OSHA Inspection: ST. MICHAEL'S MEDICAL CENTER

Issued

Nov 12, 1999

Abate by

Dec 6, 1999

Penalty

Initial $1,875 · Current $500 Reduced

General-duty citation text

Section 5(a)(1) of the Occupational Safety & 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 employees were exposed to the hazard of being infected
with Mycobacterium
Tuberculosis through contact with patients who were or may be infected
with tuberculosis:
a) 8th Floor, Infectious Disease:
Nurses and other health care providers were exposed to the hazard of being
infected with
tuberculosis through exposure to the exhaled air of the individuals with
suspected or confirmed
pulmonary TB who were placed in isolation rooms, which were not under
negative pressure.
In addition, the pressure sensing indicator lights were not working
properly.
Violation observed on or about 07/09/99.
Isolation Rooms found not to be under negative pressure included but were
not
limited to: 802
and 803.
ABATEMENT NOTE: This violation requires certification and documentation as
appropriate
proof of abatement.  See Important Notice.
Feasible and acceptable abatement methods for reducing this hazard, as
recommended by the
Centers for Disease Control, among others are:
a.) Placement of individuals with suspected or confirmed TB disease in an
AFB (Acid Fast
Bacilli) isolation room.  AFB isolation rooms for persons with suspected
or confirmed infectious
TB and areas in which high hazard procedures are performed on such
individuals must be
maintained under negative pressure and appropriately exhausted (either
directly to the outside
away from intake vents or through properly designed, installed and
maintained HEPA filters).
Once rooms have been certified as being under negative pressure, the
following
steps should be
taken to ensure that negative pressure is maintained:
1.) Where pressure-sensing devices are used to monitor negative pressure
within an AFB
isolation room, periodic checks (at least monthly) are required to ensure
that the desired negative
pressure is present and that the continuous monitoring devices  are
operating properly.  Pressure-
sending devices must also be properly maintained.  Such devices should be
designed, installed
and checked in accordance with the CDC guidelines referenced below.
2.) Where smoke tubes or other visual checks are used to ensure negative
pressure with in the
AFB isolation and treatment rooms, checks should be conducted at least at
the following
frequencies:
a.) Daily if being used for negative pressure for TB isolation or if rooms
are undergoing
changes to the ventilation system.
b) Monthly if rooms are not being used for patients who have suspected or
confirmed TB
but potentially could be used for such patients.
Reference:  Centers for Disease Control Morbidity and Mortality Weekly
Report CDC
MMWR October 28, 1994 Volume 43Guidelines for Prevention the Transmission
of Mycobacterium Tuberculosisin Health Care Facilities, 1994.ities,

Issued

Nov 12, 1999

Abate by

Dec 6, 1999

Penalty

Initial $2,625