OSHA Inspection: COLUMBIA AVENTURA HOSPITAL AND MEDICAL CENTER

Issued

Apr 3, 1997

Abate by

Aug 14, 1997

Penalty

Initial $4,500 · Current $2,250 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 exposed to the
hazard of being infected with Mycobacterium tuberculosis through
unprotected contact with
patients who were infectious or suspected to be infectious with
tuberculosis in that:
a.  On or about January 23 thru March 6, 1997:
(1)  Bronchoscopy procedures conducted on suspect/confirmed TB patients
were
conducted in the Fluoroscopy suite which was not maintained under negative
pressure.
(2)  Post exposure evaluation and follow-up of employees exposed to
MycobacteriumTuberculosis were not performed in accordance with the
U.S.P.H.S.
recommendations in that PPD testing was not completed for healthcare
workers exposed
to a confirmed TB patient from July 3-11, 1997.
(3)  Healthcare workers, such as traveling and agency nurses, exposed to
patients
withconfirmed TB were not notified in a timely manner to assure
appropriate medical
evaluation and treatment.
(4)  The two-step baseline PPD testing procedure was not utilized for
healthcare workers
who had an initial negative TB skin test result and do not have a
documented negative
TB skin test result in the preceding 12 months.
Feasible and useful abatement methods for reducing this hazard include,
but are not limited to
the following:
(1)  Perform high hazard procedures such as bronchoscopy, sputum
inductions, and other
treatments and aerosol generating procedures on  individuals with suspect
or confirmed
TB disease in AFB (acid fast bacilli) isolation rooms or AFB treatment
rooms.
(2)  Provide post exposure evaluation and follow-up to healthcare workers
exposed
topatients with suspect or confirmed TB in accordance with the U.S.P.H.S.
recommendations and in a timely manner.
(3)  Provide two-step TB skin test for new employees who have an initially
negative PPD
test result and who have not had a documented negative TB skin test result
during the
preceding 12 months.
References:
1.  Center of Disease Control and Prevention. Guidelines for Preventing
the
transmission
of mycobacterium tuberculosis in Health Care Facilities, 1994: MMWR
October 26,
1994 Vol.43, No. RR-13.
ABATEMENT NOTE:
MULTI-STEP ABATEMENT PLAN IS AS FOLLOWS;
Step 1:
(a) Employee medical monitoring program shall be established and revised to
include/ tuberculin (PPD) skin testing of appropriate frequency  for newly
hired
employees and those who receive an exposure.
(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) 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

Apr 3, 1997

Abate by

May 20, 1997

Penalty

Initial $100 · Current $50 Reduced

Issued

Apr 3, 1997

Abate by

May 20, 1997