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Rheumatology Practice Management December 2014 Vol 2 No 6 - NORM Highlights
Rosemary Frei, MSc

Rheumatology managers re­cently received expert tips and updates on Occupational Safety & Health Administration (OSHA) compliance standards, as well as how to prepare a medical practice for an OSHA inspection. Bill Fivek, President and CEO of Total Medical Compliance, discussed these government-mandated requirements at the National Organization of Rheumatology Managers (NORM) annual conference, held September 12-13, 2014, in Louisville, KY.

Mr Fivek emphasized that compliance involves more than just training. The most important step, he said, is ensuring that management teams understand the significance of adhering to OSHA guidelines and train employees as required.

“If the top folks do not believe in the program, no one else is going to follow it,” he said. “Your physicians sometimes may balk at OSHA. They think it’s another example of government getting in the way of them practicing medicine. But it’s the law. It’s not something you can get around, and ultimately the practice is held responsible for the performance of its employees.”

The Bloodborne Pathogens Standard of 1991 is a key element of OSHA as applied to clinical practices, he said.1 Main requirements include having a written exposure-control plan, providing a hepatitis B vaccination series of 3 shots—at no cost to employees—to all those who could be exposed to the virus in the workplace, having labels and signs to communicate hazards, providing personal protective equipment, and enforcing work practice controls.

“Make sure you have a hepatitis B vaccination certificate, nonresponder documentation or declination form on file for every employee. These are the most common violations in an OSHA inspection, when people cannot produce this information, especially with new employees,” Mr Fivek said. “But note that ‘employee’ is an operative word. If your physicians own the practice, they’re not employees and therefore OSHA doesn’t apply to your physicians.”

Clinics also must provide employees who may be exposed to pathogens with the appropriate personal protective equipment (PPE) at no cost to the employees. The staff person responsible for OSHA compliance determines which PPE is required, Mr Fivek said. Furthermore, it is important to comply with the Needlestick Safety and Prevention Act of 1991 and updates that came into effect in 2001 requiring an annual evaluation of safer sharps devices.1

“Anything that’s considered to be a sharp in your practice needs to be evaluated to see whether there’s a safety sharp version of it available—if you use a scalpel, if you use needles, I think in your line of work they probably are the extent of your sharps,” noted Mr Fivek. “Go to your vendors that you get your supplies from every 12 months and ask them, ‘Are there safety devices available for these items?’ Get some samples.”

Ask people in the practice to give feedback on the samples, and make purchase decisions based on that feedback, advised Mr Fivek. OSHA requires that practices document this effort, and also that they document if a safety sharp is unavailable or will endanger patients or employees if it is used. It also is important to always activate the safety device before placing equipment into a sharps container and to use other engineering controls that are available for additional protection against sharps exposure.

If an exposure does occur, the affected individual should attempt to clean the contaminated part of his or her body and immediately report the incident to the employer. The employer should direct the employee to a healthcare professional for testing for hepatitis B and C and for HIV, and to provide the healthcare professional with documentation of the details of the incident. After testing, the healthcare professional and the employer must communicate with each other and the employee about follow-up steps. These procedures should be set out in advance.

“With needle sticks, your window of opportunity is 1 hour, 2 at the most, to start any kind of postexposure prophylaxis for an HIV exposure. Hepatitis B you can do up to 14 days later, while hepatitis C has no postexposure prophylaxis procedure,” Mr Fivek said. “And you need to make sure you have a facility that’s going to be open when you are, that’s going to do that kind of blood-panel testing, and can do rapid HIV testing.”

The employer must train employees regarding exposure procedures at no cost to the employee and during work hours—with an opportunity for interactive questions and answers with the instructor—first when the person is assigned to a task where exposure may occur and then every year after that. In addition, training must be carried out within 90 days of the effective date of any change in an OSHA standard. Records of training must be kept for 3 years. Confidential medical records are also required for employees who are at risk of exposure to bloodborne pathogens, which need to be retained for the duration of the person’s employment plus 30 years.

OSHA made a rare change to the regulations in 2012, said Mr Fivek, involving hazard communication.2 As of December 1, 2013, all employees must be trained in the regulations, with full compliance by June 1, 2016, including the following: the creation of a hazard communication plan; the creation and annual maintenance of an inventory of hazardous materials; the creation of a set of standardized Safety Data Sheets that include 8 color- coded, standardized pictograms; labeling of secondary containers of hazardous materials; and ensuring there is appropriate PPE based on the employees’ chemical use.

“All of the OSHA inspections that we have gotten pulled in to work on with our clients, the OSHA inspector has asked where the Material Safety Data Sheet book is. Make sure everyone on staff, as part of your new hire orientation, knows where it is,” advised Mr Fivek. He said that some of the additional OSHA requirements are the following: flush eyewash stations weekly to reduce bacterial growth in the water reservoirs; develop a written fire response plan (only for practices with more than 10 employees) that stipulates such things as evacuating patients rather than fighting the fire; and regular inspections of electrical plugs, sockets, and breaker boxes, and of gas cylinders.

OSHA compliance checklists are available from Total Medical Compliance and many other places including the OSHA website.3 If an OSHA inspector visits your practice it will usually be without notice and for 1 of 5 reasons, said Mr Fivek:

“There was a complaint lodged against the practice by an employee or another government agency; something in the practice could cause death or serious physical harm; random inspection; there has been an incident in which 3 or more employees were hospitalized or someone died; or it is a follow-up inspection to ascertain whether a problem has been rectified, in which case the inspector could levy a daily fine until the problem is corrected.”

It is important to stay calm and to ask the inspector for identification and for the reason for the visit. Staff can use that time—but no more than 15 minutes—for a quick check of the practice, advised Mr Fivek.

“While you’re verifying their credentials, you’ve got someone else running around the practice moving all the paper coffee cups away from places they shouldn’t be, moving the Christmas decorations away from the breaker box, and fixing other things that could get you in trouble.” Then the OSHA employee will conduct a walk-through, followed by a closing conference in which the inspection findings are discussed. Fivek said examples of citations by OSHA include not providing necessary protective equipment and not having direction arrows on exit signage.

“You have a right to contest any of the inspector’s findings with no risk of things being worse due to your push-back,” noted Mr Fivek. “Always ask for any appropriate reductions in fines. It can be a scary process, but they’re pretty easy to work with.”

References

  1. Occupational Safety & Health Administration. Revisions of OSHA’s Bloodborne Pathogens Standard. Technical Background and Summary. www.osha.gov/needlesticks/needlefact.html. Accessed November 18, 2014.
  2. Occupational Safety & Health Administration. www.osha.gov/pls/oshaweb/owadisp.show_doc ument?p_table=STANDARDS&p_id=10099. Accessed November 18, 2014.
  3. Occupational Safety & Health Administration. Small Business Handbook. www.osha.gov/Publi ­cations/smallbusiness/small-business.html#check. Accessed November 18, 2014.
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