Archive for: November, 2009

NIOSH and healthcare worker respirators redux

By: November 30th, 2009 Email This Post Print This Post

Proving that a once-read blog post can still provide new information in the online world, I revisited the NIOSH blog post, “N95 Respirators and Surgical Masks,” which I previously wrote about, here.

The NIOSH post, authored by Lisa Brosseau, Sc.D., and Roland Berry Ann is still the best authoritative site explaining the ins and outs of respirator vs. surgical mask selection for H1N1 protection, in my opinion. So, on revisiting it, I was delighted to find a healthy amount of comments to which Brosseau and Berry Ann offered answers.

Here are some excerpts addressing questions that OSHA Healthcare Advisor readers have also posed.

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Ask the expert: N95 respirator use in ambulatory surgery centers

By: November 30th, 2009 Email This Post Print This Post

Q: We are an ambulatory surgery center. Does every employee need an N95 respirator for protection from H1N1; must they all be fit tested and who does the fit testing?

A: OSHA emphasizes a hierarchy of controls that includes eliminating the source of infection, engineering controls, administrative controls, and lastly, personal protective equipment, the category that concerns the use of N95 respirators.

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Weekly poll: The cost of OSHA training

By: November 30th, 2009 Email This Post Print This Post

With many OSHA standards requiring initial and annual training, OSHA education can get expensive depending on how many workers you employ. What do you estimate that your healthcare facility spends per employee on OSHA training each year? Take our poll below.

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AMA to study mandatory flu vaccines

By: November 25th, 2009 Email This Post Print This Post

About a month ago the hottest topic among healthcare workers in New York was the requirement to get seasonal and H1N1 vaccines. But the regulation left almost as quickly as it came and many doctors and nurses were relieved, even if some associations were not.

However it seems the idea of mandatory regulations hasn’t died completely. At the American Medical Association’s (AMA) interim meeting, the House of Delegates rejected a proposal to mandate vaccinations for healthcare workers, but directed the AMA to study the ethics and science behind mandatory vaccinations, according to American Medical News.

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Management under fire: Surviving a CMS survey at your ASC

By: November 25th, 2009 Email This Post Print This Post

Technically ambulatory surgery centers (ASC) across the country have been under fire for proper infection control procedures for the last few years, given the number of well-publicized incidents that have brought these issues to the surface.

Still, it wasn’t until May that ASCs came under regulatory fire, when CMS established Conditions of Coverage that included basic infection control procedures.

But now that CMS state surveyors have been awarded $9 million from the federal government, along with a new infection control survey which has been developed with help from the CDC, more than one-third of non-accredited ASCs will see a state surveyor in the next 12 months.

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OSHA follows CDC suit on enforcing against swine flu hazards

By: November 24th, 2009 Email This Post Print This Post

A little more than a month after the CDC told healthcare facilities how to protect staff members from swine flu, OSHA has posted instructions on how to inspect and enforce for H1N1 influenza hazards.

The good news is that OSHA enforcement closely follows the CDC recommendations and shouldn’t present any surprises, especially if you have been following the issue of worker protection for H1N1.

“OSHA has a responsibility to ensure that the more than nine million frontline health care workers in the United States are protected to the extent possible against exposure to the virus,” said acting Assistant Secretary of Labor for OSHA Jordan Barab in a November 20 news release. “OSHA will ensure health care employers use proper controls to protect all workers, particularly those who are at high or very high risk of exposure,” Barab added.

The enforcement directive identifies very high and high exposures as:

Very High Exposure Risk. A job task or activity involving a medical or laboratory procedure during which there is a potential of occupational exposure to high concentrations of suspected or confirmed 2009 H1N1 influenza virus.

  • Healthcare workers (for example, doctors, respiratory therapists, nurses, emergency responders, or dentists) performing aerosol-generating procedures on suspected or confirmed patients (such as, sputum inductions, endotracheal intubations and extubations, bronchoscopies, some dental procedures or invasive specimen collection).
  • Healthcare workers present during performance of aerosol-generating procedures during autopsies (such as, medical examiners).

High Exposure Risk. A job task or activity involving a high potential for exposure to suspected or confirmed 2009 H1N1 influenza virus.

  • Healthcare workers who are in close contact [working within 6 feet of suspected or confirmed patients or entering into a small enclosed airspace shared with the patient (e.g., size of an average patient room)].
  • Staff transporting suspected or confirmed 2009 H1N1 patients in enclosed vehicles (such as emergency responders).

These are the type of situations where OSHA will seek confirmation that the healthcare facility has implemented a hierarchy of engineering, administrative, work practice controls, and followed the Respiratory Protection standard for worker training and fit testing where respirators are required.

The new document also instructs OSHA inspectors to evaluate whether employers are ensuring that workers are following the current CDC guideline, which calls for respiratory protection that is at least as protective as a fit-tested disposable N95 filtering facepiece respirators for very high and high exposure procedures or situations.

OSHA says that “inspections will be conducted in response to worker complaints, referrals (including media referrals) or as part of fatality and/or catastrophe investigations.” The agency expects that most of the inspections will involve hospitals, emergency medical centers, doctors’ and dental offices and clinics.

As expected, OSHA inspectors will make allowances in the current pandemic for respirator shortage and provides details under which those conditions will apply. More on that in a later post.

Medical Environment Update—Environmental services: Prevent infections and ensure safety

By: November 24th, 2009 Email This Post Print This Post

Environmental services employees can be crucial to the well-being of your patients and your staff. That is the feature story in the November issue of Medical Environment Update, which specifically looks as training contract workers, developing policies and procedures, establishing day-to-day cleaning procedures, along with tips on identifying  high-touch surfaces, cleaning up a spill, and the bleach vs. disinfectant decision.

Here is an excerpt from that article and a look at what else is covered in November issue.

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Declining H1N1 influenza vaccination

By: November 23rd, 2009 Email This Post Print This Post

The Immunization Action Coalition (IAC) has  developed a one-page form to use when healthcare workers decline the H1N1 vaccination.

Healthcare employees are among the priority groups targeted to receive H1N1 influenza vaccine and the form states reasons why vaccination should be chosen.

The IAC is granting permission for facilities to download and use the form which is available on the Tools page.

Weekly Poll: Is your ASC prepared?

By: November 23rd, 2009 Email This Post Print This Post

With $9 million released by the Department of Health and Humans Services specifically for CMS surveys in ASCs in 43 states, there is sure to be an escalated focus on infection control best practices.

ASCs have had trouble in the past with IC compliance, particularly in Nevada when an endoscopy clinic potentially infected thousands of people by reusing syringes. In May CMS buckled down by releasing new Conditions of Coverage that included appointing one employee in charge of infection control, and evaluating IC policies and procedures.

Is your facility ready? Take our poll below.

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OSHA fines are down, but not for long

By: November 20th, 2009 Email This Post Print This Post

From HealthLeaders, Nov. 18, 2009

Total OSHA fines and inspections decreased across all types of healthcare facilities in FY 2009.

Medical and dental practices and hospitals saw the greatest decreases in fines, 30%-40% from the previous year, according to OSHA’s Statistics and Data Web page. Nursing care facilities and laboratories showed less dramatic decreases at 12%-14%.

Nursing facilities ($321,327) and hospital settings ($196,400) ranked first and second respectively in total fines by type of facility, accounting for nearly three-quarters of OSHA fines issued in healthcare. Next came medical ($52,214) and dental ($47,549) practices at approximately 7% each of total OSHA healthcare fines.

Even though this is the second straight year healthcare violations have seen a decline, the trend is not likely to continue. OSHA under President Obama has an increased budget, including 130 new inspectors, according to remarks made earlier this summer by acting Assistant Secretary of Labor for Occupational Safety and Health Jordan Barab to the American Society of Safety Engineers. “The law says that employers are responsible for workplace safety and health, and there’s a new sheriff in town to enforce the law,” said Barab.

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APIC conference updates: Ambulatory care

By: November 19th, 2009 Email This Post Print This Post

More updates from APICs “Healthcare-associated infections: A changing legal and regulatory landscape. For the previous two updates, click here for part 1, and here for part 2.

This session might be of particular interest to the OSHA Healthcare Advisor audience since it focused specifically on HAI prevention in ambulatory surgery centers (ASC).

The first to present was Dr. Joseph Perz, the prevention team leader for the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention in Atlanta, Georgia. He’s worked extensively with safe injection practices, which have been a problem in recent years among ASCs.

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APIC conference updates: A legal perspective

By: November 19th, 2009 Email This Post Print This Post

More updates from APICs “Healthcare-associated infections: A changing legal and regulatory landscape. For the first post on opening remarks, click here.

Unfortunately I didn’t catch all of this session, but I’ll pass along what I did tune into:

Sheila Namm, Esp., R.N., MA, currently the vice-president of professional affairs at Maimonides Medical Center in Brooklyn, NY, talked about the relationship between risk management and infection control:

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