training and education shall be at the time of initial
employment and at least annually thereafter. The training materials
used shall be appropriate in content and vocabulary to educational
level, literacy, and language background of the employees being
trained.
The training and education program shall contain, at a minimum, the
following elements:
i) A general explanation of the modes of transmission of bloodborne
pathogens;
ii) An explanation of the employer's Infection Control Program;
iii) An explanation of the appropriate methods for recognizing tasks
and other activities that may involve exposure to blood or other
body fluids and other potentially infectious materials;
iv) An explanation of the use and limitations of work practices that
will prevent or reduce employee exposure, including appropriate
engineering controls, work practices, and personal protective
equipment;
v) An explanation of the basis for selection of personal protective
equipment;
vi) Information of the Hepatitis B vaccination, including information
on its efficacy, safety and the benefits of being vaccinated;
vii) Information on the appropriate actions to be taken and the person
to contact in an emergency;
viii) An explanation of the procedure to follow if an exposure incident
occurs, including the method of reporting the incident and the
medical follow-up that will be made available;
ix) An explanation of the signs and labels and/or color coding used
in the workplace; and
x) A copy of the Center for Disease Control (CDC) Guidelines.
HEPATITIS B VACCINATION
The facility's infection control policy regarding Hepatitis B
vaccinations shall address all circumstances warranting such
vaccinations and shall identify employees of substantial risk of
directly contacting blood or other body fluids.
All such employees shall be offered Hepatitis B vaccinations in
amounts and at times prescribed by standard medical practice.
FOLLOW-UP PROCEDURES AFTER POSSIBLE EXPOSURE TO HIV/HBV:
i) If a laboratory technician has a percutaneous (needle-stick or
cut, mucous membrane (splash to eye, nasal mucosa, or mouth) or
a cutaneous exposure to blood or other body fluids when the
worker's skin is chapped, abraded or otherwise nonintact, the
source patient shall be informed of the incident and tested for
HIV and HBV infections, after consent is obtained.
ii) If patient consent is refused or if the source patient tests
positive, the health care worker shall be evaluated clinically
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 after exposure. HIV seronegative workers
shall be retested 6 weeks post-exposure and on a periodic basis
thereafer (12 weeks and 6 months after exposure).
iii) Follow-up procedures shall be taken for health care workers
exposed or potentially explosed to HBV. The type 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 has published
its recommendations regarding HBV post-exposure prophylaxis in
table format in the June 5, 1985, Morbidity and Mortality Weekly
Report.
iv) If an employee refuses to submit to the procedures in (ii) or
(iii) above, when such procedures are medically indicated, no
adverse action can be taken on that ground alone since the
procedures are designed for the benefit of the exposed employee.
HANDLING OF LINEN
The Infection Control Program shall have identified all laundry
operations involving substantial risk of direct exposure to blood
or other body fluids. Linen soiled with blood or other body fluids
shall be handled as little as possible and with minimum agitation
to prevent contamination of the person handling the linen.
All soiled linen shall be bagged at the location where it was used;
it shall not be sorted or rinsed in patient-care areas. Soiled
linen shall be placed and transported in bags that prevent leakage.

Issued

Apr 5, 1991

Abate by

Apr 6, 1991

Penalty

Initial $210 · Current $100 Reduced

Issued

Apr 5, 1991

Abate by

Apr 6, 1991

Penalty

Initial $210 · Current $100 Reduced

Issued

Apr 5, 1991

Abate by

May 8, 1991

Penalty

Initial $150 · Current $150

Issued

Apr 5, 1991

Abate by

May 8, 1991

Penalty

Initial $150 · Current $150