Highlights of 29 CFR 1910.1030 (Cont’d)

1. Highlights of 29 CFR 1910.1030 (Cont’d) Post-exposure Evaluation and Follow-upThe employer must make a confidential medical evaluation and follow-up to employees following an exposure incident.

2. Highlights of 29 CFR 1910.1030 (Cont’d) Communication of Hazards to Employees • Labels and signs • Information and training

3. Highlights of 29 CFR 1910.1030 (Cont’d) Recordkeeping • Medical Records • Training Records

4. Tuberculosis (TB) • Infectious disease caused by the bacterium, Mycobacterium tuberculosis • Spread by airborne droplets generated when a person with TB disease coughs, sneezes, speaks, or sings • Infection occurs when a susceptible person inhales droplet nuclei containing the bacteria which become established in the body • Mantoux tuberculin skin test detects TB infection, positive results indicate infection. Other tests needed to confirm TB disease

5. TB Occurrence • Since 1985, the incidence of TB in the general U.S. population has increased 14% reversing a 30 year downward trend. • However, during 1994 and 1995, there has been a decrease in TB cases in the U.S. likely due to increased awareness and efforts in prevention and control of TB. • Cases of multi-drug resistant TB have recently been reported in 40 states. • Worldwide, 8 million new TB cases and 3 million deaths occur annually.

6. Why Is TB Increasing? Multiple contributing factors: • Homelessness • Intravenous drug use • Overcrowding in institutional settings • HIV infection • Reduced resources for TB control and treatment • Immigration from high TB prevalence areas

7. Tuberculosis - OSHA Enforcement On 2/9/96, OSHA issued agency-wide CPL 2.106, “Enforcement Procedures and Scheduling for Occupational Exposure to Tuberculosis.”This enforcement directive cancels the enforcement guidelines issued on 10/8/93.

8. Tuberculosis - OSHA Enforcement (Cont’d) OSHA’s CPL 2.106 is based on the Centers for Control and Prevention (CDC) “Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities” issued on 10/18/94.OSHA believes these guidelines reflect an industry recognition of the hazard as well as appropriate, widely accepted standards of practice to be followed by employers in carrying out their responsibilities under the OSH Act.

9. Workplace Identified by CDC with High Incidences of TB • Health Care Settings • Correctional Institutions • Homeless Shelters • Long-term Care Facilities for the Elderly • Drug Treatment Centers

10. Highlights of CDC Guidelines and OSHA Requirements • Determine the risk of exposure • Early diagnosis, isolation, treatment • Requirements for isolation • Training of workers • Skin testing • Respirators - OSHA standard 1910.134 • Other applicable standards - recordkeeping, employee access to records, accident prevention signs

11. Workplace Violence Any physical assault, threatening behavior, or verbal abuse occurring in the workplace.The workplace may be any location either permanent or temporary where an employee performs any work-related duty.

12. Acts of Aggression Which May Indicate Risk • Disorderly conduct • Verbal threats to inflict bodily harm • Fascination with guns or other weapons • Obscene phone calls • Intimidating presence • Harassment of any nature

13. Types of Workplace Violence Incidents Based upon the relationship between the assailant/worker/workplace, violent incidents can be divided into categories: • violence by strangers • violence by customers/clients/patients • violence by co-workers • violence by personal relationship

14. Types of Workplace Violence Incidents (Cont’d) Homicides • Leading cause of job-related deaths for women, second leading cause for men • Claimed the lives of 1,171 lives in 2004 (BLS data) • Approximately 5 workers died each day under violent circumstances in 2004 Nonfatal Assaults • Between 1987-1992, one million persons were annually assaulted at work

15. Establishments Affected by Workplace Violence According to the Bureau of Labor Statistics, the highest number of homicides occur in night retail establishments.The highest number of nonfatal assaults occur in the health care and social service sectors.

16. Health Care Establishments Nonfatal assaults were primarily by patients/residents on nursing staff in health care institutions.According to one study (Goodman et al., 1994), between 1980-1990, 106 violence related deaths occurred among health care workers.

17. Nursing Homes • BLS 1994 data showed more than 4900 assaults and violent acts against employees in nursing homes. • Nursing aides and orderlies accounted for more than 50% of the assault victims. • Most of the violent acts involved hitting, kicking, and beatings.

18. Examples of Why Health Care Workers are at Risk Of Work-Related Assaults • Low staffing level during times of increased activity; • Isolated work with patients/residents during examinations or treatment; and • Lack of training of staff in recognizing and managing escalating hostile and assaulting behavior.

19. OSHA Guidelines - Overview Because of the high incidence of workplace violence, OSHA developed in 1996 a set of voluntary guidelines to prevent workplace violence.The guidelines cover a broad spectrum of workers (nearly 8 million) in psychiatric facilities, hospital emergency departments, drug treatment centers, community care and mental health facilities, pharmacies and long-term care facilities.

20. Violence Prevention Program Elements • Management Commitment and Employee Involvement • Worksite Analysis • Hazard Preventing and Control • Training and Education • Recordkeeping and Evaluation of Program

21. Availability of Guidelines The OSHA “Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers” are available on the Internet at http://www.osha.gov

22. Hazard Communication • General Requirements and Guidelines

23. Hazard Communication

24. Introduction • About 32 million workers work with and are potentially exposed to one or more chemical hazards • There are approximately 650,000 existing chemical products, and hundreds of new ones being introduced annually

25. Introduction • Chemical exposure may cause or contribute to many serious health effects such as heart ailments, central nervous system damage, kidney and lung damage, sterility, cancer, burns, and rashes • Some chemicals may also be safety hazards and have the potential to cause fires and explosions and other serious accidents

26. Purpose To ensure that employers and employees know about work hazards and how to protect themselves so that the incidence of illnesses and injuries due to hazardous chemicals is reduced. Hazard Communication Program Material Safety Data Sheet Container Labeling MSDS Program Label

27. Who is covered? • Chemical manufacturers • Importers • Employers • Employees exposed to chemical hazards

28. Standard Application • General Industry • Construction • Shipyard • Marine terminals • Longshoring

29. Employer Responsibilities • Identify and list hazardous chemicals in their workplaces • Obtain Material Safety Data Sheets (MSDSs) and labels for each hazardous chemical

30. Employer Responsibilities • Implement a written HazCom program, including labels, MSDSs, and employee training • Communicate hazard information to employees through labels, MSDSs, and formal training programs

31. How can workplace hazards be minimized? • Perform a thorough hazard assessment • Employers can rely on the evaluations performed by the manufacturers or importers to establish the hazards of the chemicals they use • MSDSs and labels

32. HazCom Program (f) "Labels and other forms of warning." (g) "Material safety data sheets." (h) "Employee information and training." Why is a written program required? • Ensures that all employers receive the information they need to inform and train their employees • Provides necessary hazard information to employees

33. Written HazCom ProgramRequirements • Describes container labeling, MSDSs, and employee training for each workplace • List of the hazardous chemicals • Make information regarding hazards and protective measures available to other employers onsite

34. How must chemicals be labeled? Each container of hazardous chemicals entering the workplace must be labeled or marked with: • Identity of the chemical • Appropriate hazard warnings • Name and address of the responsible party

35. Container Labeling in the Workplace • The hazard warning can be any type of message, picture, or symbol that provides information on the hazards of the chemical(s) and the targeted organs affected, if applicable • Labels must be legible, in English (plus other languages, if desired), and prominently displayed

36. Material Safety Data Sheets Prepared by the chemical manufacturer or importer and describe: • Physical hazards, such as fire and explosion • Health hazards, such as signs of exposure • Routes of exposure • Precautions for safe handling and use • Emergency and first-aid procedures • Control measures

37. Material Safety Data Sheets (cont’d) • Must be in English and include information regarding the specific chemical identity and common names • Must be readily accessible to employees in their work area

38. Material Safety Data Sheets (cont’d) • Must provide information about the: • Physical and chemical characteristics • Health effects • Exposure limits • Carcinogenicity (cancer-causing) • Identification (name, address, and telephone number) of the organization responsible for preparing the sheet

39. Material Safety Data Sheets (cont’d) • MSDSs have no prescribed format • If no MSDS has been received for a hazardous chemical, employer must contact the supplier, manufacturer, or importer to obtain one and maintain a record of the contact

40. Training • At the time of initial assignment • Whenever a new hazard is introduced into their work area Training is required for employees who are exposed to hazardous chemicals in their work area:

41. What training is neededto protect workers? • Explanation of the HazCom program, including information on labels, MSDSs, and how to obtain and use available hazard information • Hazards of chemicals • Protective measures such as engineering controls, work practices, and the use of PPE • How to detect the presence or release of a hazardous chemical (using monitoring devices, observation, or smell)

42. What information must beprovided to workers? • The HazCom standard and its requirements • Operations in their work areas where hazardous chemicals are present • Location and availability of the written hazard evaluation procedures, communications program, lists of hazardous chemicals, and the required MSDSs Employees must be informed of:

43. Summary • OSHA’s Hazard Communication Standard is based on a simple concept - that employees have both a need and a right to know the hazards and identities of the chemicals they are exposed to when working • Employees also need to know what protective measures are available to prevent adverse effects from occurring

44. Other Occupational Health Issues Associated With Long Term Care Facilities • Exposure Control Plans • Universal Precautions • Infection Control • Latex Allergies • Indoor Air Quality

45. Exposure Control Plan • Exposure Determination • List of job classifications (all employees exposed, some exposed) • List of tasks and procedures where exposure may occur (without regard to use of ppe) • Methods of Compliance • Universal Precautions • Engineering Controls • Work Practice Controls • Personal Protective Equipment

46. Universal PrecautionsTreat all blood samples and potentially infected materials as if infected.. • Use proper personal protective equipment • Immediate washing of hands and other skin surfaces if contact with materials • Wash hands immediately after glove removal • Management of sharps • Exposure incident reporting and follow-up • Spill response

47. Engineering and Work Practice Controls • Hand washing facilities and procedures • Contaminated needles handling (no bending, recapping) • Placement of used sharps in special containers (puncture resistant, labeled, leak proof, color coded) • No eating, drinking, smoking, hanging contacts, use of cosmetics in exposure areas • No storage of food where blood is present • Minimize splashing, spraying, spattering • No mouth pipetting • Placement of blood in leak proof containers ( labeled, color coded) • De-contamination of equipment

48. Personal Protective Equipment • Must be provided, cleaned, laundered, disposed of, replaced, and used properly. • Gloves, gowns, face shields, masks, resuscitation bags, eye protection, aprons, and caps • Consider possibility of soiling (aprons when changing dressing), and spattering (eyewear during mouth examinations) • Cleaning and disposal • Removal before leaving workplace • Stored in containers after use

49. Housekeeping • Keep written schedules and methods of cleaning and decontaminating surfaces and equipment • Maintain clean and sanitary worksite • De-contaminate work surfaces • Use protective coverings • Cleaning of receptacles, pails, bins • No hand contact with broken contaminated glassware • Handling of re-usable sharps

50. Discarding of contaminated sharps • Container must be closable, puncture resistant, leak proof, labeled and color coded • Keep closed • Secondary containment if leak occurs • Disposal according to Federal, State, local requirements