Transcript Document

Tuberculosis, MRSA, Hazard Communication,
PPE with Respirators, and Emergency Action/Pandemic Planning
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Tuberculosis (TB)
1. Determine whether the establishment has had a suspected or
confirmed TB case among residents within the previous 6 months
prior to the date of the opening conference: if not, do not proceed
with this section of the inspection. If a case has been
documented or suspected, proceed with the inspection according
to the guidance document, CPL 02-00-106, referenced above.
2. Determine whether the establishment has procedures in place
to promptly isolate and manage the care of a resident with
suspected or confirmed TB, including an isolation room and other
abatement procedures.
3. Determine whether the establishment offers tuberculin skin
tests for employees responsible for resident care, specifically
those described in CPL 02-00-106, referenced above.
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Tuberculosis (TB)
4. CPL 02-00-106, for enforcement procedures including
citation guidance for: Citation Guidance. The CSHO should
refer to
a. Respiratory Protection (Note: All respiratory
protection citations must be cited under 29 CFR
1910.134 - Respiratory Protection).
b. Accident prevention signs and tags, 29 CFR
1910.145.
c. Access to employee exposure and medical
records, 29 CFR 1910.1020.
d. Recordkeeping, 29 CFR Part 1904.
Evaluation of Exposure to Tuberculosis Among
Employees at Long-term Care Facility-HHE Program
Report No. 2012-0137-3178
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MRSA and MDRO
• Nursing and residential care facilities are among the
settings at increased risk of potential transmission of
MRSA and other MDROs.
• Recommendations for standard precautions and
contact precautions to reduce or eliminate exposure
to MRSA and other MDROs are outlined in CDC
guidelines, including the Guidelines for Isolation
Precautions: Preventing Transmission of Infectious
Agents in Healthcare Settings, 2007.
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Hazard Communication
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Site Specific Written Program
Chemical Inventory
MSDSs/SDSs
Labeling
Non-routine Tasks
Contractors
Training
Hazard Communication
Effective Completion
Date
Requirement(s)
Who
12/1/13
Train employees on new label
elements & SDS format
Employers
6/1/15
Compliance with all modified
provisions of this final rule, except:
Chemical manufacturers, importers,
distributors & employers
12/1/15
Distributors may ship products
labeled by manufacturers under old
system until 12/1/15
6/1/16
Update alternative workplace
labeling & hazcom program as
necessary, & provide additional
employee training for newly
identified physical or health hazards
Employers
Transition Period
May comply with either 1910.1200
(final standard), current standard, or
both
Chemical manufacturers, importers,
distributors & employers
Personal Protective Equipment
in the Nursing Home
Common Observations
Personal Protective Equipment Assessment
Job Task
Nursing Staff
Dietary
Laundry
Maintenance
Facilities/Housekeeping
Hazard
Required PPE
Content of the Assessment
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Documented as “written certification”
Location evaluated
Completed by…
Date
• 1910.132(d)(2)
• The employer shall verify that the required workplace
hazard assessment has been performed through a written
certification that identifies the workplace evaluated; the
person certifying that the evaluation has been performed;
the date(s) of the hazard assessment; and, which
identifies the document as a certification of hazard
assessment.
Common Omissions
• Faceshield and safety glasses in laundry and/or
dietary
• Gloves and apron in laundry
• Respirators…
Respiratory Protection
• Is a filtering face piece a respirator?
• How about a one-strap mask?
• How about a two-strap mask?
• What about a surgical mask?
• Why would you wear a respirator?
Respiratory Protection
• Mask vs. respirator
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2
3
1 Dust mask (not NIOSH approved)
2 Surgical mask (not a respirator and not PPE)
3 NIOSH approved filtering face piece respirator
What is a Respirator?
Respirators are devices that protect workers from
inhaling harmful airborne substances.
Some respirators also ensure that workers do not
breathe air that contains dangerously low levels of
oxygen (O2).
(OSHA’s Small Entity Compliance Guide, 9/30/98)
When Do We Need
Respirators?
• Engineering or administrative controls are not
always possible:
• Confinement of infectious agent may be difficult or
impossible
• Improved ventilation may not be practical or feasible
• Employees may be exposed to a wide
variety of air contaminants
• infectious agents
• chemical agents
• Environmental controls may not be
feasible
If respirators are REQUIRED, a
Respirator program is also REQUIRED
Limitations of Respirators
• All respirators have limitations:
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improper fit
improper donning
damage
contamination
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Respiratory Concerns
 SARS
 Smallpox
 Measles
 Varicella (Chicken Pox)
 Tuberculosis (TB)
The minimal acceptable
level of respirator
protection for TB is the
N95 respirator
 Chemical agents
REMEMBER:
Surgical masks are not considered respirators and are not approved to
protect from infectious disease or chemicals.
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What’s Happening Down in Maintenance?
 Painting
 Welding
 Adhesives
 If maintenance is using
more than a disposable
N95 for any tasks….
 A comprehensive
respiratory protection
program is required.
Emergency Preparedness
Hindsight Is 20/20
 Whether evacuating or shelter-in-place, there are
potentially problems with both:
 Transportation contracts not honored
 Lengthy travel times
 Complicated medication needs
 Inadequately prepared host facilities
 Inadequate staffing
 Insufficient food/water
http://oig.hhs.gov/oei/reports/oei-06-06-00020.pdf
Office of Inspector General:
Nursing Home Emergency Preparedness & Response During Recent Hurricanes (2006 Report)
Example Plan Overview
 Organizational
Structure
 Assumptions
 Business Continuity
 Employee Health
 Management of
Ill/Injured Staff
 Management of
Ill/Injured Residents
 Attendance and Leave
policies
 Payroll Administration
 Training
 Employee Services
 Workplace Practices
 Recovery
Plans should address…
 Evacuation or Shelter-inPlace
 Method of alert
 Assembly areas
 Facility access and
infrastructure
 Supply/Deliveries/Services
Plans should address…
 Communication
planning
 Mental health planning
 Vulnerable populations
 Residents
 Staff
Plans should address…
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 Pandemic/Disease
Access and use of
antivirals and
vaccines
Disease surveillance
Clinical evaluation &
diagnosis
Isolation & quarantine
Top 10 Errors in Workplace
Planning
1. Lack of UpperManagement support
2. No employee buy-in
3. Poor or no planning
4. Limited
training/practice
5. No designated leader
6. Communication
failure
7. Exclusion of OSHA
regulations
8. Contingency plan for
facility equipment
9. No roles and
responsibilities
10. Non-occupational
exposure risk