1. Are we required to provide employee TB skin testing?
Possibly not. OSHA does not have a formal tuberculosis standard but may use the General Duty Clause to cite employers who are not adequately protecting employees from recognized hazards. Federal OSHA currently relies on its compliance directive from 1996, which essentially exempts dental procedures unless performed in a hospital or a correctional institute and medical practices that are not performing high risk procedures (bronchoscopy, intubation, sputum induction, aerosolized treatments) on patients suspected or confirmed for active tuberculosis infection.
The Centers for Disease Control and Prevention issued new guidelines in December 2005, stating that all healthcare employers should provide initial TB testing for all healthcare workers. The CDC has no enforcement authority. A few State OSHA programs have indicated that they are already following the new recommendations: Alaska, Arizona, Massachusetts, Michigan, Nevada, New Mexico, South Carolina, Vermont and Wyoming. However, we had no luck in verifying this on their web sites.
Washington’s State OSHA continues to use the older CDC guidelines, and Tennessee OSHA says they will follow Federal OSHA’s lead. To date, other State programs have not responded to our query.
2. May we have coffee cups at the nurses’ station?
Whether you can have food and/or beverages in areas within the medical or dental practice depends not upon what you call the area but rather how you use the area.
¨ If injections are administered at the nurses’ station, or bandages are changed there, for example, no food or beverages are allowed.
¨ If the nurses’ station is used only for administrative tasks, such as talking to patients over the phone or completing paperwork, food or beverages would not be forbidden by OSHA. However, keep in mind all the other issues, such as general untidiness, insects, and potential damage to computers and important papers.,
3. Does OSHA allow employees to take home scrubs to launder them?
The purpose of the scrubs rather than a descriptor determines the answer.
¨ If the scrubs are used as personal protective equipment, the employer must purchase and maintain or replace them. This means the employees must wear street clothing from home, change into the scrubs at the practice, and change from scrubs to street clothing before leaving. The employer must launder them on site or send them to a commercial linen service.
¨ If, however, the scrubs are your uniform and you will add another garment, such as a lab coat or gown over the scrubs, that extra garment becomes the personal protective equipment which must be purchased and maintained or replaced by the employer. In this case, employees may launder scrubs at home.
¨ Perhaps a more difficult determination—is it a part of your uniform or is it personal protective equipment? Again—how is it used? If you remove it or cover it when performing tasks that may cause splattering, that extra garment is your personal protective equipment, and the lab coat is part of your uniform. If, however, the lab coat is meant to protect your other clothing—street clothes, uniform, or scrubs—it is personal protective equipment and must be provided by and maintained or replaced by the employer.
4. The last OSHA Bulletin stated that we are not required to maintain a Sharps Injury Log because we are not required to maintain the OSHA 300 Log. Does this exempt us from documenting sharps injuries?
Absolutely not! Employers are required to document details of all sharps injuries! The documentation must include at least all information required for sharps injury logs. In the Bloodborne Pathogen section of the DoctorsManagement OSHA Manual, there are forms for this purpose.
Some State programs DO require all healthcare facilities, including medical and dental offfices with 11 or more employees, to maintain the OSHA 300 Log. This includes Minnesota OSHA.
5. How often are we required to have OSHA training?
OSHA requires training for all employees when they are first hired (prior to being exposed to the hazards), anytime new hazards (new chemicals, for example) are added or the individual’s job responsibilities change resulting in exposure to different hazards, anytime the regulations change, and each year.
6. How should we discard expired medications?
OSHA does not address the disposal of wastes. The Environmental Protection Agency (EPA), the Resource Conservation and Recovery Agency (RCRA), and various State agencies do. Your very best resource for your locality is your waste hauler. Waste haulers are highly regulated themselves and will not give you information that may put them at risk if your, their customer, does something inappropriate. Some waste haulers will tell you to place expired medications in the biohazard bags, while others will tell you to package it separately and label the container “Chemical Waste.” It depends upon local regulations and how the waste hauler ultimately disposes of the waste.
7. Does OSHA require Hepatitis A Vaccine for healthcare workers?
Not at this time. HVA is transmitted through contaminated food and water, meaning that you are more likely to be exposed through ingesting contaminated restaurant food than through patient care.
8. .Does OSHA allow health care workers to wear “Crocs”?
Here an excerpt from a letter from OSHA dated July 17, 2006, responding to this question. The same response pertaints to sandals, open toe shoes, clogs, and flip flops.
You had a specific question relating to the use of "Crocs" Brand shoes (those that have a partially open heel but a covered toe) in a pharmacy setting. You asked for OSHA to interpret its guidelines on foot protection.
OSHA does not have a specific policy, or guidelines, on the wearing of open-heeled shoes. However, OSHA does have regulations pertaining to personal protective equipment, and more specifically, to protective footwear. They are found at 29 CFR 1910.132 and 1910.136 (copies enclosed). 29 CFR 1910.136(a) requires the use of protective footwear when employees are working in areas where there is a danger of foot injuries due to falling or rolling objects, or objects piercing the sole, and where there is a possibility of the employee's feet being exposed to an electrical hazard.
In general, the standards require that foot protection be used whenever it is necessary by reason of hazard of processes or environment which could cause foot injury. If you are exposed, however infrequently, to those hazards during the course of your business activities, then, during that period of exposure, you would be required to wear protective footwear. If an employee is not exposed to any hazards to the feet, then the use of protective footwear would not be required.
Normally, the employer will determine which, if any, of the employees are exposed to a foot injury hazard. Ultimately, the determination of appropriate footwear in the absence of any of the previously mentioned hazards would be a matter for labor-management negotiation to which OSHA would not be a party.
9. What are OSHA’s regulations about storing items under the sinks in the clinical areas?
We have been unable to find any OSHA regulations relating to the storage of items under the sink, nor have we been able to link it to employee health and safety. This question seems to be triggered by guidelines from some accrediting agency (possibly Joint Commission, formerly the Joint Commission on the Accreditation of Health Care Organizations or JCAHO) or a managed care organization. One explanation is that patient care items could be contaminated by potential leakage.
10. How often do we need to update our OSHA Manual?
OSHA requires all employers to evaluate hazards and produce a written protection program initially, and to update the written program anytime the hazards change or when OSHA’s standards change. The last standard change impacting healthcare was in 2001, with the release of the new Bloodborne Pathogen Standard. The Hazardous Communications Standard requires employers to update their Chemical List annually. The Bloodborne Pathogen Standard requires employers to review their exposure risk categories every year to be sure they are still accurate and to update them if needed. This Standard also requires employers to evaluate new safer medical devices periodically. Interpretations from OSHA indicate that this means at least every year.
11. What are OSHA’s guidelines for tracking medication samples?
Again, this is a patient care issue, not an employee safety or health t issue and therefore is not addressed by OSHA at all. However, many managed care organizations and accrediting agencies are very concerned about medication samples. Liability issues are involved as well. Because of the burden placed on the doctors’ offices to keep up with samples, we have developed two tracking logs: one to document your inventory and expiration dates, and the second to enable you to link lot numbers with patients in case of a recall.. Please see the next two pages.
12. Does OSHA require us to have a special license to transport small amounts of biohazardous waste from satellite offices to the central office for pick up by our waste hauler?
No. OSHA does not govern the transport of waste. The transport of hazardous waste, both biohazardous waste and hazardous chemicals, is under the Department of Transportation (DOT) and the Environmental Protection Agency (EPA). Your local EPA is your best resource for licensing questions. The federal Hazardous Materials (HazMat) Regulations do not require placarding for private vehicles, such a cars used by home health agencies or laboratory couriers.
13. In one of the past issues, you mentioned that OSHA is concerned with the accuracy of information in the MSDSs. Will we be fined if OSHA inspects us and finds errors in our MSDSs?
No. OSHA holds the manufacturer, not the employer or the distributor, responsible for the accuracy of the information in the MSDS. However, if the distributor or employer has information indicating errors, he or she should report that to the manufacturer and to OSHA. OSHA is working with manufacturers to improve the reliability of this information.
14. Is there a safety needle for administering epidurals? We have not been able to find one, but luckily we have not had any needle sticks. Would OSHA fine us?
Yes, there is a safety epidural needle, but we have not evaluated it or heard results from any practice that has evaluated it. It is the “Periflex Safety Epidural Needle.” More information is available at www.bbraunusa.com. OSHA requires every employer with employees at risk for exposure to bloodborne pathogens to evaluate safer devices that are available and to use the ones that will work in their setting. If there is only one manufacturer of a particular device, OSHA does not require the employer to use that device. However, a perfect track record does not protect employees from poten tial exposures in the future, so OSHA certainly could fine employers for failure to evaluate available devices at least every year.
15. How should we transport contaminated dental impressions?
According to “Guidelines for Infection Control in Dental Health-Care Settings-2003,” published in the MMWR December 19, 2003/Vol. 52/No. RR-17, dental impressions must be handled as any other biohazardous material. Impressions should be disinfected with an EPA-registered hospital disinfectant that claims to be effective against tuberculosis. Ask the manufacturer of the impression material to recommend a disinfectant that will not harm the material, then follow the instructions on the disinfectant’s container (time, temperature, etc.). Rinse the impression thoroughly following disinfect ion.
If the impression cannot be disinfected, it must be handled with Universal Precautions. If it is to be transported between locations by a commercial courier system, it comes under the Hazardous Materials Regulations enforced by the Department of Transportation.
16. What are OSHA’s regulations concerning personal heaters?
OSHA does not govern personal heaters, but the local fire marshal does. Follow electrical safety guidelines and use only those heaters approved by your local fire marshal.
17. What are OSHA requirements for Hepatitis B Vaccine?
Healthcare employers must offer Hapatitis B vaccination to all employees at risk for exposure to bloodborne pathogens. The vaccine must be offered within 10 days of being assigned responsibilities that pose a risk for exposure. It must be offered totally free of charge to the employee and under the supervision of a healthcare professional authorized by State laws. There must be documentation that the healthcare professional has evaluated the employee and determined that it is safe for the employee to receive the vaccine. The employee has the right to decline the vaccine but must sign the declination form.
The employer must provide a blood test 1- 2 months following the tjhird shot. If the test does not show that the employee is immune, the employer must offer a second series, folloing the same requirments as for the first series. The employer must pay for the blood tests as well. If the employee still does not show immunity, the employer must encourage the employee to seek further medical evaluation but is not required to pay for it.
The employer must maintain documenation (shot records, test results, or signed declination) for the duration of employment plus 30 years unless the employee stays with that employer less than 12 months from hire. In that case, the employer should offer the documentation to the employee when he or she leaves. If the employee does not want the records, the employer should shred them.
18. Is a routine booster dose of hepatitis B vaccine required?
This response is directly from OSHA.
Because the U.S. Public Health Service (USPHS) does not recommend routine booster doses of hepatitis B vaccine, they are not required at this time. However, if a routine booster dose of hepatitis B vaccine is recommended by the USPHS at a future date, such booster doses must be made available at no cost to those eligible employees with occupational exposure.
19. Do we have to have an eyewash station?
If you have a chemical on the premises with a pH less than 2 or greater than 12, you must have an eyewash station that is separately plumbed and operable with a foot pedal. Otherwise, a faucet adapter should suffice. Read your material safety data sheets! Many common chemicals used in healthcare are eye irritants, requiring the employee to “flush with copious quantities of fresh water” or “flush for 15 mihutes with fresh water.” Hand-held squeeze bottled do not accommodate this requirement.
20. Do we have to use safer sharps? Can’t we just evaluate them?
Reponse from OSHA: (emphasis added)
OSHA's bloodborne pathogens standard at 29 CFR 1910.1030(c)(1)(iv) requires employers to evaluate safer medical devices to eliminate or minimize employee exposure to blood or other potentially infectious materials (OPIM). Employers must solicit input from non-managerial employees in the selection process [29 CFR 1910.1030(c)(1)(v)]. Engineering controls, including safety scalpels, must be implemented where their use is feasible [29 CFR 1910.1030(d)(2)(i)].
The Exposure Control Plan (1910.1030(c)(1)(i)) shall:
Reflect changes in technology that eliminate or reduce exposure to bloodborne pathogens [1910.1030(c)(1)(iv)(A)].
Document annually consideration and implementation of appropriate commercially available and effective safer medical devices designed to eliminate or minimize occupational exposure [1910.1030(c)(1)(iv)(B)].
Solicit input from non-managerial employees responsible for direct patient care, who are potentially exposed to injuries from contaminated sharps, in the identification, evaluation, and selection of effective engineering and work practice controls and shall document the solicitation in the Exposure Control Plan [1910.1030(c)(1)(v)].
21. What are OSHA’s guidelines for the use of hand sanitizers?
Response on OSHA’s web site:
The new Centers for Disease Control and Prevention (CDC) "Guideline for Hand Hygiene in Health-Care Settings" (Morbidity and Mortality Weekly Report, October25, 2002) supports the use of alcohol-based hand rubs as an effective means for decontaminating hands in healthcare settings. Is this consistent with the requirements for handwashing established in OSHA's bloodborne pathogens standard?
Many of CDC's hand hygiene guidelines are for infection control and patient safety, which OSHA standards do not specifically address. However, we feel that these guidelines which do address occupational exposures to blood or other potentially infectious materials (OPIM) are consistent with OSHA's bloodborne pathogens standard. In paragraph (d)(2) of OSHA's standard, the section that most appropriately addresses "handwashing" in the scenario that you describe, the following is stated:
(v) Employers shall ensure that employees wash their hands immediately or as soon as feasible after removal of gloves or other personal protective equipment. (vi) Employers shall ensure that employees wash hands and any other skin with soap and water, or flush mucous membranes with water immediately or as soon as feasible following contact of such body areas with blood or other potentially infectious materials.
OSHA interprets this to mean that when an employee is removing gloves and has had contact, meaning occupational exposure to blood or blood or other potentially infectious materials (OPIM), hands must be washed with an appropriate soap and running water. If a sink is not readily accessible (e.g., in the field) for instances where there has been occupational exposure, hands may be decontaminated with a hand cleanser or towelette, but must be washed with soap and running water as soon as feasible. If there has been no occupational exposure to blood or OPIM, antiseptic hand cleansers may be used as an appropriate "handwashing" practice.
Again, if there has been no occupational exposure to or contact with blood or OPIM (as defined in [29 CFR 1910.1030(b)]), the use of alcohol-based hand cleansers described in the CDC's October 2002 guidelines would be appropriate. The application of the standard and its specific elements must be put into place where there has been actual or reasonably anticipated exposure to blood or OPIM and does not apply if no occupational exposure exists.
OSHA has consistently relied on the findings and recommendations of the CDC in developing good work practices for those employees with occupational exposure to blood or OPIM and feels that the existing standard does not compromise or contradict the recommendations included in the CDC's most recent guidelines.
22. What does OSHA require concerning disposal of contaminated sharps used in the home?
Homes are not governed by OSHA. Therefore, OSHA has NO guidelines for disposal of contaminated sharps used in the home. However, this may be governed by state regulations. Please refer to ¨www.cdc.gov/needledisposal or call your solid waste dept. or public health department for advise.
US EPA Recommendations:
Place in puncture-resistant container and seal
Take to drop box or supervised collection site
Consider
Mail back program
Home needle destruction devices
Syringe exchange program
23. What are OSHA’s regulations concerning the use of lighted candles in private practices?
OSHA does not govern the use of candles, but the local fire marshal may. The use of lighted candles is forbidden in many public buildings. Yes, restaurants, spas and other establishments do use them.
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