OSHA Compliance for the Funeral Home

1. OSHA Compliance for the Funeral Home Kathleen K. Ryan, Esquire

2. OSHA Law29 U.S.C. Sec. 654 (b) • Each Employer shall: • Assure their workplace is safe and free from hazards that are likely to cause death or serious injury; • Provide training; • Follow standards and keep current; • Keep records

3. Inspection Priorities • Imminent danger • Catastrophes and fatal accidents • Employee complaints • Referrals • Planned or targeted inspections • Follow-up inspections

4. Pennsylvania Law49 Pa. Code Sec. 13.181 • “A funeral director is responsible for the knowledge of and compliance with State and local health laws and regulations in addition to the act, this chapter and current Occupational Safety and Hazardous Administration regulations.

5. Discrimination29 C.F.R. Sec. 1977 Employers cannot discharge or in any manner discriminate against any employee for: • Filing a complaint or instituting any proceeding related to OSHA • Testify or who will testify in any proceeding • Has exercised any right afford to he/she or others under OSHA

6. Accident/Illness Recordkeeping 29 C.F.R. Sec. 1904 Funeral Homes are classified as a “low hazard industry” and are generally exempt from this requirement EXCEPT funeral home employers must: • Report fatalities or inpatient hospitalizations of three or more employees (within 8 hours of incident) as a result of a work-related accident/illness • Report fatalities caused by a heart attack • Maintain a log of occupation injuries and illnesses when notified by OSHA or Bureau of Labor Statistics (Form on website)

7. Access to Employee Exposure and Medical Records29 C.F.R. Sec. 1910.1020 • Employers must provide access to employees, their designated representatives and OSHA for relevant exposure and medical records, regardless of whether these records are maintained by a specific standard.

8. Employee Exposure Record A record that contains any of the following: • Workplace monitoring or measuring of a toxic substance or harmful physical agent to which an employee has been exposed; • Biological monitoring results which directly assess the absorption of a toxic substance or harmful physical agent by body systems • MSDS sheets • Chemical inventories • Records must be kept for at least 30 years

9. Employee Medical Record Any record concerning the health status of an employee which is made or maintained by a physician, nurse or other health care person including: • Medical and employment questionnaires/histories • Results of medical exams • Medical opinions, diagnoses, progress notes and recommendations • First aid records • Descriptions of treatment and prescriptions • Employee medical complaints • These records must be kept for a duration of employment plus 30 years

10. OSHA Requests If OSHA requests personal medical information, the employer MUST post a copy of the written access order and accompanying cover letter for at least 15 working days.

11. Employee Training Employee training is required upon: • First entering into employment • Annually thereafter Training consists of: • Existence, location and availability of records • Person in charge of records • Employee’s right of access to records

12. Hazardous Communication Standard29 C.F.R. Section 1910.1200 Purpose is to ensure hazards of all chemicals are evaluated and that information about the hazard is transmitted to employees through a Written Hazard Communication Program • Develop • Implement • Maintain

13. MSDS Sheets MSDS Sheets must be kept on all hazardous chemicals to which employees are or could be exposed. • Must have a current sheet from manufacturer • Should be in two locations (prep room) and some other easily accessible place in FH • Procedure on replacement and removal of old ones • Can be electronic • Must provide training

14. Training for MSDS Must Include: • An overview of the HCS requirements (on initial hire and every time a new chemical is introduced) • Hazardous chemicals in workplace • Physical/health risks of chemicals • How to determine release of chemicals through use of control procedures, work practices and PPE • Steps employer has taken to reduce exposure • Procedures to follow if exposed • How to read MSDS and obtain information • Location of Written Hazard Comm. Program and MSDS

15. Revised Hazard Communication Standard • 12/31/13, funeral establishments must train on new MSDS sheets (now called Safety Data Sheets or SDS) • 6/1/15, manufacturers must comply with new standard but distributors can use up old products • 6/1/16, funeral establishments must update workplace labeling and hazard communication program to comply with revised standard

16. Bloodborne Pathogen Standard29 C.F.R. Sec. 1910.1030 Purpose: To minimize exposure to bloodborne pathogens or other potentially infectious materials Bloodborne Pathogen - pathogenic microorganisms that are transmitted via human blood and cause disease. Ex: HIV, HBV .

17. Exposure Control Plan Must include: • Exposure determination • Schedule and implementation of compliance • Hepititus B vaccination status • Post exposure follow up • Recordkeeping • Annual documentation of innovations to prevent/reduce risk of injury • Solicit non-managerial employees input • Date you sought information • Decision reached and reason therefor

18. Storage of Hazardous Waste28 Pa. Code, Sec. 284 • Infectious waste may be stored at room temperature until the container is full but no longer than 30 days from the date the waste is placed in the container. • A storage container that has been filled within 30 days from the date the first waste was placed may be frozen immediately for up to 90 days from the date the waste was first put in the container.

19. Engineering Controls • Eliminates hazards at their source • Examples: Special containers for sharps/needles

20. OSHA’s Position on Safer Needle Devices: • Bloodborne Pathogens Standard requires use of engineering and work practice controls • Failure to use engineering/work practice controls could result in a citation • Devices which offer alternatives to needles are preferable

21. Source: Chiarello, 1995

22. Retractable Blade Scalpel

23. Blunt Nose Needle

24. Sharps Containers • Sharps must be disposed in special containers • Must be labeled with universal biohazard symbol and the word biohazard • Containers must be readily accessible to employees, be puncture resistant, have leak-proof sides and bottoms, be upright throughout use, be replaced routinely and be filled only to capacity (not overflowing)

25. Other Hazards Require Signage Labels are required on: • Regulated waste • Laundry bags • Refrigerators/Freezers with waste • Bags/Containers used to store, dispose or transport infectious materials • Contaminated equipment that is to be serviced or shipped

26. Work Practice Controls Practices to minimize hazards from blood/infectious materials: • Wash hands, minimize spraying/splashing of blood. • Prevent needle sticks • Use PPE • Don’t allow eating/drinking, applying of cosmetics, contacts in prep room • Remove contaminated clothing before leaving work area

27. 800,000 Needlestick Injuries Occur Each Year in the United States Source: Occupational Safety and Health Administration

28. 16,000 of These Are Likely to Be Contaminated by HIV Source: American Hospital Association, 1992 Source: Occupational Safety and Health Administration

29. Up to 80% of All Accident Exposures to Blood Are Caused by Needlestick Injuries 80% Source: Jagger, J., 1988 Source: Occupational Safety and Health Administration

30. Source: Chiarello, 1992 Source: Occupational Safety and Health Administration

31. HBV and HCV Pose an even Greater Risk than HIV Source: Centers for Disease Control and Prevention, 1991 Source: Occupational Safety and Health Administration

32. Occupational Risk of Hepatitis B • Much more transmissible than HIV • Risk after needlestick: 2% - 40% • 1994 - 1000 health care workers developed HBV infection • Approximately 200 HCWs die each year Source: CDC, 1991; 1997 Source: Occupational Safety and Health Administration

33. Occupational Risk of Hepatitis C • HCV - major cause of chronic liver disease • No vaccine • No effective post-exposure prophylaxis • 85% of HCV infected people develop chronic infection Source: CDC, 1997; NIH, 1997 Source: Occupational Safety and Health Administration

34. Occupational Risk of HIV • Risk after needlestick - 1 in 300 • Exposures from needlesticks or cuts cause most infections Source: CDC, 1991; 1996 Source: Occupational Safety and Health Administration

35. HCWs with Occupationally Acquired HIV/AIDS Infection Source: CDC, 1997 Source: Occupational Safety and Health Administration

36. Needlestick Injuries Are Costly • Time and money to investigate the source • Post-exposure care • Lost work time and productivity • Treatment of resulting illnesses • Workers’ lives Source: Occupational Safety and Health Administration

37. Hollow-bore needles are the cause of injury in 68.5% of cases Source: Ippolito, et al, 1997 Source: Occupational Safety and Health Administration

38. When Do Needlesticks Happen?

39. PPE Standard • Employer must offer PPE free to employees • Must have a job hazard assessment to determine what type of PPE needed • Must have written certification that employees have been trained in use of PPE • Prep room – gloves, aprons, booties, face shields, shoe covers, eye protection

40. Housekeeping Techniques • Adhere to a regular cleaning schedule that provides for decontamination • Clean and decontaminate equipment and work areas after each contact with potentially infectious substance • Apply at least 10% solution of bleach on contaminated site and allow to stand for 15 minutes • Remove and replace protective coverings

41. Formaldehyde Standard29 C.F.R. 1910.1048 Purpose: To ensure that no employee is exposed to an airborne concentration of formaldehyde that: • Exceeds 0.75 parts formaldehyde per million part of air as an 8 hour time-weighted average (TWA) or • Exceeds two parts formaldehyde per million parts of air (2 ppm) as a 15 minute short term exposure limit (STEL)

42. Fan Location • Ceiling fans draw fumes directly into the breathing space of the embalmer • Wall fans are better because they draw the fumes horizontally away from the upper torso of the embalmer

43. When to do test? • Initially • Each time there is a change in production, equipment, process, personnel or control measures OR • If employer receives report of signs/symptoms of respiratory or dermal conditions associated with exposure to formaldehyde

44. Notification Employers must notify affected employees within 15 days of receiving results of monitoring AND Post the results in writing

45. Signage For every area where the concentration of formaldehyde is present YOU MUST HAVE A SIGN THAT READS: DANGER: FORMALDEHYDE. IRRITANT AND POTENTIAL CANCER HAZARD. AUTHORIZED PERSONNEL ONLY

46. Requirements Employers must have: • Quick drench showers AND • An eyewash station in immediate work area • A Change room to change to and from contaminated clothing • PPE provided free of charge

47. Respiratory Protection Standard29 C.F.R. Section 1910.134 Respirators must be used in an emergency. Emergency - “any occurrence, such as but not limited to, equipment failure, rupture of containers or failure of controlled equipment that results in a release of a significant amount of formaldehyde.

48. Employer Musts for Respirator Use • A procedure for selecting respirator • Medical evaluations for those required to use respirator • Annual fit testing for tight-fitting respirator • Procedures for proper use in routine and emergency situations • Procedures for cleaning/disinfecting, storing, inspecting, repairing, discarding • Training in respiratory hazards • Training in proper use, putting on, removing • Program evaluation procedures • Individual selected to give program • Medical evaluations – free of charge if resp. required

49. General Duty Clause • General safety: train staff on use of equipment, lifting, ladders • Electrical safety training: temporary and permanent wiring, power cords and outlets • Exit and egress, evacuation plan • First aid, fire extinguishers • Signage • Workplace violence

50. Final Thoughts • Forms for many of these programs • Must assign an individual at the FH to be responsible • DO IT • Document IT • Expect more visits • State Inspectors can cite you for violations • Disgruntled employees