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$68,000 proposed OSHA fine for ASC raises concerns: Is the field complying?
Accused of not protecting staff exposed to bloodborne pathogen hazards
Compliance with the bloodborne pathogen standard from the Occupational Safety and Health Administration (OSHA) is an ongoing issue, and now apparent lack of compliance has resulted in a proposed $68,000 fine for a surgery center regarding claims that it failed to protect workers exposed to bloodborne pathogen hazards.
Health East Ambulatory Surgical Center in Englewood, NJ, was cited with 10 “serious” violations of the bloodborne pathogens standard. The serious violations include failing to counsel an employee who was stuck with a contaminated needle, test the employee’s blood in a timely manner, and provide the appropriate medicine to the employee to prevent contracting a potential disease, OSHA says. (See entire list, below.) A serious citation is issued when there is substantial probability that death or serious physical harm could result and the employer knew, or should have known, of the hazard, OSHA said in a press release. According to a statement from Anson Moise, MD, medical director of the center, the violations are disputed, a conference to resolve the dispute was scheduled, and none of the proposed violations arise out of any harm to any employees, patients, or physicians. The center has had “zero instances of infection or contamination to patients, employees or physicians after treating over 8,000 patients,” the statement said.
These citations are not an isolated case, according to Mary Ogg, MSN, RN, CNOR, perioperative nursing specialist at the Association of periOperative Registered Nurses (AORN). “State and regional OSHA offices have been conducting random, unannounced visits” including surgery centers, Ogg says. At the top of the OSHA list of violations? The bloodborne pathogen standard, Ogg says. Several healthcare facilities have been cited, she warns.
Where workers are occupationally exposed to blood or other potentially infectious materials, OSHA requires engineering controls (e.g., sharps disposal containers, engineered sharps injury protections) and work practice controls such as hands-free passing during surgical procedures and the use of appropriate personal protective equipment (e.g., gloves, garments). An OSHA spokesperson, who asked not to be identified, said, “Failure to comply can and may result in citations and monetary penalties.”
AORN is replacing its guidance statement in the recommended practice (RP) for Sharps Injury Prevention in the Perioperative Setting, which is scheduled for electronic release in June. “This RP is structured on OSHA’s hierarchy of controls of eliminating the hazard, engineering controls, work practice controls, administrative controls, and PPE [personal protective equipment],” Ogg says. “The RP goes into great detail in how to implement each of these steps, explains the importance of each step using over 200 evidence-rated references.” (To keep up with the changes, go to http://www.aorn.org/RecommendedPracticesNews.)
An estimated 80,000 sharps injuries occur in the OR each year. Stephen Morrison, BSEH, health compliance officer with the Tennessee Occupational Safety and Health Administration, says, “I have trouble understanding why people who take the Hippocratic Oath are so reluctant to protect themselves, their coworkers, and their patients by following procedures proven to be effective, recommended by various medical professional groups, and mandated by federal and state law.”
Providers are exposed to HIV, Hepatitis B and Hepatitis C every day, Ogg says. “Sharps injuries not only harm the healthcare worker,” she says. “There have been 132 incidences of healthcare provider to patient transmission of HIV, hepatitis C, etc.”
How can lack of compliance be explained? “Change is difficult,” Ogg says. Like everyone else, healthcare providers fall into patterns. “If we were initially trained on one device and have used it for years, we don’t want to learn a new technique,” Ogg says.
Surgeons often are reluctant to change equipment and procedures, Morrison says. “A lot of surgeons refuse to use blunt suture needles when suturing muscle and fascia even though it is recommended by the American College of Surgeons, and numerous studies have shown that the blunt suture needles cause no more trauma than cutting suture needles when suturing muscle and fascia.”
Another theory, which Ogg heard from a surgeon colleague, is that surgeons are risk-takers. “If they have had a sharps injury in the past with no consequence, why should they take precautions to prevent one now?” Ogg said, in reporting her colleague’s explanation.
Another early problem was the design of the sharps safety devices, she says. “... many of the sharps safety products that were initially produced were difficult to use and did not have the same `feel’ of a traditional sharps device,” Ogg says. However, that problem has been virtually eliminated, she says. “Manufacturers have responded to feedback and altered the design of sharps safety devices to make it ‘feel’ like the traditional product and increased ease of use,” Ogg says..
Safety measure might take extra effort, and they might not be as comfortable, she acknowledges. “Like wearing a seat belt in your car, it takes an extra few seconds to fasten your seat belt, and movement is restricted,” Ogg says. “If you have never been injured in a car accident, do you stop wearing your seat belt?”
• American College of Surgeons Statement on Sharps Safety. Web: http://bit.ly/14esaLM.
• Occupational Safety and Health Administration’s (OSHA’s) Bloodborne Pathogens and Needlestick Prevention page, which includes frequently asked questions on bloodborne pathogens. Web: http://1.usa.gov/xb9rkm.
• Safety in Surgery resources from the Global Initiative in Healthcare Worker Safety at the University of Virginia in Charlottesville. Web: http://bit.ly/102seIw.
OSHA Citations for Health East Ambulatory Surgical Center
• The employers’ exposure control plan did not include a procedure for evaluating the circumstances surrounding exposure incidents. In other words, they did not have a procedure to determine how an exposure incident (i.e. needlestick) occurred, which could hinder them from preventing its reoccurrence.
• The exposure control plan did not document that annually the company considered and implemented the use of safer medical devices designed to eliminate or reduce the potential for injury. In other words – they needed to have a written procedure in their exposure control plan which made them research and consider or implement any new devices that have been made commercially available which are better at preventing needlesticks.
• When the company developed their exposure control plan, they did not solicit input from non-managerial employees responsible for direct patient care in the identification, evaluation, and selection of needles or other devices used that could assist in the prevention of exposure to blood.
• The employer did not determine which of its employees could potentially be exposed to blood or other potentially infections materials.
• The company did not test the source individual’s blood as soon as feasible after the needlestick occurred.
• The employer did not make post exposure prophylaxis (HIV-fighting meds) available in a timely manner to an employee stuck by a needle.
• The post exposure evaluation of an employee stuck by a needle did not include counseling.
• The employer did not provide the healthcare professional’s written evaluation of an employee stuck by a needle to that employee. This written evaluation contained information regarding medical conditions potentially resulting from exposure to blood.
• The employer did not provide a copy of the OSHA Bloodborne Pathogen standard to the employee’s healthcare provider after a needlestick occurred.
• The employer did not provide a description of the exposed employee’s duties as they related to the exposure incident (needlestick).
• The employer did not provide documentation of the routes of exposure and circumstances under which the exposure occurred to the employee’s healthcare provider.
• The employer did not provide the results of the source individual’s blood test results to the exposed employee’s healthcare provider.
Source: Occupational Safety and Health Administration, Englewood, NJ.