Author Archive for: Matt Vensel

A rundown of new, increased OSHA penalties

January 16th, 2018 Email This Post Print This Post

In case you missed it, new, increased civil penalties for violations of workplace safety and health standards went into effect two weeks ago today.

Effective January 2, OSHA increased its penalties by 2% to adjust for inflation, as required by the Federal Civil Penalties Inflation Adjustment Act of 2015, with a max fine of nearly $130,000. The new fines apply to all violations that occurred after November 2, 2015, with penalties assessed after January 2, 2018.

Employers that violate OSHA standards are now subject to the following fines, as reported in the latest edition of BLR’s OSHA Compliance Advisor newsletter:

  • Willful violations: between $9,239 and $129,336 per violation (previously between $9,054 and $126,749)
  • Repeat violations: up to $129,336 per violation (previously up to $126,749)
  • Serious violations: up to $12,934 per violation (previously up to $12,675)
  • Other-than-serious violations: up to $12,934 (previously up to $12,675)
  • Failure to correct a violation: up to $12,934 for each day the condition continues (previously up to $12,675 for each day it continued)
  • Violation of posting requirements: up to $12,934 per violation (previously up to $12,675 per violation)

SHEA offers needed guidance for ending treatment of multi-drug resistant bacteria

January 12th, 2018 Email This Post Print This Post

So far, a good amount of clinical research has been dedicated to establishing protocols for starting and continuing treatment of patients battling multi-drug resistant bacteria. But until Thursday, there had not been much guidance for healthcare facilities on when their personnel can safely cease contact precautions for these patients.

Addressing that need, the Society for Healthcare Epidemiology of America (SHEA) published in their journal, Infection Control and Hospital Epidemiology, new expert guidance giving recommendations on how long personnel should use contact precautions to reduce the spread of potentially deadly organisms within the healthcare setting, which the study’s authors say “in most cases” ranges from one to three negative cultures before ceasing.

Their recommendations for the duration of contact precautions — including gowns, gloves, and masks — are, according to a SHEA press release, “specific to key multi-drug resistant organisms,” such as MRSA, Clostridium difficile infections (CDIs), Carbapenem-resistant Enterobacteriaceae (CRE), and Vancomycin-resistant enterococci (VRE).

One of the study’s authors, David Banach, MD, MPH, a hospital epidemiologist at the University of Connecticut Health Center, stated in a press release that “because of the virulent nature of multi-drug resistant infections and C. difficile infections, hospitals should consider establishing policies on the duration of contact precautions to safely care for patients and prevent spread of these bacteria. Unfortunately, current guidelines on contact precautions are incomplete in describing how long these protocols should be maintained. We outlined expert advice for hospitals to consider.”

Per that guidance document — which SHEA says has been endorsed by the Association for Professionals in Infection Control and Epidemiology (APIC), the Society of Hospital Medicine (SHM), and the Association of Medical Microbiology and Infectious Disease Canada (AMMI Canada) — personnel should consider how much time has passed since the most recent positive culture when evaluating whether transmission is likely.

The guidance also advises on patient characteristics that could determine for how long contact precautions should remain in place. For example, the recommendation for CDIs is to continue precautions for at least 48 hours after the resolution of diarrhea, possibly extending that if CDI rates are elevated.

The press release stated that “any guidance should be overseen and revisited by infection prevention and control leadership, especially in outbreak situations” and that the study’s authors recommend facilities “carefully assess their institutional risks, priorities, and resources prior to adopting a new policy on the duration of contact precautions, as well as weigh the cost and feasibility of implementation.”

“The duration of contact precautions can have a significant impact on the health of the patient, the hospital, and the community,” another of the authors, Gonzolo Bearman, MD, MPH, the chairman of the Division of Infectious Diseases at Virginia Commonwealth University, stated in the release. “This guidance is a starting point, however stronger research is needed to evaluate and optimize the use.”

CDC to brief healthcare professionals on responding to a nuclear detonation

January 9th, 2018 Email This Post Print This Post

Here’s your unsettling news release of the day: The CDC next week will hold a briefing teaching healthcare professionals how to respond to a nuclear bomb.

“While a nuclear detonation is unlikely, it would have devastating results and there would be limited time to take critical protection steps,” stated a CDC news release for a “Grand Rounds” session that included an image of a massive nuclear mushroom cloud. “Despite the fear surrounding such an event, planning and preparation can lessen deaths and illness. For instance, most people don’t realize that sheltering in place for at least 24 hours is crucial to saving lives and reducing exposure to radiation. While federal, state, and local agencies will lead the immediate response efforts, public health will play a key role in responding.”

Recent tweets by President Trump, who a week ago boasted that his “nuclear button” is “much bigger and more powerful” than North Korean leader Kim Jong Un’s, came to mind after seeing the release. But a CDC spokesperson told Stat News that the event has been in the works for a few months and pointed to a “radiation/nuclear incident exercise” that FEMA put on back in April.

The CDC’s presentation, which will be held January 16 from 1 to 2 p.m. ET at the CDC’s Roybal Campus in Atlanta, will educate healthcare professionals on what federal, state, and local public health officials have done to prepare for a nuclear detonation while also comparing and contrasting the planning and preparation methods to other emergency response situations.

For more information about the CDC’s briefing, here’s that news release.

Topics for last year’s CDC’s “Grand Rounds” sessions included maternal mortality, hearing health, neural tube defects, and emerging tickborne diseases.

UPDATE: CDC has changed the topic for this month’s “Grand Rounds” to a discussion on public health response to severe influenza due to “the spike in flu cases around the country.” CDC says, however, that the presentation on responding to a nuclear detonation will be rescheduled for a later date.

Report: OSHA losing inspectors under Trump

January 8th, 2018 Email This Post Print This Post

Before taking office, President Donald Trump expressed a desire to trim the federal workforce, something he has taken action on since getting sworn in last year.

OSHA is reportedly one of the federal agencies that have been impacted.

According to data obtained by NBC News through a Freedom of Information Act request, OSHA has lost 40 inspectors through attrition since Trump took office last January, and as of October 2, the federal agency had made no new hires to replace them. The 40 vacant positions represent 4% of the OSHA’s total federal inspection force, which fell below 1,000 in early October, according to the NBC News report.

A Labor Department spokesman told NBC News that OSHA has hired “several additional inspectors” since early October and is currently recruiting at least two dozen more. Still, even if OSHA is allowed to fill some of those open positions in the coming months, last year’s hiring lull could affect the agency’s future performance, argued Jordan Barab, an OSHA official under former President Barack Obama.

“Even after OSHA hires someone, they can’t just send them out to do an inspection by themselves,” Barab told NBC News. “This will have an impact for years.”

Meanwhile, due to limited resources and manpower, OSHA is prioritizing high-risk workplaces — such as construction sites and manufacturing plants — with increased rates of fatal accidents, serious injuries, and illnesses, the report said. It is not yet clear how much impact the loss of inspectors has had on the healthcare industry.

Back in May 2017, when the White House released its budget request for 2018 that sought to slash, among other things, the Labor Department’s budget, a cut of about 2% of OSHA’s budget was proposed. We noted at the time that even a modest cut could significantly impair OSHA’s ability to enforce workplace safety regulations.

According to the Labor Department, OSHA from October 2016 to September 2017 actually increased its number of inspections for the first time in five years, NBC News reported. But some activists, politicians, and former OHSA officials argue the loss of on-the-ground inspectors in specific regions expose workers to greater risk.

“OSHA is far too understaffed to fulfill its mandate of reducing workplace injuries,” U.S. Representative Rosa DeLauro, a Democrat from Connecticut, told NBC News. “Under the Trump administration, OSHA has suffered a troubling decline in both staff and work-place inspections in key areas of the country.”

A noisy OR puts more than patients at risk

January 8th, 2018 Email This Post Print This Post

Excessive noise can be distracting in any work environment. You might expect that to be an issue on a construction site or at an airport, but not in the OR.

A recent story published online by OR Today serves as a reminder that it can get loud in the OR, too, adding another degree of difficult to already-challenging tasks.

“Noise is a distraction that interrupts patient care and potentially increases the risk for error,” Mary J. Ogg, MSN, RN, CNOR, senior perioperative practice specialist with the Association of periOperative Registered Nurses (AORN), told OR Today. “It may minimize the ability of OR team members to communicate effectively, making it difficult to understand content and contributing to miscommunication.”

And that not only puts patients in peril, but potentially your employees, too.

A lack of focus in the OR could result in accidental injuries to surgeons or one of their assistants via needlestick injuries or knife cuts, for example.

Plus, as Ogg told OR Today, excess noise in the OR can negatively impact employees because it “is associated with job dissatisfaction, irritability, tachycardia, anxiety, fatigue, illnesses, stress, emotional exhaustion, burnout and injury.”

The article cited one study that found that the average noise level during OR trauma procedures was 85 decibels, nearly double the EPA-recommended limit of 45.

In addition to medical equipment such as powered surgical instruments and clinical and alert alarms, Ogg said common sources of noise in the OR include HVAC systems, phones and audio players, and non-case-relevant chitchat.

OR Today offered suggestions for reducing noise and distractions in the OR. The list included turning off cell phones and personal music devices (or leaving them outside the OR), limiting the amount of foot traffic in and out of the OR, and evaluating the noise level of medical equipment while deciding which devices to purchase.

Study: OR docs suffer high rates of ergonomic-related injuries

January 5th, 2018 Email This Post Print This Post

Is scrubbing into the operating room akin to walking onto a busy construction site?

A study published online last week in the Journal of the American Medical Association (JAMA) found that the prevalence of work-related musculoskeletal disorders (MSDs) among at-risk physicians, defined as surgeons and interventionalists, is comparable to what is reported among industrial workers and other high-risk laborers.

Citing “long work hours involving repetitive movements, static and awkward postures, and challenges with instrument design” endured by procedural physicians in operating rooms, researchers said they appear to face a high risk of developing MSDs.

Researchers examined 21 articles in their meta-analysis. Of the 5,828 physicians that made up the data pool, 19% had degenerative lumbar spine disease, 18% had rotator cuff pathology, 17% had degenerative cervical spine disease, and 9% had carpal tunnel syndrome. Researchers also noted that from 1997 to 2015, the prevalence of degenerative lumbar spine disease and degenerative cervical spine disease increased by 27% and 18.3%, respectively.

In addition to the pain an estimated 35% to 60% of physicians with a work-related MSD experienced, the study found that 12% of those physicians required a leave of absence, had to make changes or restrictions to their practice, or were pushed into early retirement — concerns that the researchers say continue to be overlooked.

They concluded that “given the impending physician shortage, this problem warrants prompt attention and action” and “further research is needed to develop and validate an evidence-based applied ergonomics program aimed at preventing these disorders.”

Until the healthcare industry does that, work-related MSDs are likely to continue to take a physical toll on procedural physicians while also costing hospitals and clinics financially via workers compensation payouts and decreased productivity.

Joint Commission to increase hand hygiene focus

December 21st, 2017 Email This Post Print This Post

The Joint Commission (TJC) will soon be scrutinizing hand hygiene more closely.

Starting in 2018, if a surveyor from the accrediting organization witnesses an individual who directly cares for patients fail to perform required hand hygiene, the person’s healthcare organization will receive a citation under TJC’s Infection Prevention and Control (IC) standard IC.02.01.01, element of performance 2, which requires organizations to use precautions such as hand hygiene to reduce infection risk. In addition, healthcare facilities must meet National Patient Safety Goal (NPSG) 07.01.01, which requires them to implement and maintain a hand hygiene program.

The change, announced Thursday, will go into effect on January 1, 2018.

Previously, healthcare organizations were not penalized for an individual failure to perform proper hand hygiene if that organization had an otherwise compliant hand hygiene program. But under this change, if a surveyor spots an individual who does not properly wash his or her hands, the surveyor will cite the organization for a deficiency resulting in a Requirement for Improvement.

In 2004, TJC first required all healthcare organizations to implement hand hygiene programs and keep track of individual performance within that plan. Proper hand hygiene, of course, is critical for preventing infections in a healthcare setting.

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