By Tina Ross Sheedy, R.N. & Megan Neuhard
The Occupational Safety and Health Administration (OSHA) is charged with reviewing, revising and enforcing the standards under the Occupational Safety and Health Act (also known as OSHA). Historically, OSHA auditors have focused on compliance among industrial organizations where the incidence and overtness of injury was significant. However, with the recent push for legislation to protect health care workers, as well as a report by the Institute of Medicine regarding the large number of injuries and deaths in health care facilities, OSHA has refocused review efforts on the health care industry.
As this focus has shifted, many medical practices and hospitals are finding the need to evaluate their preparedness for an OSHA audit. OSHA violations can quickly add up—and cost your practice money. A worse case scenario, of course, is injury or death to a patient or employee.
Many of the most common violations are simple to correct, but being prepared and constantly evaluating your readiness is essential. Some of these most common violations, and ways you can protect your staff and practice, are outlined below.
Needlestick Safety and Prevention Act
Perhaps one of the most important issues involves the use of sharps. The Centers for Disease Control and Prevention estimate that health care workers sustain nearly 600,000 percutaneous injuries annually involving contaminated sharps.
The Needlestick Safety and Prevention Act directed OSHA to revise the bloodborne pathogens standards to address use of sharps with engineered sharps injury protection and/or needleless systems. The revision became effective April 18, but OSHA did not begin enforcing them until mid-July.
Some of the most important components to the new OSHA requirements include record keeping, employee input and implementation of sharps protections. Any employer who has employees that are occupationally exposed to blood or other potentially infectious materials, and who are required to maintain a log of occupational injuries and illnesses under existing record keeping rules, must also maintain a sharps injury log.
Employers must also solicit input from non-managerial employees responsible for direct patient care regarding the identification, evaluation and selection of effective engineering controls, including safer medical devices.
The revision also specifies that “safer medical devices, such as sharps with engineered sharps injury protections and needleless systems” must be used where feasible. These products include nonneedle sharps or needle devices containing built-in safety features that are used for collecting fluids or administering medications or other fluids, or other procedures involving the risk of sharps injury.
An area that OSHA routinely evaluates is the presence, placement, use, maintenance and testing of fire extinguishers. This evaluation is performed in conjunction with a review of an employer’s written fire prevention plan.
When portable fire extinguishers are present in the workplace, they must be visually inspected and recorded on a monthly basis, along with the performance of an annual maintenance check. This annual maintenance check must be documented with records retained for one year after the last maintenance check or the life of the extinguisher shell, whichever is less.
If the written fire prevention plan requires employees to use the fire extinguishers, the employer must ensure the fire extinguisher is mounted, located and identified so that it is readily accessible to employees without subjecting them to possible injury. Additionally, the employer must provide training to the employees on extinguisher use and hazards involved in incipient stage fire fighting.
Any stored pressure dry chemical extinguishers that require a hydrostatic test must be emptied and subjected to maintenance procedures every six years. To ensure employee safety, OSHA requires an employer to provide an alternative equivalent form of protection if a portable extinguisher is removed from service for maintenance or recharging.
Incomplete Material Safety Data Sheet Files
As part of a written Hazard Communication Plan, OSHA requires the availability of Material Safety Data Sheets, or MSDSs, for every hazardous material present in the workplace. These MSDS are supplied by the manufacturers of these materials and provide detailed information about the hazardous materials.
Each MSDS provides information that includes chemical composition, physical and chemical characteristics, acute and chronic health effects, exposure limits, precautionary measures, emergency and first-aid procedures, and the identification of the organization preparing the sheet along with their emergency contact information. An MSDS must be available in close proximity to the location in which the hazardous chemical is used and must be readily accessible during each work shift to employees when they are in their work area(s).
Hazardous chemicals that are covered under the Hazard Communication Standard do not include any food, drug or medical device or product when they are subject to the labeling requirements by either the Food and Drug Administration or the Department of Agriculture.
Exposure Control Plan
It is not simply enough to have an exposure control plan in place—it must be in writing. It is hard to believe, but not having an exposure control plan in writing is a common violation of OSHA. The written plan must include an exposure determination for each of your employees, methods of compliance, procedure(s) for the evaluation of an exposure incident, the availability of Hepatitis B vaccine and vaccination series to all employees who have occupational exposure, and a schedule and method for implementation of the plan. The exposure control plan must be reviewed and updated on an annual basis and whenever necessary to acknowledge new work practices or modifications of current practices.
In addition, the Needlestick Safety and Prevention revision includes new requirements regarding an employer’s Exposure Control Plan. These requirements include an annual review and update to reflect changes in technology that eliminate or reduce exposure to bloodborne pathogens. Additionally, the revisions call for employers to solicit frontline employee input in selecting safer devices that assist in preventing occupational exposure from needlesticks at the workplace. Employers must also keep a sharps injury log that documents all employee needlestick injuries.
Annual Training not Conducted on Time
Finding the time to get that annual training conducted may be a problem, but not having this training conducted may cost the practice and become an even bigger problem. Training programs for employees should include a review of the exposure control plan, fire safety plan and hazard communication plan. These training programs should provide employees with a detailed understanding of workplace practices and requirements of their position along with necessary methods to be instituted to create and maintain an environment of safety.
Each employee should be provided with appropriate training prior to the employee engaging in any assigned tasks. This training can be accomplished through a comprehensive orientation program, monthly staff meetings, annual training days and periodic updates for all employees. Take the time to make sure your staff is ready and prepared.
The bottom line: by being prepared for an OSHA audit you assure that your staff and practice are safe. Remember, prevention is often the best medicine.
Tina Ross Sheedy, BS, RN, is a clinical analyst with PMSCO Health Care Consulting, and is an authorized general industry OSHA trainer. Megan Neuhard is principal of M2 Communication Solutions.