Beware: OSHA inspections for pathogen reg

By Katherine West, BSN, MSEd, CIC

Infection Control Consultant

Infection Control/Emerging Concepts

Manasas, VA

Many health care facilities, offices, and clinics feel that OSHA is not interested in whether or not they are complying with the federal mandate for protection of healthcare workers from exposure to bloodborne pathogens. If you are at one of these sites, here is a wake-up call.

From April 1996 to April 1998, OSHA inspected a total of 291 medical and surgical hospitals. Violations totaled 739, and 58% were listed in the "serious" category. In addition, 123 offices and clinics were inspected. These inspections led to 289 violations being noted, and 52% of the violations were listed as serious. For skilled care and nursing/personal care facilities, 322 inspections were conducted. Overall, 447 violations were noted, and 41% were listed in the "serious" category. Serious violations do result in fines. The fines can vary in amount depending on the type of violation. It should be noted that these inspection figures were from federal OSHA states only. Data from state plan states was not available.

Inspections can come about in several ways: first, an anonymous employee complaint regarding unsafe workplace conditions; second, a random computer selection, and third, a patient generated complaint. Yes, patients do call OSHA! Complaints are placed on a triage system, and only those that pose a serious threat to staff are acted on immediately. In some cases, a phone/fax system is used for query and follow-up. OSHA will contact your workplace by phone to discuss the complaint and information to resolve the issue can be handled by phone/fax transmission.

At the end of this review period, OSHA issued its new top 10 list of violations, including improper red bag use for medical waste and problems with availability of hepatitis B virus vaccine. (See OSHA violations list, p. 141.) It is amazing, too, in many ways, this list has not really changed in the past five years. Health care workplace settings are still not fully meeting the requirements.

Compliance is not difficult, nor is it expensive if you know how to use the compliance directive to the regulation for clarification.1 This document, along with the interpretive quips published by OSHA, shed a great deal of light on what is required by OSHA and how to keep up with the changes. (For more information on these and other OSHA's materials, access the agency's Internet home page at http://www.osha.gov.)

Here are a couple of examples: First, OSHA withdrew its requirement for disinfectant solutions to be tuberculocidal in February 1997. This widened your purchasing ability and may lower cost. Second, many facilities are looking to sorting as a way to decrease the cost of medical waste disposal. Did you know that your state and local medical waste regulations may offer even more assistance? Environmental Protection Agency regulations and your state and local regulations must be considered by OSHA.

Compliance and a good infection control program is a risk-reduction process. In this age of litigation, a well functioning program that benefits both patients and staff is the way to proceed. It is risk management. If your workplace is not in compliance, now is the time to get working on correcting any deficiencies. If administration is not cooperating, perhaps they would like to review the top 10 listing.

^Reference

1. U.S. Department of Labor. OSHA Instruction CPL 2-2.44C: Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens Standard. 29 CFR 1910.1030. Washington DC:1992.